3 Residents of LTCFs are particularly vulnerable to contracting disease, not the least a viral respiratory disease like COVID-19. Several factors contribute to this, such as congregant living conditions and the weakened immune systems of the frail older adults living in these types of residential facilities (Sepulveda et al. 1572; Thompson et al. 2). As a result, an alarmingly high rate of COVID-19 deaths in LTCFs was experienced around the globe. During the first wave of the pandemic, residents of LTCFs in many countries represented a large portion of COVID-19 deaths (Inzitari et al. 1046). An examination of COVID-19 death rates for twelve OECD countries¹ (including Canada) reported that nursing home deaths accounted for 90% of deaths in all thirty-seven OECD countries and 56% of all global deaths during the first wave of the pandemic (Sepulveda et al. 1572). The proportion of LTCF death rates varied widely, from 4% in Slovenia to 83% in Norway (CIHI, Pandemic Experience in the Long-Term Care Sector 2). It is necessary to note that definitions of what constitutes long-term care and reporting criteria for LTC-related COVID-19 deaths vary widely from country to country (Comas-Herrera et al. 3) and thus the data reported here is not definitive.

4 It has been suggested that the first case of COVID-19 in a Canadian LTCF was in Quebec on 12 March 2020 (Picard 15). As the pandemic progressed, the number of LTCF deaths during the first wave was staggering, but it varied from province to province. During the first wave, Newfoundland and Labrador, Prince Edward Island, and the Territories had not reported any LTCF COVID-19 related deaths (CIHI, Pandemic Experience in the Long-Term Care Sector 2). However, in Quebec, Ontario, and Alberta, LTCF deaths related to COVID-19 accounted for over 70% of the total provincial pandemic casualties, and in Nova Scotia, for 97% (CIHI, Pandemic Experience in the Long-Term Care Sector 2). The death rates became so alarmingly high that in the spring of 2020, the Canadian Army was called into Quebec LTCFs that were unable to care for residents due to staff illness and absences (Webster 183). During the peak of the first wave, 81% of COVID-19 deaths in Canada occurred in LTCFs (CIHI, Pandemic Experience in the Long-Term Care Sector 1) and by the end of it, that number had dropped to 78.2% (Thompson et al. 5). This high rate of LTCF COVID-19 related deaths was extremely disconcerting when compared to a twelve-country OECD LTC death rate average of 47.3% during the same time (Sepulveda et al. 1573). By March 2021, Canadian LTCFs accounted for more than 50% of all COVID-19 deaths in Canada (Clarke 2).

5 During the second wave, deaths of residents in Canadian LTCFs decreased to 69% (as of 15 February 2021), reaching the proportion of 1 in 5, down from more than 1 in 3 in the first wave (CIHI, The Impact of COVID-19 on Long-Term Care in Canada 12). Although the death rates in Canadian LTCFs were on the decline, they remained alarmingly high compared to a 41% (based on twenty-two countries) death rate in LTCFs around the globe (Comas-Herrera et al. 21). The decline of death rates in Canadian LTCFs may, in part, be attributable to provincial governments accepting recommendations that once a vaccine was secured, residents and staff of LTCFs would be given priority for immunization (National Advisory Committee on Immunization).

6 In Canada, the definition of LTC and LTCF varies from province to province. This has resulted in a sector without a continuity of standards and practices, which became painfully obvious during the pandemic. In New Brunswick, LTC operates under the auspices of the Department of Social Development. LTC services include home support, adult day centres, relief care, and adult residential facilities. These residential facilities, designated as special care homes and nursing homes,² are licensed by the province, and provide various levels of care. In the seven New Brunswick health zones, there are a total of 404 special care homes ranging in size from two to 130 beds, with approximately 6,905 clients (New Brunswick Special Care Home Association) and seventy licensed nursing homes (Government of New Brunswick), providing a total of 4,925 beds.

7 The trajectory of COVID-19 related deaths in New Brunswick LTCFs did not follow the national trend. As noted in Table 1, there was one COVID-19 death in an LTCF during the first wave. These death rates were much lower than those that occurred in other parts of the country. For example, Quebec was experiencing the highest mortality rates in LTCFs at 43.2 deaths per 100,000 population and Ontario reported 13.5 LTCF deaths per 100,000 population during the first wave (CIHI, COVID-19’s Impact on Long-Term Care in Canada). In the second wave, there were sixteen identified COVID-19 related deaths in New Brunswick LTCFs, and in the third wave, eight COVID-19 related deaths. During the second wave, New Brunswick LTCFs maintained the second lowest rates of COVID-19 related deaths at 11 per 100,000 population. However, the number of deaths began to increase during the third wave, when of eight provinces reporting, New Brunswick had the second highest rate of COVID-19 deaths in LTCFs at 0.9 per 100,000 population, second only to Quebec at 1.6 per 100,000 population (CIHI, COVID-19’s Impact on Long-Term Care in Canada).

