Academic literature on the topic 'After-death communication experience'

Background: The notification of unexpected and violent death represents a challenging experience for police officers and health workers. These professionals are exposed to very intense emotions during this task. Aim: We aimed to investigate the degree of preparation, and the emotions and attitudes of police officers and health professionals while communicating such a death. Method: An ad hoc online questionnaire was created and disseminated through Qualtrics software. The participants were recruited through the institutional channels of Police, the College of Physicians, the ONG De Leo Fund and the Department of General Psychology of the University of Padua. In this qualitative study, thematic content analysis was used to examine the responses. Results: A total of 155 individuals participated in the study (44 females, 111 males): 102 individuals were police officers, 23 were doctors and were 30 nurses. Five main themes were identified: (1) how the communication took place; (2) the experiences during the communication; (3) the difficulties encountered; (4) coping strategies, and (5) forms of support. Most communications were performed in person, and most represented an intense emotional experience for the notifiers. There is a generalised lack of specific preparation and training for this practice. The recipient’s characteristics (culture of origin, language, age, health conditions, psychological vulnerability) may add to the difficulties of the notification process. Professionals unload their tension by practicing sport, relying on their hobbies or interacting socially. The presence of other colleagues during and after the death notification is usually able to alleviate the burden of the communication. Conclusions: Communication modalities can have a profound impact on the recipients and intensify the trauma of the loss; however, they also have the possibility of mitigating it. The notification of a violent and unexpected death remains a difficult and challenging task for the notifier, which is potentially stressful and emotionally charged. The topic is of great relevance and more research should be promoted in this area.

This study explores the recovery experiences of survivors of a flash flood event, five years after a natural disaster in South East Queensland. In-depth interviews were conducted with 33 of the original cohort of 120 post-disaster interviewees who experienced sudden traumatic bereavement and/or their own near-death experience. The data reveals that many of the survivors and rescuers were in worse—or far worse—situations than they had been in the weeks and months immediately after the disaster. Interviewees identified the worsening of their situation as being caused by systems failures by civil authorities, health care systems, welfare programmes and the insurance industry. Further research is recommended to assess the needs of people affected by natural disasters and the viability of a state-funded recovery scheme that could expedite personal, family and community recovery. The proposed scheme is based on the Queensland WorkCover scheme that scaffolds recovery and return to work for injured workers.

BackgroundPandemic-related restrictions are expected to continue to shape end-of-life care and impact the experiences of dying hospitalised patients and their families.ObjectiveTo understand families’ experiences of loss and bereavement during and after the death of their loved one amidst the SARS-CoV-2 (COVID-19) pandemic.DesignQualitative descriptive study.SettingThree acute care units in a Canadian tertiary care hospital.ParticipantsFamily members of 28 hospitalised patients who died from March–July 2020.Main outcome measuresQualitative semistructured interviews conducted 6–16 months after patient death inquired about family experiences before and beyond the death of their loved one and garnered suggestions to improve end-of-life care.ResultsPandemic restrictions had consequences for families of dying hospitalised patients. Most family members described an attitude of acquiescence, some framing their experience as a sacrifice made for the public good. Families appreciated how clinicians engendered trust in the name of social solidarity while trying to mitigate the negative impact of family separation. However, fears about the patient’s experience of isolation and changes to postmortem rituals also created despair and contributed to long-lasting grief.ConclusionProfound loss and enduring grief were described by family members whose final connections to their loved one were constrained by pandemic circumstances. Families observed solidarity among clinical staff and experienced a sense of unity with staff, which alleviated some distress. Their suggestions to improve end-of-life care given pandemic restrictions included frequent, flexible communication, exceptions for family presence when safe, and targeted efforts to connect patients whose isolation is intensified by functional impairment or limited technological access.Trial registration numberNCT04602520; Results.

Background. It is noticeable that doctors’ avoidant behavior while dealing with emotional consequences of critical events not only lowers physician’s quality of sleep (Kahn, Sheppes, & Sadeh, 2013), brings them less satisfaction with the results of their work (Gleichgerrcht & Decety, 2013), but also worsens medical care as they provide poorer services related to the patient (Austin Saylor, & Finley, 2017; Meier, Back, & Morrison, 2001). The lack of scientific publications shows that this topic is underresearched and relevant. The purpose of the study is to reveal physicians’ experience of critical events. Methods. Five practicing physicians of anesthesiology-reanimatology and surgery participated in the qualitative part of the research. The data was collected using semi-structured interview and processed using inductive thematic Braun & Clarke (2006) analysis. Results. Qualitative analysis revealed the complicated experiences in a physician’s workplace, which doctors described as: taking responsibilities in the presence of a patient’s death, the risk of burnout and negative emotions experienced after a critical event. The analysis also emerged techniques used in dealing with emotions after critical events and consequences of the latter in one’s personal life. Conclusions. The study revealed that physicians in their work environment come across difficulties such as risk of burnout, balancing between formal and informal communication with patients and emotional strain which is caused by facing a patient’s death. Doctors tend to cope with negative emotions that emerge during critical events using various methods, but the most elucidated technique was the avoidance to deal with emotions. Analysis also revealed that experiences, gained through medics’ work, modify their attitude towards life and death and change the emotional connection between a physician and his relatives.

