������ϱ�

Between March 1, 2020, and August 15, 2021, over 56,000 residents and 22,000 staff in Canada’s LTCFootnote i and retirement homes were infected with COVID-19, resulting in more than 14,000 deaths among staff and residents. In early 2021, LTC residents and staff were given priority to receive COVID-19 vaccinations. Between January 15 and March 31, 95% of residents in most jurisdictionsReference1 had received their first dose of the vaccine, compared with only 3% of the general population.Reference2 This high vaccination rate reduced both infections and deaths among LTC residents by over 90%. The vaccine rollout for staff was slower. By March 15, 2021, 60% of staff had been vaccinated and cases had declined by 63%.

COVID-19 devastated Canada’s LTC and retirement homes. As soon as it was understood that residents and staff were at a higher risk of death, they were prioritized to be among the first Canadians to receive vaccines. Although earlier access to vaccines would have allowed these settings to have a greater level of protection during Canada’s second wave, thousands of residents and staff survived the third and fourth waves because they were vaccinated.— Dr. Samir K. Sinha, Peter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics, Sinai ������ϱ� System and the University ������ϱ� Network

LTC resident COVID-19 deaths versus COVID-19 community deaths, March 1, 2020, to August 15, 2021

Show text version Hide text version

Month and year	LTC resident deaths	COVID-19 community deaths
Mar-20	13	96
Apr-20	804	3,093
May-20	3,692	4,116
Jun-20	948	1,301
Jul-20	391	349
Aug-20	100	196
Sep-20	37	176
Oct-20	259	844
Nov-20	927	1,999
Dec-20	924	3,481
Jan-21	2,076	4,381
Feb-21	981	1,962
Mar-21	338	965
Apr-21	66	1,260
May-21	61	1,328
Jun-21	26	747
Jul-21	9	299
Aug-21	<5	106

Notes
COVID-19 community deaths in Canada include deaths of LTC residents.
Many deaths that occurred in March and April 2020 were not reported to the National Institute on Ageing until as late as July 2020. See data tables for full notes.
The NIA's Long Term Care COVID-19 Tracker is based on provisional data and was accessed August 17, 2021. 

Sources
National Institute on Ageing. , 2020–2021 (pandemic LTC deaths). Accessed August 17, 2021.
Public ������ϱ� Agency of Canada. (monthly COVID-19 community deaths). Accessed September 10, 2021.

Provinces experienced peaks in infections and deaths in LTC homes at different times from March 2020 to August 2021.

COVID-19 deaths in LTC residents per 100,000 population during the first, second and third waves, by province

Notes
In Alberta, LTC is defined as any site with LTC spaces, including sites with co-located supportive living spaces.
There were no LTC cases in Prince Edward Island, Yukon, the Northwest Territories or Nunavut.

Sources
National Institute on Ageing. , 2020–2021 (pandemic LTC deaths). Accessed August 17, 2021.
Alberta ������ϱ� Services, accessed October 8, 2021, and Saskatchewan Ministry of ������ϱ�, accessed September 14, 2021 (pandemic LTC deaths).
Statistics Canada. Population estimates, 2020. Accessed August 17, 2021.

LTC resident deaths were higher than expected in waves 1 and 2

Capturing deaths due to COVID-19 can be elusive. Not all residents are tested for COVID-19 before or when they die, and COVID-19 can indirectly contribute to resident deaths by accelerating deterioration; both factors make it difficult to determine the exact cause of death. As in other countries,Reference3 deaths from all causes increased among Canada’s LTC residents as COVID-19 infections surged. CIHI’s analysis shows an increase in LTC resident deaths (above the usual or expected numbers) during the first and second waves of the pandemic. However, once resident vaccinations were implemented, deaths declined, bringing rates closer to the expected number of deaths (based on the average of the past 5 years). In fact, by January 2021, the number of LTC resident deaths had dropped below the expected level. 

A combination of factors may have contributed to this lower-than-expected death rate, such as COVID-19 deaths of the most frail and vulnerable residents early in the pandemic, public health measures that prevented deaths related to seasonal respiratory viruses such as influenza, and the admission of fewer people to LTC homes (i.e., a 40% decrease in the first 6 months of the pandemic Reference12).

Excess LTC resident deaths* during the pandemic for reporting provinces,^† March 2020 to June 2021

