Accommodation centers | isolation kills

It is sometimes more deadly than COVID-19, according to a large American study

Ariane Lacoursiere
The Press

The seniors’ accommodation centers that applied health measures against COVID-19 the most rigorously were more effective in limiting outbreaks within their walls in the first weeks of the pandemic. But these results hide an important blind spot: the residents of these establishments have been over the months more likely to die for other reasons, possibly related to isolation and loneliness, reveals a new American study.

“Preventing COVID-19 cases and associated deaths comes at a cost” in nursing homes, say two researchers from the University of Notre Dame whose study published in the Journal of Health Economicswas funded by the National Institute of Health.

These researchers analyzed data on COVID-19 cases and deaths that occurred at more than 15,000 U.S. nursing homes. In the United States, the quality of these centers is evaluated on a scale of 1 to 5 stars according to very specific criteria by the Centers for Medicare and Medicaid. Establishments qualified as “5 stars” have notably better staff-resident ratios, report fewer falls and fewer pressure sores.

In the first months of the pandemic, “5-star” establishments were quicker to apply preventive measures against COVID-19. Like the lower quality centers, they failed to prevent the virus from entering their walls. But they were much more effective at limiting internal transmission. In particular because they have experienced fewer staff shortages, have facilitated screening and have applied the isolation of residents more rigorously. Shortages of protective equipment were also less severe there.

So much so that, from January 2020 to September 2020, 5-star centers recorded 15% fewer deaths related to COVID-19 than lower quality centers. A gap that faded in the months that followed.

Many have wondered, however, if precautions to contain COVID-19 “didn’t come with a cost”, report the researchers at the University of Notre Dame. “Several data suggests that the lack of contact of residents with their loved ones has not only created a feeling of loneliness, isolation and despair, but has also possibly accelerated certain deaths,” they write. And the data seems to prove them right. At the end of April 2021, US 5-star shelters had on average 8.4% more deaths (all causes) than 1-star establishments, and 15% more non-COVID-19 related deaths.

Questioning

Philippe Voyer, a researcher at the Center of Excellence on Aging in Quebec and a professor in the Faculty of Nursing at Université Laval, brought the American study to the attention of The Press. “Good quality facilities have done so well in preventing COVID-19 by isolating patients, reducing leisure activities, visits, not allowing residents to eat together, that the total death rate is greater in the 5 stars than in the 1 star. Because people have died from the side effects of isolation. These residents died of various causes, such as malnutrition, cognitive loss or the consequences of reduced access to health services, among others.

In the opinion of Philippe Voyer, this study provides an answer to the many Quebec caregivers who contacted him in April and May 2020 and who were worried about the effect of isolation on their residents. “We didn’t have any data on that at the time,” says Mr. Voyer, who stresses that “we can’t go back”.

But for him, this new study should lead governments to “question our ways of doing things”.

Member of the Board of Directors of the Community of Practice of Physicians in CHSLDs, the D^D Andrée Robillard notes that certain studies report the harmful effects of confinement in CHSLDs. “But we will never be able to know what would have happened without this measure,” she says. In the opinion of the D^D Robillard, “it is the exceptional duration of the confinement which had so many deleterious effects” on the elders accommodated. Mortality rates must also be analyzed carefully, according to the D^D Robillard. Because accommodation centers, some of which are “less well-off”, can transfer their end-of-life patients to hospitals more significantly than accompany them until their death, which can affect their mortality rate.

The D^D Robillard also urges caution before concluding that the American study automatically applies to Quebec. Notably because American nursing homes are more like intermediate resources in Quebec than CHSLDs. She nevertheless retains that what emerges from the study is “the importance of the human factor and the links for elderly patients”.

Upcoming relaxations in Quebec

This study is published at a time when Quebec is announcing relaxation of sanitary measures in CHSLDs and private residences for the elderly.

As of Saturday, visits to seniors’ residences and CHSLDs will no longer be limited to caregivers. However, all visitors must show their vaccination passport. A maximum of two visitors per day, one at a time, will be authorized in the CHSLD. In seniors’ residences, a maximum of four visitors per day, two at a time, will be allowed. “The elderly need to have visitors,” said Premier François Legault.

Other relaxations could also come, suggested the acting national director of public health of Quebec, the D^r Luc Boileau. “The whole issue of everything called infection prevention and control in living environments, whether CHSLDs or RPAs, we are actively working on it. We are on this file with the ministerial teams, the teams of experts also to find a way to alleviate these conditions, while managing the risks of contagion, and to bring us with a rapid progression towards a more normal management of how to live with the virus. »