AbstractThis paper examines a recent arrival on the American pop cultural scene, a type of ghost encounter called After-Death Communications (ADCs). Delivered in dreams, visions, voices, odors, coincidences, etc., these cheerful greetings from deceased loved ones help bereaved survivors cope with their loss. Since the Enlightenment, spirits of the dead have become increasingly irrelevant to collective life. The new phantoms, however, are assigned roles in the family, health, and faith. How has this occurred? Strands of a complicated process are delineated, including medical origins in the bereavement hallucination, a designated symptom of grief. Cultural dynamics behind the current ADC phenomenon are contrasted with national trends that shaped the nineteenth-century spiritualist enthusiasm for ghosts. The literature, published since the 1990s, is reviewed in which the ADC has been formalized as a source of bereavement therapy and revelation. A tally of the peculiar features and functions of this twenty-first-century ghost experience links it to two American industries, psychotherapy and spiritual seeking.

Hypoxic ischaemic encephalopathy may lead to death or severe long-term morbidity. Therapeutic hypothermia (TH) increases survival without impairments in childhood, but prognostic uncertainty may remain for years after birth. Clear and accurate communication is imperative but challenging. This article explores the predictive value of routinely performed assessments during TH, as well as the qualitative research relating to parental experience. This article will benefit paediatric trainees, consultants and nurse practitioners in providing: (1) the background information needed for initiating a conversation with parents regarding outcome and (2) optimising their communication with parents in translating jargon, prognosis and uncertainty.

Understanding family dynamics is a key component in providing comprehensive care for persons with progressive illnesses and their caregivers. The purpose of this study was to investigate what families experience during an advancing illness and to describe their patterns of response. In-depth interviews (n=108) were conducted with families two weeks after hospice admission. Interviews were tape recorded, transcribed, and analyzed using qualitative methods. Six modes were distilled: reactive (illness generates intense responses), advocacy (vulnerability ignites assertive actions), fused (illness and decline are shared experiences), dissonant (diametrically opposed viewpoints cause struggle), resigned (decline and death are anticipated), and closed (outward responses are impassive). Three events triggered movement from one mode to another: (1) functional changes, (2) crisis events, and (3) provider communication. Providers who understand varied family reactions can ease the patient's suffering, assist relatives in providing effective care, and prepare them for the approaching death.

Introduction: Childbirth is natural phenomenon. The statement ‘fear of death’ and ‘losing the child’ is manifest childbirth among the primipara (Nakano et al, 2012). Childbirth among the primipara manifest by ‘fear of death’ and ‘losing the child’. Even the mother was happy met her baby, but negative feelings, such as fear, guilt, or anger could lead their memories of the birth (Ryding, 1998). The problems during childbirth process can be affected both of the mother’s health and baby in the future. Even birth by EmCS, women could be helped to have more positive chilbirth experiences (Ayers et al., 2006), by created positive athmosphere in maternity ward. There is need to explore caring experience among of primiparaous undergone EmCS, so health care professional understand how to empowerment mothers in the emergency situation.Objectives : To conduct a systemetic review of the literatur to explore caring experience of primipara childbirth with emergency cesarean section, to understand the factors internal contributing of caring and the factors hindering or enhancing by health care professional. Methods: A systematic review was performed to explore experience primipara and identify the strategies which measure health care professional delivered care before, during and after emergency emegergency cesarean section (EmCS). The search strategy included database ProQuest and grey literature using Google scholar. Caring experience of childbirth among the primipara were evaluate with explore their experience, expactation and contributing factors which influence physical and psychological the primiparaous mothers who get EmCS. Results : Seven qualitative and four quantitative studies were found. This systemtic shows same experiences primiparous mother EmCS in qualitative studies, the dominant feeling is ”fear”. The other expereinces are pain in high intensity, have negative expereince, losing the child, lose of control, disappointed, feelings of failure and alienation for their infant, and difficulties to breastfeed esspecialy in holding and childcare the baby when already at home.The results from qualitative studies are supported by quantitative studies showed mothers with EmCS significant fear of delivery and have a more negative experience of childbirth (P< 0.001) and 80% more higher negative experience. Care before, during and after should be guided by foundation that mothers are the central of chilbirth actions, that grant their have autonomy and empowerment in this situation. Conclusion: This systematic review identified the primiparous mothers’ experience EmCS.“Fear” is the dominant felling for mothers’ EmCS, mothers needed social support and caring very approprietly in this situation esspecially in maternity ward. Caring for mothers as nurses being fully present in this moment, avoid lack of the communication and give a control to get comfortable and feeling treated with respect and as an individual, mothers’ experience more positively.The suggest for this study is to development instrument include before, during and after delivery with caring, control and communication both for mothers and nurses.

