Review of COVID-19 outbreaks in care homes recommends increased paid leave for staff

A province-wide review of COVID-19 outbreaks in long-term care and assisted living sites during the first year of the pandemic says that sites that provided fewer days of paid sick leave were more likely to experience a larger outbreak.

One of the recommendations made by the review is to increase paid leave for staff.

B.C. Seniors Advocate Isobel Mackenzie on Wednesday released the results of the review.

The review examined factors that can influence the probability that a site will experience a COVID-19 outbreak and factors that can minimize the number of staff and residents who become infected when an outbreak occurs.

“We saw how quickly COVID-19 can spread in long-term care and assisted living sites, and we saw the devastating impact of this virus on the older population. Even with everyone’s best efforts, we have tragically lost over 800 residents to COVID-19,” Mackenzie said.

“This is not just a set of numbers, these are people. Residents and their family members had their lives upended with the trauma of life in long-term care and assisted living during a pandemic, and those who operate and work in these care homes have been deeply affected by the experience.”

The review examined 365 outbreaks at 210 sites for the period of March 1, 2020, to February 28, 2021, and found:

  • 84% of outbreaks occurred at sites in the Lower Mainland
  • 72% of outbreaks were contained to four or fewer cases
  • 75% of outbreaks had no COVID-19 fatalities with an overall case fatality rate of 30%
  • 87% of outbreaks were experienced in Wave 2 (September 2020 to February 2021)

Data collected was used to examine the physical characteristics of each site, the specific characteristics of its residents and staff, and the specifics of each outbreak to identify factors that might have contributed to an outbreak occurring and/or spreading to more staff and residents.

In most outbreaks (76%), the first COVID-19 case was a staff member. In 22% of outbreaks, a resident was the first case and there was only one outbreak where the confirmed first case was a visitor. The report identifies that a site was more likely to have a large outbreak:

  • if the first case was a resident (four times more likely)
  • if the first case was a nightshift worker (five times more likely)
  • if the first case was a registered nurse or a licensed practical nurse (1.5 times more likely)

The report also identifies that fast notification of the first case and testing staff within the first 48 hours were more likely to contain an outbreak and 40% of outbreaks that had not tested all staff by the fourth day grew into larger outbreaks.

The review analyzed what factors were more common in larger outbreaks and found:

  • sites that provided fewer days of paid sick leave were more likely to experience a larger outbreak (while almost all sites provide paid sick leave to staff, the number of days ranged from 2.5 to 18 days per year)
  • sites with lower levels of registered nurses as a proportion of the direct care hours were more likely to experience large outbreaks
  • sites that had shared rooms were more likely to experience a larger outbreak

Overall, the probability of experiencing any outbreak (defined as one test-positive case in either staff or residents) was most closely associated with the level of local community transmission of COVID-19.

The review included feedback from over 6,500 staff who reported they were concerned about infecting residents and their own family members, and reported their overall health and wellbeing was compromised by the experience of working through the pandemic. Overtime increased by 63%, with sites that experienced a large outbreak increasing overtime by 178%. A total of 2.3 million hours of overtime was delivered during the year.

As well, site operators experienced significant increases in workloads related to managing staff, families of residents, supplies and health authority officials.

The review highlighted that B.C. performed significantly better than Ontario in Wave 1— likely a result of both lower rates of community transmission and the early protection measures taken in long-term care and assisted living in B.C.

In Wave 2, after Ontario adopted the same measures as B.C., the percentage of overall COVID-19 cases in long-term care was the same for the two provinces.

The report includes seven recommendations:  

  1. Increase paid sick leave for staff
  2. Increase the pool of direct care staff
  3. Decrease contracting for direct care staff
  4. Increase levels of registered nursing staff as a proportion of direct care staff
  5. Increase testing scope, timeliness and frequency
  6. Eliminate shared rooms
  7. Require staff of long-term care to be vaccinated and provide booster shots to residents

The complete report is available at