8 The World Health Organization acknowledges that communication is a key element to effective pandemic management (WHO, Outbreak Communication Guidelines 1). This includes being attentive to factors such as establishing trust, making announcements early, being transparent, understanding the target population, and planning (WHO, Outbreak Communication Guidelines 2–7). These goals can be demonstrated through “empathy and caring, competence and expertise, honesty and openness, and dedication and commitment” (Reynolds and Crouse 135). Effective communication during a global pandemic not only transmits public health guidance but can also reduce negative social, psychological, and health impacts (McClelland et al. 127). To the contrary, a lack of communication can heighten negative outcomes in an already volatile situation (McClelland et al. 128).

9 At the beginning of the COVID-19 outbreak, public health messaging was limited to reporting the number of cases, deaths, and ways to mitigate transmission of the virus by wearing a mask, physical distancing, and handwashing. However, as the pandemic progressed, and provinces began to implement different strategies, the volume of information provided by government agencies was at “infodemic” proportions (Chief Public Health Officer of Canada 16). As the guidance became more complex, it was difficult to have consistency in messaging (Chief Public Health Officer of Canada 52). Unlike the 1921 Spanish flu pandemic where the mediums of communicating public health messages were limited to newspaper, telephone, and word of mouth (MacDougall 85), the technologies of the twenty-first century made the transmission of pertinent public health information a significant challenge. To say the least, there was a deluge of information, both official and unofficial, based on fact and fiction, which spread in a nanosecond across official news organizations and social media (Chief Public Health Officer of Canada 16).

10 Effective communication during a pandemic is particularly important for vulnerable populations. In the case of older adults, increased age has been linked to higher mortality rates from COVID-19 (Sharma e72). Although there is not one universally accepted definition, vulnerability can be defined simply as “an increased potential for loss in a hazardous situation, including reduced capability to respond effectively” (Vaughan and Tinker S329). Public Health New Brunswick defines a vulnerable population as a “group or community at a higher risk for poor health as a result of the barriers they experience to social, economic, political and environmental resources, as well as limitations due to illness or disability” (Public Health New Brunswick 1). It may be safe to assume that many individuals seeking information about family living in LTCFs would be in an older demographic. Older adults would therefore fall within the vulnerability criterion, whether they are residents of a LTCF or living in the community. The government of New Brunswick provides guidance for the preparation of information to be disseminated by including the following practices: “Prepare and practice calm, reassuring and accurate communication with residents, their families and other stakeholders. Acknowledge the seriousness of the situation and the feelings of fear and anxiety that might produce” (COVID-19 Management Guide for Adult Residential Facilities and Nursing Homes – Version 1.1 10). Therefore, any attempt to mitigate undue health, social, and psychological hardship would seem prudent.

11 Providing information through a variety of platforms is essential when communicating with older adults. Although web-based information is efficient and wide-ranging, there can be inequities in accessing information for older adults who do not own a computer or smartphone and are unfamiliar with the Internet (McClelland et al. 132). As a result, the format in which information is delivered can have a direct impact on the ability of an older adult to access it. Unlike younger age groups, older adults also consult more traditional communication media—which would include radio, television, and word-of-mouth—to obtain information (Rosales and Fernandez-Ardevol 51). With respect to the consultation of web-based sources of information (such as searching the Internet or using a smartphone), age is not a sole determinant of use, but it is a factor. For example, the young old (65–75 years) use the Internet more often than the old-old (75+ years) (Hülür and Macdonald 555). Furthermore, older adults may not have the interest, resources, or skills necessary to access digital information (Yuan et al. 163). This is evident in Canada, where Internet usage is 97.2% for the fifteen to sixty-four-year-old age group compared to 68.2 % of those aged sixty-five years and older (Davidson and Schimmele 6).

12 Not only can technology use vary by age, but there can also be regional differences in the Canadian context. In 2018, 79.1% of older Canadians reported access to the Internet at home, compared to a higher rate of 81.9% in Atlantic Canada (Statistics Canada). In addition, research shows that only 51.8% of individuals aged sixty-five years and over living in Atlantic Canada have a smartphone for personal use, compared to 60.4% of the national sample (Statistics Canada). In New Brunswick, although the proportion of those of age sixty-five and older with Internet access at home has increased to 85.7% (New Brunswick Health Council), there are challenges around access to reliable Internet service. The Canadian Radio-Television and Telecommunications Commission reports that only 45.6% of rural households have access to 50/10 megabits per second speeds with unlimited data, compared to 87.4% in urban areas of the country (CRTC, Broadband Fund). There are 67,000 New Brunswick rural households that do not have access to Internet (Auditor General of New Brunswick, 2021 Report 3).