AbstractBereavement is an ongoing process of negotiation and meaning-making in which widows and widowers make sense of the changed nature of their relationship with their deceased spouse. We analyzed the experiences of meaning in life among older widows and widowers (aged 65+) using interpretative phenomenological analysis (IPA; see Smith et al. in Interpretative phenomenological analysis: Theory, method and research, Sage, 2009), with the following question: How do widows and widowers search for meaning through continuing and/or transforming their bond to their deceased spouse? The results demonstrate that some of the widowed persons sought meaning through rituals or various means of after-death communication with their deceased spouses. Other participants transformed the bond, for example, through clearing out their deceased spouse’s belongings or a process of reconciliation. Many continued and transformed the bond simultaneously, which shows that negotiation of the relationship after the death of a spouse is an ongoing process in which both continuity and change are present. The experience of a violation of meaning in life affected the participants’ capacity to continue their bond with their deceased spouse.

Introduction:In many countries, ambulance personnel are authorized to start or stop resuscitation efforts in accordance with clinical guidelines. Research shows that decisions to withhold or terminate resuscitation and manage patient death scenes can be particularly challenging.Aim:To identify preparation and support mechanisms for ambulance personnel who are authorized to withhold or terminate resuscitation efforts, and manage patient death in the field.Methods: A scoping review provided an overview of international research in this area. A qualitative exploratory study was then undertaken. Focus groups were held with senior ambulance personnel currently working in clinical education, managerial, or pastoral support roles across New Zealand.Results:Well-supported clinical experiential learning and resolved personal experiences with grief and death were considered most useful to increase self-efficacy and coping with patient death. Participants felt some of the personal and interpersonal skills needed to manage death in the field were difficult to teach. Relatively little time is spent preparing ambulance personnel for the non-technical skills associated with resuscitation decision-making, particularly communicating with family and bystanders. Ambulance personnel responses and support-needs during or after the event are idiosyncratic. Ambulance personnel appear to primarily rely on colleagues and managers checking in and offering informal debriefing.Discussion:Results from this study identify opportunities for improvement in the preparation and support of ambulance personnel faced with managing patient death in the field. Clinical experience with supportive mentoring may provide the best opportunities for learning, but novices may not get exposure to patient death in this context. Ambulance personnel may benefit from training, which includes opportunities to role-play death notification and communication with family and bystanders at the scene of a patient death. Ambulance employers should allow downtime to facilitate personalized peer and managerial support where needed.

The purpose of this qualitative study is to describe the nature and significance of the after-death communication experience (ADC). The research asks what is it like to have an experience of communication with a deceased loved one, what is the essential nature of the experience, and what are the effects and meanings of the experience within the lives of the participants? This study explores the lived experiences of eighteen participants, sixteen women and two men, who report a variety of ADCs over the years following their bereavement. The ADCs are explored within the context of the participants’ lives so as to show how these extraordinary experiences can be understood as happening to real people within their own history rather than as isolated events. The first part of the thesis gives biographical descriptions of the participants’ lives following their ADCs. The second part of the thesis analyses the essential nature and qualities of the ADC experience and gives a robust description of the nature of the phenomenon. Phenomenological analysis of the data occurs in overlapping steps consisting of the individual descriptions, reduction techniques and emergence of seven themes describing the essence of the experiences for these participants. The themes show the experiences are unexpected and startling and intrude into ordinary experience. Familiar characteristics authenticate the presence of the deceased. Information, care, love and ongoing relationship are conveyed. The participants grapple with the experiences over time. They find they are deeply imprinted and powerful, and produce immediate and long-term effects. Heightened awareness that transcends ordinary experience gives the bereaved a ‘knowing’ of the ongoing life of their loved one. Expanded consciousness and reflection lead to seeing reality as larger and more complex and includes an unseen world where their loved one is continuing to live in another form. The themes are illustrated using the participants’ descriptions of their ADCs. Last of all a description of the phenomenon is compiled using an intuitive reflective process. Powerful and transforming after-effects demonstrate that the ADCs contribute to managing grief in the major losses of the participants’ lives, to the allaying of fears of death, to belief in an after-life and to belief in the interconnectedness and continuity of relationships across the boundary of death. There are major changes in sense of self, life and living, purpose and meaning, spiritual and religious understanding, and psychic sensitivity.

