The Impact of the COVID-19 Pandemic on End-of-Life Outcomes in Chinese-Speaking Nursing Home Residents in Canada: A Pre-Post Retrospective Observational Study.

OBJECTIVES

Ethnic and linguistic minorities in nursing homes often face poorer health outcomes, particularly in language-discordant settings. This study examined the impact of the pandemic on end-of-life outcomes for Chinese-speaking residents in language-concordant and language-discordant facilities.

DESIGN

Population-based retrospective cohort study.

SETTING AND

PARTICIPANTS

Chinese-speaking nursing home residents over 65 years old in Ontario, Canada, who died within the first 10 months of the pandemic (n = 636), compared with those who died before the pandemic (n = 423).

METHODS

Primary language spoken was identified using the Resident Assessment Instrument-Minimum Data Set, version 2.0. Nursing homes were classified as language concordant if they were culturally designated facilities or if Chinese-speaking residents represented at least 20% of their resident population. Outcomes included location of death and acute care use (ie, hospitalization or emergency department [ED] visits) in the last 30 days of life. Multilevel models were used to assess the immediate impact of the pandemic on these outcomes by language concordance status.

RESULTS

Chinese-speaking residents in language-concordant homes had significantly lower risks of hospitalization (risk ratio [RR], 0.52; 95% CI, 0.30-0.91), ED visits (RR, 0.48; 95% CI, 0.34-0.69), and hospital deaths (RR, 0.55; 95% CI, 0.37-0.83) during the pandemic relative to the prepandemic period. In language-discordant homes, risk of hospitalization declined (RR, 0.51; 95% CI, 0.32-0.80), but changes in ED visits and hospital deaths were not statistically significant between the 2 periods.

CONCLUSIONS AND IMPLICATIONS: Lower ED visits and hospital deaths were observed primarily among Chinese-speaking residents in language-concordant nursing homes, despite their prepandemic rates being equivalent to or higher than those in language-discordant settings. This suggests that enhanced language support may have facilitated better conversations about care that could be provided in place during the public health crisis, thereby avoiding transfers to acute care at the end of life.