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Observational Study
. 2021 Mar;22(3):494-497.
doi: 10.1016/j.jamda.2021.01.068. Epub 2021 Jan 26.

Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic

Aaron Jones  1 , Alexander G Watts  2 , Salah Uddin Khan  2 , Jack Forsyth  2 , Kevin A Brown  3 , Andrew P Costa  4 , Isaac I Bogoch  5 , Nathan M Stall  6
Affiliations
Observational Study

Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic

Aaron Jones et al. J Am Med Dir Assoc. 2021 Mar.

Abstract

Objectives: To assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes.

Design: Pre-post observational study.

Setting and participants: 623 nursing homes in Ontario, Canada, between March 2020 and June 2020.

Methods: We used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1-April 21) and after (April 22-June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test.

Results: In the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain.

Conclusions and implications: Mobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.

Keywords: COVID-19; infection control; long-term care; staff mobility.

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