Thesis (Ph.D.)--University of Western Sydney, 2005.
A thesis presented to the University of Western Sydney, College of Arts, Education and Social Sciences, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

The purpose of this qualitative study is to describe the nature and significance of the after-death communication experience (ADC). The research asks what is it like to have an experience of communication with a deceased loved one, what is the essential nature of the experience, and what are the effects and meanings of the experience within the lives of the participants? This study explores the lived experiences of eighteen participants, sixteen women and two men, who report a variety of ADCs over the years following their bereavement. The ADCs are explored within the context of the participants’ lives so as to show how these extraordinary experiences can be understood as happening to real people within their own history rather than as isolated events. The first part of the thesis gives biographical descriptions of the participants’ lives following their ADCs. The second part of the thesis analyses the essential nature and qualities of the ADC experience and gives a robust description of the nature of the phenomenon. Phenomenological analysis of the data occurs in overlapping steps consisting of the individual descriptions, reduction techniques and emergence of seven themes describing the essence of the experiences for these participants. The themes show the experiences are unexpected and startling and intrude into ordinary experience. Familiar characteristics authenticate the presence of the deceased. Information, care, love and ongoing relationship are conveyed. The participants grapple with the experiences over time. They find they are deeply imprinted and powerful, and produce immediate and long-term effects. Heightened awareness that transcends ordinary experience gives the bereaved a ‘knowing’ of the ongoing life of their loved one. Expanded consciousness and reflection lead to seeing reality as larger and more complex and includes an unseen world where their loved one is continuing to live in another form. The themes are illustrated using the participants’ descriptions of their ADCs. Last of all a description of the phenomenon is compiled using an intuitive reflective process. Powerful and transforming after-effects demonstrate that the ADCs contribute to managing grief in the major losses of the participants’ lives, to the allaying of fears of death, to belief in an after-life and to belief in the interconnectedness and continuity of relationships across the boundary of death. There are major changes in sense of self, life and living, purpose and meaning, spiritual and religious understanding, and psychic sensitivity.
Doctor of Philosophy (PhD)

This descriptive, exploratory study framed within Parse’s theory of humanbecoming, addressed the research question: What is the meaning of persons’ experiences of keeping in touch with their loved ones who have died. Seven persons described their experiences of keeping in touch with their loved ones who had died. Study themes in the language of the participants were treasured events and signs give rise to lasting comfort while constant yet changing bonds come with turmoil and tranquility amid unfolding strength and confidence. Interpreted in the language of the researcher, study findings were written as cherished ciphers and occurrences engender solace as enduring-shifting ties abide with ease unease amid fortifying expansion. Study themes were linked primarily with theoretical concepts of valuing imaging, connecting-separating, and transforming. Findings were discussed in light of relevant literature, and possibilities for nursing practice, education, policy, and further research were offered.

This chapter begins with a quasi-historical overview of dominant mortuary practices and rituals. This overview seeks to connect new media practices with their media genealogies. The chapter focuses on the open nature of mobile communication and the ways in which this then lends itself to be the perfect medium, like a psychomanteum, through which parapsychological phenomenon can be experienced. Drawing from fieldwork in the United States, this chapter explores the ways in which mobile media can cultivate a haunted culture and facilitate a continuation of bonds with the deceased beyond death. Mobile media provide mobile-emotive forms of after-death communication that can lead to new ways of “reanimating” the dead.

People are increasingly turning to the Internet to grieve and manage the traumatic experience of losing a loved one and to cope with emotional pain after the loss. Many bereaved individuals establish personal blogs following the death of a parent, spouse or partner, sibling, close family member, or child. For some, blogging about the death of someone special serves as a form of therapy, healing, and emotional release; for others, it serves as a public way to cope with grief. This chapter zeroes in on the communicative experiences of grief bloggers and examines the role of computer-mediated communication in the process of grieving. It starts with a discussion of the stages of grief, explicates the positive and negative impact of blogging on the grieving process, and outlines practical and ethical dilemmas presented by grief blogs and blogging.

