The catastrophe that occurred in Quebec’s Centres d’hébergement de soins de longue durée (CHSLDs) during the pandemic should have come as no surprise. The problems facing these facilities have long been known, and the pandemic highlighted the extent to which prior health care reforms failed to resolve them. The Quebec government should make urgent reforms to improve the quality of elder care by adopting a three-pronged approach: it should reassess the needs of older adults across the full continuum of care and invest accordingly; review the governance and organization of CHSLDs and bring them up to modern standards; and create a “Qualité Québec” agency to enhance the learning capacity of the province’s health care system and promote the ongoing evaluation of policies and practices.
The purpose of the special investigative report is to identify the causes of this human tragedy that plunged thousands of vulnerable CHSLD residents and workers into a morass of botched health and administrative moves that wreaked death and calamity.
Aryal K, Mowbray F, Gruneir A, Griffith LE, Howard M, Jabbar A, et al.
Journal of the American Medical Directors Association 2021 dec.
OBJECTIVES To determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers. DESIGN We conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers. SETTING We used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario. PARTICIPANTS The cohort included the admission assessment of 56,433 NH residents. METHODS PPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92 days after admission. RESULTS Overall, 6.2% of residents had at least 1 PPED transfer within 92 days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy [of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer’s or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED. CONCLUSIONS AND IMPLICATIONS Though many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers.
