The association of facility ownership with COVID-19 outbreaks in long-term care homes in British Columbia, Canada: a retrospective cohort study

BACKGROUND: Long-term care (LTC) in Canada is delivered by a mix of government-, for-profit- and nonprofit-owned facilities that receive public funding to provide care, and were sites of major outbreaks during the early stages of the COVID-19 pandemic. We sought to assess whether facility ownership was associated with COVID-19 outbreaks among LTC facilities in British Columbia, Canada. METHODS: We conducted a retrospective observational study in which we linked LTC facility data, collected annually by the Office of the Seniors Advocate BC, with public health data on outbreaks. A facility outbreak was recorded when 1 or more residents tested positive for SARS-CoV-2 between Mar. 1, 2020, and Jan. 31, 2021. We used the Cox proportional hazards method to calculate the adjusted hazard ratio (HR) of the association between risk of COVID-19 outbreak and facility ownership, controlling for community incidence of COVID-19 and other facility characteristics. RESULTS: Overall, 94 outbreaks involved residents in 80 of 293 facilities. Compared with health authority–owned facilities, for-profit and nonprofit facilities had higher risks of COVID-19 outbreaks (adjusted HR 1.99, 95% confidence interval [CI] 1.12–3.52 and adjusted HR 1.84, 95% CI 1.00–3.36, respectively). The model adjusted for community incidence of infection (adjusted HR 1.12, 95% CI 1.07–1.17), total nursing hours per resident-day (adjusted HR 0.84, 95% CI 0.33–2.14), facility age (adjusted HR 1.01, 95% CI 1.00–1.02), number of facility beds (adjusted HR 1.20, 95% CI 1.12–1.30) and facilities with beds in shared rooms (adjusted HR 1.16, 95% CI 0.73–1.85). INTERPRETATION: Findings suggest that ownership of LTC facilities by health authorities in BC offered some protection against COVID-19 outbreaks. Further study is needed to unpack the underlying pathways behind this observed association.