Show text version Hide text version

Date	Number of LTC deaths, pandemic	Number of LTC deaths, 5-year average	Weekly COVID-19 community cases (all Canada)
Mar-7-20	720	731	1,172
Mar-19-20	785	772.8	8,479
Mar-30-20	951	762	10,036
Apr-17-20	1,124	735	11,360
May-1-20	1,085	713.8	8,163
May-10-20	836	676.6	6,569
May-27-20	745	637.6	3,353
Jun-9-20	564	601	2,013
Jun-23-20	589	633.6	2,030
Jul-11-20	576	585	3,557
Jul-19-20	597	577.8	2,622
Aug-7-20	541	597	2,740
Aug-18-20	618	593	3,822
Aug-31-20	593	609.2	6,633
Sep-17-20	596	642.6	12,800
Sep-27-20	630	651.4	16,142
Oct-17-20	643	703	21,485
Oct-26-20	749	690.6	32,530
Nov-11-20	825	679.2	39,136
Nov-27-20	874	714.4	45,982
Dec-7-20	943	742.4	45,132
Dec-23-20	941	778.2	56,638
Jan-9-21	877	840.8	40,291
Jan-22-21	893	857.2	26,029
Jan-31-21	786	818.6	20,000
Feb-14-21	657	802.8	19,788
Feb-28-21	627	772.4	24,317
Mar-16-21	576	775.6	39,639
Apr-3-21	564	768.8	61,113
Apr-16-21	500	716.4	54,983
Apr-30-21	593	700.2	43,558
May-9-21	592	672.6	20,870
May-28-21	526	634	9,713
Jun-11-21	528	597.2	4,752
Jun-24-21	527	615.2	3,623

Notes
* Excess LTC resident deaths is determined by comparing the number of deaths that occurred during the pandemic period with the average of deaths that occurred during the same period in the previous 5 years (2014 to 2019). Deaths includes death from all causes and captures LTC residents who died in their LTC home or in hospital.
^† Only the provinces that report to the Continuing Care Reporting System are included in this analysis (Newfoundland and Labrador, Ontario, Manitoba, Alberta and B.C.).
COVID-19 community deaths in Canada include deaths of LTC residents.

Sources
Continuing Care Reporting System, Discharge Abstract Database and National Ambulatory Care Reporting System, 2014–2015 to 2021–2022 (COVID-19 LTC deaths), Canadian Institute for ������ϱ� Information.
Public ������ϱ� Agency of Canada. (weekly COVID-19 community cases). Accessed September 15, 2021.

Since the start of the pandemic, many changes have been made in LTC to limit outbreaks while maintaining access to care. These include increased paramedic services to support the medical needs of residents, digital health innovations to provide virtual support, and implementation of different models to better support physician duties on site.References4-8 LTC residents had fewer visits from physicians, less contact with unpaid caregivers such as family and friends,Reference9 and fewer transfers to hospital for medical care.

Physician visitsFootnote ii to LTC residents declined by 22% in the early spring of 2020 but returned to near pre-pandemic levels by June 2021. Changes were also implemented in several provinces to reduce transfers to hospital from LTC during the pandemic. From March 2020 to June 2021, more than 1,600 LTC residents were transferred to hospital because of a COVID-19 infection, yet there was an overall drop in transfers of 25% compared with the pre-pandemic period. 

Changes in transfers of LTC residents to hospital during the pandemic, by reason for transfer, March 2020 to June 2021* 

Show text version Hide text version

Reason for transfer of care from LTC to hospital	Percentage change
Hip fracture	-10
Palliative care	-14
Delirium	-23
Urinary tract infection	-27
Sepsis (bloodstream infection)	-31
Pneumonitis due to food and vomit	-37
Heart failure	-41
Pneumonia, organism unspecified	-52
Chronic obstructive pulmonary disease (COPD)	-58

Note
* Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change. The data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.

Source
Discharge Abstract Database, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for ������ϱ� Information.

Patient transfers have been discouraged throughout the pandemic to prevent the spread of COVID-19. Residents continued to be transferred to hospital for urgent acute conditions such as hip fractures and palliative care, but transfers for infections and chronic conditions such as heart failure declined by over 40%. 

There are 3 major factors influencing this trend:

• New and regular use of infection control practices,Reference10 such as masks and physical distancing, protected people from infections that trigger hospitalizations for chronic obstructive pulmonary disease (COPD) and pneumonia.
• Some conditions, such as heart failure, were displaced by COVID-19. Residents with cardiac conditions or other frailties (who are generally more at risk for poor COVID-19 outcomes) were likely to be admitted for COVID-19Reference11 instead of these other chronic diseases.
• Most LTC homes in Canada reported experiencing staff shortages among their health care workers that impacted the quality of resident care,Reference6 which may have led to reduced identification of illnesses like urinary tract infections. This was further complicated by admissions of new residents with higher care needs during the pandemic. 

2020–2021 results for 9 quality indicators for LTC related to safety, appropriateness and effectiveness, and health status are available at the facility, region and province/territory levels. To explore this data, please visit Your ������ϱ� System: In Depth, CIHI’s interactive web tool.

• What are the mental health consequences for LTC residents resulting from the changes in care and social isolation during the pandemic?
• What were the impacts to unpaid caregivers and the health of frail seniors in the community with decreased access to LTC?

• COVID-19 Intervention Timeline in Canada
• COVID-19 resources web page

• Long-term care and COVID-19: The first 6 months
• Overview: COVID-19’s impact on Canada’s health care systems
• COVID-19’s impact on emergency departments
• COVID-19’s impact on hospital services
• COVID-19’s impact on physician services
• Unintended consequences of COVID-19
• COVID-19’s impact on home care