COVID-19 resources

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A balanced approach to decision-making in supporting people with IDD in extraordinarily challenging times

Research in Developmental Disabilities

A balanced approach to decision-making during challenging times is necessary in order to avoid risks that jeopardize the lives and wellbeing of people with intellectual and developmental disabilities (IDD). The COVID-19 pandemic is the recent example of a crisis that places people with IDD at risk for lopsided societal reactions and threats to them or their wellbeing. Attention to decision-making is required to safeguard hard-earned achievements, including public policies and organization practices that emphasize human and legal rights, self-advocacy, individualized supports, inclusive environments, choices, and community inclusion. This paper suggests maintaining a holistic approach to understanding the lives and human functioning of people with IDD, a balanced approach to accountability and performance management, an understanding of the multidimensional properties of context, and a heightened vigilance in professional responsibility. A balanced approach will strengthen the likelihood of a return to high quality services and supports to people after the crisis, reduce loss of critical progress, and enhance stability across future social, political, and financial changes and challenges.

Last updated on hub: 13 November 2020

Long-term care facilities and the coronavirus epidemic: practical guidelines for a population at highest risk

Journal of the American Medical Directors Association

Editorial. Considers why long-term care preparedness for COVID-19 is important. Comments on the practical considerations for reducing the risk of transmission in the workplace; ensuring protection of healthcare workers; maintaining health care infrastructure; the assisted living experience; the blame game and what next? Suggests that appropriate preparedness includes five key elements: 1) reduce morbidity and mortality among those infected; 2) minimize transmission; 3) ensure protection of health care workers; 4) maintain health care system functioning; and 5) maintain communication with worried residents and family members

Last updated on hub: 13 November 2020

Rapid return of children in residential care to family as a result of COVID-19: Scope, challenges, and recommendations

Child Abuse and Neglect

Background: As a result of the COVID-19 pandemic, some governments have mandated that residential care providers rapidly return children and youth to family. Objective: The goal of the present study was to better understand the scope and characteristics of rapid return, and to provide data-informed recommendations for service providers working with this population. Participants and setting: Representatives from 67 non-government organizations (NGOs) providing residential care that were government-mandated to rapidly return children and youth to family completed a brief online survey. They collectively serve 12,494 children in 14 nations. Methods: Using a mixed methods design, results examined 1) characteristics of the rapid return mandate, 2) preparation received by children and families, 3) support services provided since the return, and 4) primary concerns for children and families. Results: Data revealed that rapid return was characterized by compressed timelines that did not allow for adequate child and family assessment and preparation. However, all respondents indicated they believed at least some families would be able to remain intact safely with appropriate support. Primary concerns for children and families related to unresolved antecedents to separation, lack of economic capacity, limited monitoring, and lack of access to education. Conclusions: Based on the findings, 9 recommendations were made for service providers working with children and families that have been rapidly reunified as a result of the COVID-19 pandemic.

Last updated on hub: 13 November 2020

Seeking Answers for Care Homes during the COVID-19 pandemic (COVID SEARCH)

Age and Ageing

The care and support of older people residing in long-term care facilities during the COVID-19 pandemic has created new and unanticipated uncertainties for staff. This short report presents analyses of the uncertainties of care home managers and staff expressed in a self-formed closed WhatsApp discussion group during the first stages of the pandemic in the UK. This study categorised their wide-ranging questions to understand what information would address these uncertainties and provide support. This study has been able to demonstrate that almost one-third of these uncertainties could have been tackled immediately through timely, responsive and unambiguous fact-based guidance. The other uncertainties require appraisal, synthesis and summary of existing evidence, commissioning or provision of a sector- informed research agenda for medium to long term. The questions represent wider internationally relevant care home pandemic-related uncertainties.

Last updated on hub: 13 November 2020

Real-time digital contact tracing: development of a system to control COVID-19 outbreaks in nursing homes and long-term care facilities

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. Citation: Wilmink G et al. (2020) Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities. JMIR Public Health Surveill 2020;6(3):e20828

Last updated on hub: 13 November 2020

COVID-19 and nursing home residents' rights

Journal of the American Medical Directors Association

Letter to the editor. Makes the point that restriction of resident rights is concerning, even in the face of a global pandemic. In the United States, nursing homes are required by federal regulations to provide maximal quality of life. Considers the question: How can we keep residents safe while protecting their right to self-determination and choice Makes recommendations for safer reopening of visitors to nursing homes.

Last updated on hub: 13 November 2020

Outcomes in French nursing homes that implemented staff confinement with residents

Question: Was self-confinement of staff members with residents in French nursing homes during the coronavirus disease 2019 (COVID-19) pandemic associated with better outcomes related to COVID-19 compared with overall national outcomes? Findings: This cohort study including 17 nursing homes with staff self-confinement and 9513 nursing homes in a national survey found that nursing homes with staff self-confinement experienced lower mortality related to COVID-19 among residents and lower incidence of COVID-19 among residents and staff members than rates recorded in a national survey. Meaning: These findings suggest that self-confinement of nursing home staff members with residents may help protect residents from mortality related to COVID-19 and residents and staff from COVID-19 infection. Citation: Belmin J. et al. (2020). Coronavirus disease 2019 outcomes in French nursing homes that implemented staff confinement with residents. JAMA network open, 3(8), e2017533-e2017533.

Last updated on hub: 13 November 2020

Could we have done better with COVID-19 in nursing homes?

Editorial. Analysis from the first wave of COVID-19 coronavirus pandemic to identify which features of long-term care (LTC) did and did not work. The editorial covers: organization and structure limitations; lack of infection control; education via e-learning; insufficient human resources; emotional burden of the staff; ethical crisis; lack of plan for a crisis situation. Citation: Szczerbinska, K. Could we have done better with COVID-19 in nursing homes?. European Geriatric Medicine 11, 639–643 (2020). https://doi.org/10.1007/s41999-020-00362-7

Last updated on hub: 13 November 2020

Finding the right balance: an evidence-informed guidance document to support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus disease 2019 pandemic

Journal of the American Medical Directors Association

During the first few months of the coronavirus disease 2019 (COVID-19) pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable, and potentially harmful. We reviewed the nursing home visitor policies for Canada's 10 provinces and 3 territories as well as international policies and reports on the topic to develop 10 provi-informed, data-driven, and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.

Last updated on hub: 13 November 2020

Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study

BMC Geriatrics

Background: The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. Methods: Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. Results: Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. Conclusions: This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.

Last updated on hub: 13 November 2020