The death of a child is an intense, deeply personal experience for the child and his or her family and for everyone involved. Anticipatory guidance regarding the various aspects of end-of-life care can be helpful for families but requires compassion and exquisite communication skills to match the appropriate level of information with the patient and family’s state of coping. This chapter provides guidance on how to manage and address both common and special symptoms and circumstances that may arise during the dying process. Clinician efforts to optimize a child’s comfort at end of life relieves suffering and may also have long-lasting effects for grieving family members. Thoughtful attention to actions after a child’s death can promote both family and staff resilience.

Relational strain can be activated by cancer or the effects of its treatment, reducing couple communication and marital satisfaction over time, especially when sexual intimacy declines. Meta-analyses show a modest benefit from couple therapy, with some evidence suggesting better outcomes for couples where one or both partners have greater distress or cancer-related concerns. Presenting problems can include role or transition challenges, communication failure, loss of mutual consensus and conflict, boundary violations, fractures and frustration with sexuality or intimacy. Assessment of the couple includes understanding their experience of the oncology diagnosis and its treatment, their family-of-origin and relational background, coping styles, impact on communication, cohesion, and sexuality alongside any agendas they bring. Behavioral couple therapy strategies can facilitate constructive communication and problem solving to restore intimacy and connectedness during and after treatment. In the advanced cancer setting, existentially oriented models examine grief, death talk, caregiving, and preparation for dying. A search for continued meaning and purpose can empower the couple to live life out to the full, while also preparing for a good death and considering bereavement needs for the survivor.

This chapter examines the similarities between the techno-fantasies promoted by the modern spiritualist movement and the claims made by contemporary scientists and engineers with regard to the uploading of human consciousness onto computers. It argues that these similarities help to explain why spiritualist concepts, such as the survival of the soul after death and the possibility of communication with disembodied spirits, appear so frequently in contemporary science fiction narratives, which often depict the survival of human personalities as virtual subjects in cyberspace. Instead of celebrating these spiritual possibilities, however, science fiction narratives often represent simulated experience as a loss of true identity and agency, which more closely resembles the arguments made by the opponents of spiritualism in the nineteenth century. Spiritualist concepts thus remain relevant today because they continue to serve as a common language for representing and critiquing the effects of new information technologies.

This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.

This chapter addresses deficiencies in pre-anaesthesia communication. Here, the use of medical narrative illustrates communication-enhancing techniques and attitudes that may help anaesthetists anticipate and respond to the biopsychosocial content, extant in the pre-anaesthesia assessment setting. By any measure, the pre-anaesthesia evaluation sets anaesthesia care in motion. Until now, little has been written about the development of a learnable framework for effective communication, in this or any other anaesthesia care setting. With respect to pre-anaesthesia communication, the need for heuristics or ‘rules of thumb’ is ever acute to improve rapport, elicit and respond to questions, manage ambiguity, as well as to obtain valid consent. Furthermore, anaesthetists have to communicate effectively with patients about conflicting advice, prior negative anaesthetic experiences and fears about awareness and intraoperative death. A 56-year-old man scheduled for an elective left inguinal herniorrhaphy meets his anaesthetist minutes before surgery is to begin. Three days before, the patient presented to hospital with his hernia incarcerated. It was easily reduced. A follow-up office visit with his surgeon preceded the surgery. The patient’s sole co-morbidity is benign prostatic hypertrophy. On the morning of surgery this otherwise healthy-appearing man, accompanied by his wife, meets the anaesthetist for the first time. After record review the patient is told three anaesthetic options exist—local anaesthesia with intravenous sedation, general anaesthesia and spinal anaesthesia — and that ‘spinal is the way to go’. Unquestioningly, the patient agrees to spinal anaesthesia. The spinal block is easy to place. The surgery is uneventful. Post-operatively, the patient cannot urinate. His discharge from the day-surgery unit is delayed by hours. He is told it is because of ‘the spinal’. Bladder catheterization ensues. The rest of his recuperation is uneventful, except for lingering feelings of betrayal, distrust and disappointment. He wonders why he was not told spinal anaesthesia might cause urinary retention. He becomes angry. He resolves never to use that anaesthetist’s or hospital’s services again. His wife even urges him to sue them both for pain and suffering. What could have been done to effect a more positive outcome for the patient, the anaesthetist and the hospital? The answer lies, at least in part, in improved communication.

Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.