Implementation of the “one high risk site only” policy – its impact on staff, family and LTC residents

Dr. Joanie Sims-Gould’s team is one of two BC research teams being co-funded by Health Research BC and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by Healthcare Excellence Canada.

 

It is essential that we stop the spread of the COVID-19 virus in long-term care. The Public Health Agency of Canada instituted evidence-based, rapid redesign and resource redeployment practices to protect the health and ensure the safety of staff, residents and their families. Measures included strict visitation and “one high risk site” staffing policies, prohibiting LTC staff from employment in more than one facility. Our mixed methods, exploratory study will focus on implementation and impact of the “one high risk site” staffing policy on staff, family and residents in 4 LTC facilities in 2 British Columbia health authorities. We are guided by the Consolidated Framework for Implementation Research (CFIR).

 

We have the necessary expertise to conduct this study that spans implementation science, LTC, quantitative and qualitative methods and knowledge translation (KT). Our team includes early (Havaei – co-PI, Hung), mid-career (Sims-Gould – PI) and established (Macphee, Phinney, Robinovitch, McKay) researchers, and trainees (Franke, Staempfli) together with committed and passionate LTC administrators (Keselman, Lee, Kirk, Strath), senior health authority executives (Mak, Sorensen) and Min of Health (Neilson) partners and KU. Two collaborators offer expertise in implementation measures (Lewis) and national LTC policy (Tamblyn-Watts).

 

Short-term outcomes: Knowledge users are positioned to immediately translate evidence into practice to inform LTC improvements at the facility level. We will share results through the LTC+ Acting on Pandemic Learning Together Initiative. Facilities that signed up to participate in this initiative have immediate access to results of our study across jurisdictions.

 

Long-term outcomes: Lessons learned about positive and negative consequences of the “one high risk site” policy can be applied in other jurisdictions. We will provide a roadmap to effectively implement future policies in response to COVID-19 in LTC settings. Partnerships we develop foster future collaborations and capacity building among academics and the LTC sector.

End of Award Update – May 2023

 

Most significant outputs

Implementation of the Single Site Order (SSO) proved to be a challenge for all facilities in our study. In a system already facing staffing concerns and a highly dependent and increasingly frail resident population, implementation of the SSO further taxed already stretched resources. The SSO was not truly ‘single site’ given that workers were able to move from acute care to long-term care. Inconsistent communication, lack of external and internal supports, along with lack of quality of evidence of effectiveness impacted implementation of the policy. Contextual factors and overlap with other pandemic policies (e.g., changes to visitation policies, dining policies, infection control policies) influenced outcomes of the SSO, such as increased resident acuity due to intake of residents from hospitals only and not communities. This, along with staffing shortages and loss of volunteer and family hours, placed a heavy physical and mental toll on an already overburdened workforce.

 

While the facilities in our study found “a way” to implement the SSO, there are concerns as to the sustainability of such a policy. Sustained implementation will require a comprehensive overhaul of staffing and resource challenges. Although government investments have already supported financial resources, additional financial support is needed to sustain the order (Giannasi and Hystad, 2020).

 

Impact

We have presented our findings to BC Ministry of Health stakeholders and were able to clearly outline the impacts of the SSO on residents, family members and caregivers. The meeting also provided an opportunity to obtain policy- and decision-makers’ input for data interpretation and for future in-depth analysis of the data (e.g. potential questions to ask of the data). The Ministry of Health has invited the research team to present to Home and Community Care leads for each provincial Health Authority. The leads provide policy directions to contracted LTC operators over and above the Ministry’s policy directions.

 

Potential Influence

Administrative data reports for individual LTC homes:

Next Steps

As a result of this research project, we have expanded our network of LTC researchers, administrators, providers, users and advocacy organizations with whom we have developed funding applications to explore their most urgent needs (e.g. workload management). These engagement opportunities enabled the development and submission of a CIHR Catalyst Grant application to address an urgent need of LTC homes and their users focused on workload management. Key stakeholders including three LTC homes, family and resident councils, and LTC organizations such as BC Care Providers Association, SafeCare BC and the provincial Seniors Advocate Office are serving as collaborators or knowledge users in this application which is currently under review.

 

Useful Links

Publications under review: