Wellness Hub

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Summary

Long-term care homes (LTCH) and Retirement homes (RH) were disproportionately impacted by COVID-19. In Canada, more than 80% of COVID-related deaths were associated with LTCH, and in Ontario, more than 60% of COVID-related deaths were LTCH residents. LTCH/RH staff were also at an increased risk. It was imperative to understand the individual-, household-, neighbourhood- and LTCH-level factors influencing COVID-19 infection and immunity in these settings, while also addressing the needs of these homes and provide immediate supports to address these needs. Therefore, the Wellness Hub (WH) project was initiated as an immunology study with a strong implementation support program component.

WH was built on a model of integrated KT. To define various research questions specific to the prevalence and correlates of COVID-19 infection and protection in LTCH/RH, we formed and engaged a multidisciplinary network that spanned rmore than 20 research and clinical disciplines, and those with lived experience. These partnerships guided and supported the collection of saliva, serum, dried blood spot (DBS), wastewater and survey data. Wastewater surveillance was conducted across 12 LTCH/RHs and shelters, and 20 neighbourhoods where staff lived to facilitate early COVID-19 detection. We collected more than 1600 DBS samples and demographic surveys across 59 LTCH/RHs in Ontario, recruiting staff, their household members, residents, and residents’ essential care partners/caregivers.

Our findings provided critical insights on COVID-19 antibody status in the LTCH/RH populations. We showed that neighbourhood-level social determinants (e.g., lower income, racialized communities) were risk factors for individual-level and population-level COVID-19 rates, and that cases among LTCH staff were more closely linked to community cases, when compared to cases in other healthcare workers.

To ensure the supports offered to LTCH/RH staff were relevant and thoughtfully produced, we also conducted interviews with 91 LTCH/RH leaders across 47 homes in Ontario. Through the interviews, home leaders identified three areas of challenges experienced during the pandemic:

(1)   Managing infection, prevention and control (IPAC+)

(2)   Vaccine uptake and vaccine confidence among staff (Vaccine+)

(3)   Staff mental and occupational health and well-being (CARE+).

To address these challenges, we created an open-access resource repository with more than 630 resources (including 38 original resources), organized 50 educational events (e.g., Town Halls with expert speakers in the fields of virology, public health, medicine), and held 22 community-of-practice meetings. We conducted an implementation science study to determine how best to support homes during the pandemic. Data show that homes who received support from a trained facilitator were two times more likely to resolve pandemic-related challenges. Homes in our Wellness Hub intervention arm demonstrated a near two-fold higher resolution of IPAC related challenges and a four-fold higher resolution of Vaccine related challenges compared to homes in the control arm.

Through this work, we identified a need for more research to better support the well-being and mental health of LTCH and RH staff. We secured CIHR funding and completed a randomized trial to determine the impact of 1:1 coaching for LTCH/RH staff (namely personal support workers) on burnout, well-being and mental health outcomes. Data analysis for this implementation science study is currently underway.

The impact of Wellness Hub is far reaching:

  • We advanced the understanding of vaccine immunity in LTCH/RH populations, which helped shape the COVID-19 vaccine schedule recommendations in Canada, for example, this led to national recommendations for the timing of subsequent doses of the vaccine. 
  • We highlighted the importance of post-pandemic mental health supports for LTCH/RH staff
  • We facilitated the development of wastewater surveillance methods at facilities that complemented clinical testing and demonstrated that wastewater surveillance can be used to identify outbreaks early and tailored strategies can be implemented early to mitigate outbreaks.
  • We identified specific variables most associated with COVID-19 infection and spread. These findings will improve pandemic preparedness and outbreak management in LTCH/RHs, and ensure individuals caring for LTCH and RH residents have the appropriate supports to stay safe and healthy.

We sustained our WH network, and continue to collaborate with LTCH/RH partners and researchers to address post-pandemic needs and prepare for future public health emergencies. One example is the Vaccine+ expansion, recently funded by the Public Health Agency of Canada’s Immunization Prioritization Fund, which will expand the scope of Wellness Hub’s Vaccine+ arm to COVID-19 and influenza vaccines and expand reach to all LTCH and RH in Ontario.

We would like to thank our study funders and partners.

Project Resources

Funded By

  • COVID-19 Immunity Task Force
  • Canadian Immunization Research Network
  • Health Excellence Canada
  • John and Myrna Daniels Foundation
  • Ontario Ministry of Labour, Training and Skills Development
  • Canadian Institutes of Health Research
  • Unity Health Toronto
  • University of Toronto

Principal Investigator

  • Sharon Straus

Co-Investigators

  • Christine Fahim
  • Linn Holness

Collaborators

  • Ontario Personal Support Workers Association
  • Ontario Long-Term Care Association
  • Inner City Health Associates

KTP Project Staff

  • Vanessa Bach
  • Jamie Boyd
  • Jessica Firman
  • Claire Gapare
  • Vanja Grubac
  • Vincenza Gruppuso
  • Ana Mrazovac
  • Nimitha Paul
  • Temi Odunuga