13 The purpose of this research project was to study how individuals with a family member/sponsor living in a New Brunswick special care home or nursing home accessed information during the COVID-19 pandemic. Specific attention was given to examining how the delivery of information in the digital age impacted the exchange of information. The findings presented here are part of a larger study, which investigated communication strategies used by administration and staff in LTCFs during the pandemic.

14 The participants in Survey I (n=101) and Survey II (n=110) were family/sponsors of residents living in either a special care home or nursing home in New Brunswick. An invitation with a link to the survey was posted on Facebook. In Survey I, most of the sample (67%) identified that their family/sponsor lived in a nursing home and 17% in a special care home, while 16% did not indicate the type of LTCF. Nearly all (99%) surveys were completed in English. In Survey II, most participants (62%) identified that their family/sponsor lived in a special care home, 13% in a nursing home, and 25% did not indicate the type of LTCF. Nearly all (95%) surveys were completed in English and 5% in French.

15 Survey I consisted of sixteen closed- and three open-ended questions about the experience of obtaining COVID-19 related information from the family/sponsor’s LTCF during the first wave of the pandemic. For the purpose of this paper, only responses to the question about satisfaction with the information supplied will be included. Open-ended questions provided participants with the opportunity to comment on the effectiveness of communication strategies and recommendations for improvements.

16 Survey II consisted of two closed- and two open-ended questions about the experience of obtaining COVID-19 information regarding visitation rules/regulations. The closed-ended questions pertained to type of facility and satisfaction with the information on visitation rules/regulations. The two open-ended questions provided participants with the opportunity to comment on the challenges in obtaining this information and to propose recommendations for improvements.

17 Potential participants were invited to take part in the surveys using Hosted in Canada (www.hostedincanada.com). After giving consent, the participants proceeded to complete the survey. Survey I was distributed in August 2020 at the end of the first wave of the pandemic, whereas Survey II was circulated in March 2021 at the end of the second wave of the pandemic.

18 The closed-ended questions in Surveys I and II were analyzed using SPSS v27. The text from the open-ended questions in these surveys was exported to NVivo 12 (QSR International, Burlington, MA, USA) and a thematic analysis (Braun and Clarke) was conducted to develop a coding frame of the content. Verbatim examples are included in the results to illustrate the themes identified.

19 The participants were asked to rate their level of satisfaction with information provided during the first wave. Table 2 indicates a very high level of satisfaction with the information provided and reveals that it answered their questions and concerns.

20 The participants were also asked to identify any positive aspects of communicating with the facility. Two distinct themes emerged from the analysis: appreciation for “great staff” and the use of technology to communicate with family (see Table 3). Terms such as “have their best interests at heart,” sympathetic, empathetic, and helpful were used to describe interactions with LTCF staff. The participants indicated that staff were key in terms of providing information. Participants also reported that being able to use technology to communicate with family members on platforms such as FaceTime and Skype alleviated concerns about the well-being of family members.

21 The participants were also asked to identify any challenges in communicating with the LTCF. Two distinct themes emerged from the analysis: poor quality communication and a lack of staff, which contributed to the inability to access information about family members/sponsors. The participants expressed concerns regarding poor-quality communication, such as inconsistent updates about the status of family members. In addition, it was suggested that the lack of staff contributed to the challenge of acquiring information (see Table 4).

22 The participants in Survey II were asked to rate how satisfied they were with the information received regarding visitation rules/regulations during the second wave. As noted in Table 2, slightly more than half (52%) indicated they were very satisfied, and the remaining participants were satisfied (44%) or not satisfied (4%).

23 The participants were also asked about their greatest challenge in getting accurate information about visitation rules/regulations from the LTCF. From the analysis of these responses three themes emerged: quality of information, inability to contact the facility, and uninformed staff (see Table 5). Participants indicated that a lack of clarity, inaccuracy, and inconsistency in the information provided was a source of frustration. This was further complicated by a lack of available information, which resulted in family members having to initiate contact with the facility. Participants also reported that once contact was made, staff seemed to be uninformed and unaware of the status of visitation guidelines and regulations.

24 The participants in both Surveys I and II were asked to make recommendations that could help improve communication between themselves and the LTCFs. Three distinct themes emerged from the analysis: regular updates, clear and consistent information, and having a digital presence (see Table 6). Family members repeatedly indicated that regular updates that contained clear and consistent information were essential. The participants also suggested that a stronger digital presence would enable more effective communication. This included recommendations for regular posts on Facebook and updated websites.