{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T23:16:25Z","timestamp":1782515785063,"version":"3.54.5"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018\u20132019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p &lt;0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04)<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions and implications<\/jats:title>\n<jats:p>Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0264240","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T17:32:33Z","timestamp":1667583153000},"page":"e0264240","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-3614","authenticated-orcid":true,"given":"Aaron","family":"Jones","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice I.","family":"Mowbray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Falk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan M.","family":"Stall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil","family":"Malikov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3457-0696","authenticated-orcid":true,"given":"Sarah L.","family":"Malecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Lail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae Young","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9212-5641","authenticated-orcid":true,"given":"Andrew P.","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amol A.","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad","family":"Razak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"pone.0264240.ref001","unstructured":"Canadian Institute for Health Information. COVID-19\u2019s effect on hospital care services. [cited 18 Oct 2021]. Available: https:\/\/www.cihi.ca\/en\/covid-19-resources\/impact-of-covid-19-on-canadas-health-care-systems\/covid-19s-effect-on-hospital"},{"key":"pone.0264240.ref002","unstructured":"Financial Accountability Office of Ontario. Ontario Health Sector: A Preliminary Review of the Impact of the COVID-19 Outbreak on Hospital Capacity. [cited 3 Dec 2021]. Available: https:\/\/www.fao-on.org\/en\/Blog\/Publications\/health-2020"},{"key":"pone.0264240.ref003","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/PEC.0000000000002484","article-title":"Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments","volume":"37","author":"Y Finkelstein","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"pone.0264240.ref004","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1161\/STROKEAHA.120.030792","article-title":"The Curious Case of the Missing Strokes During the COVID-19","volume":"51","author":"D Aguiar de Sousa","year":"2020","journal-title":"Pandemic. Stroke"},{"key":"pone.0264240.ref005","doi-asserted-by":"crossref","first-page":"e043828","DOI":"10.1136\/bmjopen-2020-043828","article-title":"Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study","volume":"10","author":"AG Lai","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0264240.ref006","unstructured":"Canadian Institute for Health Information. Long-term care and COVID-19: The first 6 months. [cited 18 Oct 2021]. Available: https:\/\/www.cihi.ca\/en\/long-term-care-and-covid-19-the-first-6-months"},{"key":"pone.0264240.ref007","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.jamda.2021.04.008","article-title":"Variation in Care of Community and Nursing Home Residents Who Died of COVID-19 in Ontario, Canada","volume":"22","author":"KA Brown","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0264240.ref008","first-page":"E842","article-title":"Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study","volume":"5","author":"AA Verma","year":"2017","journal-title":"Can Med Assoc Open Access J"},{"key":"pone.0264240.ref009","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1093\/jamia\/ocaa225","article-title":"Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience","volume":"28","author":"AA Verma","year":"2021","journal-title":"J Am Med Inform Assoc JAMIA"},{"key":"pone.0264240.ref010","unstructured":"Canadian Institute for Health Information. COVID-19 data collection and coding direction. [cited 14 Oct 2021]. Available: https:\/\/www.cihi.ca\/en\/covid-19-resources\/covid-19-data-collection-and-coding-direction"},{"key":"pone.0264240.ref011","unstructured":"Canadian Institute for Health Information. COVID-19 Intervention Timeline in Canada | CIHI. [cited 29 Jun 2022]. Available: https:\/\/www.cihi.ca\/en\/covid-19-intervention-timeline-in-canada"},{"key":"pone.0264240.ref012","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A Modification of the Elixhauser Comorbidity Measures into a Point System for Hospital Death Using Administrative Data","volume":"47","author":"C van Walraven","year":"2009","journal-title":"Med Care"},{"key":"pone.0264240.ref013","doi-asserted-by":"crossref","first-page":"e1002249","DOI":"10.1371\/journal.pmed.1002249","article-title":"Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort","volume":"14","author":"L Mondor","year":"2017","journal-title":"PLOS Med"},{"key":"pone.0264240.ref014","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/MLR.0b013e3181589bb6","article-title":"Risk-adjusting hospital inpatient mortality using automated inpatient, outpatient, and laboratory databases","volume":"46","author":"GJ Escobar","year":"2008","journal-title":"Med Care"},{"key":"pone.0264240.ref015","doi-asserted-by":"crossref","first-page":"e005256","DOI":"10.1161\/JAHA.116.005256","article-title":"Derivation and Validation of an In\u2010Hospital Mortality Prediction Model Suitable for Profiling Hospital Performance in Heart Failure","volume":"7","author":"T Lagu","journal-title":"J Am Heart Assoc"},{"key":"pone.0264240.ref016","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1001\/jamainternmed.2021.0224","article-title":"Assessment of Psychotropic Drug Prescribing Among Nursing Home Residents in Ontario, Canada, During the COVID-19 Pandemic","volume":"181","author":"NM Stall","year":"2021","journal-title":"JAMA Intern Med"},{"key":"pone.0264240.ref017","article-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2020","journal-title":"Vienna, Austria"},{"key":"pone.0264240.ref018","article-title":"Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia","author":"A