The effects of COVID-19 in Quebec public long-term care facilities on various stakeholder groups: a mixed-methods retrospective study across all waves of the pandemic

Background The COVID-19 pandemic had devastating consequences for long-term care facilities (LTCFs), particularly in Quebec, where mortality rates were especially high during the early waves. Although the psychological effects of the pandemic on frontline healthcare workers have been documented, less is known about the experiences of managers and relatives of residents, particularly in the context of end-of-life care across the course of the pandemic. This study aimed to explore multiple stakeholder perspectives to provide a more integrated understanding of the psychological, organizational, and relational effects of the pandemic within Quebec’s public LTCFs over all seven pandemic waves. Methods A mixed-methods design was employed. In the quantitative phase, an online survey was conducted with managers of public LTCFs across six regional health and social service centres in Quebec (Canada). Measures included the Peritraumatic Distress Inventory, sociodemographics, and organizational and COVID-19 related characteristics. In the qualitative phase, semi-structured interviews were conducted with healthcare workers and relatives of deceased residents to explore their experiences of the pandemic and their perspectives on communication and care. Descriptive and bivariate analyses were conducted on survey data, while qualitative narratives were analyzed using a conceptual categorization approach. Quantitative and qualitative findings were integrated narratively and interpreted using the Job Demands-Resources model and Conservation of Resources theory. Results Seventy-seven managers completed the survey (57% response rate). Nearly half (48.6%) scored above the adjusted threshold used in this study, suggesting elevated levels of peritraumatic distress. No significant associations were found with gender, age, or working experience, although the data suggested a pattern toward higher distress among women and those aged ≤50 years. Qualitative findings provided complementary insight into stakeholders’ experiences during the pandemic. Healthcare workers identified the first waves as the most critical period, marked by uncertainty, high mortality, and restricted visitation. They also described exhaustion, moral distress, and professional grief, while relatives described helplessness and constrained grieving amid organizational instability. Conclusions This study highlights the substantial psychological, organizational, and relational effects of the pandemic within Quebec’s LTCFs. By integrating the perspectives of managers, healthcare workers, and relatives, the findings underscore the importance of addressing professional grief, supporting psychological well-being, and enhancing organizational preparedness in long-term care settings during future public health crises.