Prevention Patterns and Difficulties of Long-Term Care Facilities in China During the COVID-19 Pandemic

ABSTRACT BACKGROUND Long-term care facilities (LTCFs) worldwide experienced severely impacts during the coronavirus disease 2019 (COVID-19) pandemic. Lockdown measures and infection-control protocols exposed these institutions to unprecedented challenges, including workforce shortages, supply chain disruptions, financial constraints, and intensified infection-prevention pressures. While the pandemic has prompted growing research on LTCF resilience, systematic evidence regarding how Chinese LTCFs developed context-specific prevention strategies tailored to local economic conditions, geographical settings, and cultural environments remains scarce. OBJECTIVE This study aimed to assess the institutional capacity of Chinese LTCFs during public health emergencies, characterize their COVID-19 prevention patterns, and identify the operational difficulties they encountered. METHODS A qualitative study was conducted between October 2020 and June 2021 across 15 LTCFs located in eight provincial capitals and one prefecture-level city in China. Semi-structured interviews were undertaken with 65 stakeholders, comprising 15 administrative staff, 18 care providers (nurses and physicians), 16 residents, 7 family members, and 9 local government officials. Data were collected to examine operational conditions and capacity-building performance during the pandemic. RESULTS Four distinct prevention patterns emerged: volunteer-based pattern, corporate culture-driven protocol, traditional culture-informed practices, and technology-assisted strategies. Concurrently, the difficulties faced by LTCFs include the dilemma of LTCFs, commercial operation and the standardization for elderly care services. CONCLUSION Chinese LTCFs need to identify and implement development pattern aligned with their regional, economic, cultural, and infrastructural diversity to enhance service delivery and strengthen frontline staff capacity for infectious disease prevention. Addressing operational vulnerabilities and establishing robust evaluation frameworks for LTCFs remain critical priorities for policy and practice.