Jones","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0264240.ref019","article-title":"The Impact of COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases","author":"The Commonwealth Fund"},{"key":"pone.0264240.ref020","doi-asserted-by":"crossref","first-page":"e214599","DOI":"10.1001\/jamahealthforum.2021.4599","article-title":"Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic","author":"SE Bronskill","year":"2022","journal-title":"JAMA Health Forum. American Medical Association"},{"key":"pone.0264240.ref021","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jamda.2021.01.068","article-title":"Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic","volume":"22","author":"A Jones","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0264240.ref022","unstructured":"Canadian Armed Forces Depart Ontario Long-Term Care Homes. In: news.ontario.ca [Internet]. [cited 13 Oct 2022]. Available: https:\/\/news.ontario.ca\/en\/release\/57468\/canadian-armed-forces-depart-ontario-long-term-care-homes"},{"key":"pone.0264240.ref023","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1111\/jgs.16625","article-title":"A Hospital Partnership with a Nursing Home Experiencing a COVID-19 Outbreak: Description of a Multiphase Emergency Response in Toronto, Canada","volume":"68","author":"NM Stall","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"pone.0264240.ref024","doi-asserted-by":"crossref","first-page":"e0262807","DOI":"10.1371\/journal.pone.0262807","article-title":"COVID-19 excess mortality among long-term care residents in Ontario, Canada","volume":"17","author":"N Akhtar-Danesh","year":"2022","journal-title":"PLOS ONE"},{"key":"pone.0264240.ref025","unstructured":"Canadian Institute for Health Information. COVID-19\u2019s impact on long-term care. [cited 13 Oct 2022]. Available: https:\/\/www.cihi.ca\/en\/covid-19-resources\/impact-of-covid-19-on-canadas-health-care-systems\/long-term-care"},{"key":"pone.0264240.ref026","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7029a1","article-title":"Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic\u2014United States, 2020\u20132021","volume":"70","author":"SJ Olsen","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0264240.ref027","first-page":"6","article-title":"Trends in respiratory virus circulation following COVID-19-targeted nonpharmaceutical interventions in Germany, January\u2014September 2020: Analysis of national surveillance data","author":"D-Y Oh","year":"2021","journal-title":"Lancet Reg Health\u2013Eur"},{"key":"pone.0264240.ref028","doi-asserted-by":"crossref","first-page":"e2118441","DOI":"10.1001\/jamanetworkopen.2021.18441","article-title":"Comparison of Medication Prescribing Before and After the COVID-19 Pandemic Among Nursing Home Residents in Ontario, Canada","volume":"4","author":"MA Campitelli","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0264240.ref029","doi-asserted-by":"crossref","first-page":"E135","DOI":"10.1503\/cmaj.202636","article-title":"The case for relaxing no-visitor policies in hospitals during the ongoing COVID-19 pandemic","volume":"193","author":"L Munshi","year":"2021","journal-title":"CMAJ"},{"key":"pone.0264240.ref030","doi-asserted-by":"crossref","first-page":"e2119028","DOI":"10.1001\/jamanetworkopen.2021.19028","article-title":"The COVID-19 Pandemic and Drug Prescribing in Ontario Nursing Homes\u2014From Confinement Syndrome to Unconfined Prescribing","volume":"4","author":"C Reppas-Rindlisbacher","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0264240.ref031","article-title":"Delirium in Older Patients With COVID-19: Prevalence, Risk Factors, and Clinical Relevance","author":"A Mendes","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0264240.ref032","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1001\/jama.2020.13484","article-title":"Social Isolation\u2014the Other COVID-19 Threat in Nursing Homes","volume":"324","author":"J. Abbasi","year":"2020","journal-title":"JAMA"},{"key":"pone.0264240.ref033","first-page":"1","article-title":"Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations","author":"W Sep\u00falveda-Loyola","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"pone.0264240.ref034","doi-asserted-by":"crossref","first-page":"e256","DOI":"10.1016\/S2468-2667(20)30061-X","article-title":"COVID-19 and the consequences of isolating the elderly","volume":"5","author":"R Armitage","year":"2020","journal-title":"Lancet Public Health"},{"key":"pone.0264240.ref035","author":"SD Canada E and","year":"2022","journal-title":"Social Isolation among Older Adults during the Pandemic"},{"key":"pone.0264240.ref036","unstructured":"Social isolation and loneliness among older people: advocacy brief. [cited 13 Oct 2022]. Available: https:\/\/www.who.int\/publications-detail-redirect\/9789240030749"},{"key":"pone.0264240.ref037","doi-asserted-by":"crossref","first-page":"e21608","DOI":"10.2196\/21608","article-title":"Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?","volume":"3","author":"AN Dula","year":"2020","journal-title":"JMIR Aging"},{"key":"pone.0264240.ref038","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1111\/jgs.17227","article-title":"Emergency Department Visits for Emergent Conditions Among Older Adults During the COVID-19 Pandemic","volume":"69","author":"AT Janke","year":"2021","journal-title":"J Am Geriatr Soc"},{"key":"pone.0264240.ref039","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/j.jamda.2020.07.038","article-title":"Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian Nursing Homes to Family Caregivers and Visitors during the Coronavirus Disease 2019 Pandemic","volume":"21","author":"NM Stall","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0264240.ref040","article-title":"A Novel Collaborative Care Program to Augment Nursing Home Care During and After the COVID-19 Pandemic","author":"BM Wong","year":"2021","journal-title":"J Am Med Dir Assoc"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T17:33:07Z","timestamp":1667583187000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264240"}},"subtitle":[],"editor":[{"given":"Enrico","family":"Mossello","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264240","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,4]]}}}