COVID-19 resources

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Introduction to and spread of COVID-19-like illness in care homes in Norfolk, UK

Journal of Public Health

Background: Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. Methods: This study undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) and residents (if any) with suspected COVID-19 in the period 6 April to 6 May 2020. Concurrent descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and sanitizer) were in the data. PPE access was categorized as (most to least) green, amber or red. This study undertook two-stage modelling, first for suspected COVID-19 cases amongst residents and second relating any increases in case counts after introduction to staffing or PPE levels. Results: Counts of non-care workers had strongest relationships (P < 0.05) to introduction of suspected SARS-CoV-2 to the homes. Higher staff levels and more severe PPE shortages were linked to higher case counts (P < 0.05) during the monitoring period. Conclusion: Managing aspects of staff interaction with residents and some working practices might reduce ingression to and spread of COVID-19-like illness within care homes.

Last updated on hub: 27 January 2021

Social connection in long-term care homes: a scoping review of published research on the mental health impacts and potential strategies during COVID-19

Journal of the American Medical Directors Association

Objectives: Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. Design: Scoping review. Settings and Participants: Residents of LTC homes, care homes, and nursing homes. Methods: We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; this study limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, this study included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), this study identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies. Results: This study included 133 studies in the review. his study found 61 studies that tested the association between social connection and a mental health outcome. This study highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents. Conclusions and Implications: Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Last updated on hub: 27 January 2021

Transforming aging services: Area Agencies on Aging and the COVID-19 response


For over four decades, Area Agencies on Aging (AAAs) have served as focal points to help older adults remain in their homes and communities. AAAs partner with other organizations to administer services authorized under the Older Americans Act (OAA). AAAs represent loosely coupled systems; they are responsive to guidelines established by the OAA while maintaining flexibility to leverage limited resources, establish partnerships, and create innovative programs to meet community needs. As stay-at-home orders and concern for safety have kept many older adults homebound during the COVID-19 pandemic, an important question is how the Aging Network, including the over 600 AAAs, has responded to these rapidly changing needs. Although time and more systematic assessments are required, available information suggests that the loosely coupled network of AAAs has been a key, adaptable resource. This article begins with a description of the Aging Network and its history before turning to how the community-specific, collaborative, and evolving nature of AAAs places them at a unique position to respond to the challenges that arise with COVID-19. It concludes with how AAAs can continue to adapt to meet the needs of older adults and the people who care for them. [Note: this is an accepted manuscript]

Last updated on hub: 27 January 2021

The concept of care: insights, challenges and research avenues in COVID-19 times

Journal of European Social Policy

This review focuses on the concept of care, a concept that has never been more popular as a focus of study. It undertakes a critical review, motivated by the breadth of the field and the lack of coherence and linkages across a diverse literature. The review concentrates first on organizing and reviewing the literature in terms of key focus and, second, drawing out the strengths and weaknesses of existing work and making suggestions for how future work might proceed in COVID-19 times. While the existing literature offers many insights, some quite basic things need to be reconsidered, not least definition and conceptualization. Defining care as based on the meeting of perceived welfare-related need, I develop it as comprising need, relations/actors, resources and ideas and values. Each of these dimensions has an inherent disposition towards the study of inequality and it is possible, either by looking at them individually or all together, to identify care as situated in relations of relative power and inequality. The framework allows a set of critical questions to be posed in relation to COVID-19 and the policies and resources that have been mustered in response.

Last updated on hub: 27 January 2021

Ethical care during COVID-19 for care home residents with dementia

Nursing Ethics

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood – of residents and staff – are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued.

Last updated on hub: 27 January 2021

Rapid review of decision-making for place of care and death in older people: lessons for COVID-19

Age and Ageing

Introduction: The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults. In the context of COVID-19, decision-making surrounding place of care (PoC) and place of death (PoD) in older adults involves significant new challenges. Aims: To explore key factors that influence PoC and PoD decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19. Methods: Rapid review of reviews, undertaken using WHO guidance for rapid reviews for the production of actionable evidence. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation. Results: 10 papers were included for full data extraction. These papers were published between 2005 and 2020. Papers included discussed actual PoD, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Conclusions: The process and outcomes of decision-making for older people are affected by many factors - all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

Last updated on hub: 27 January 2021

Discharge into care homes for people who have tested positive for COVID-19

Department of Health and Social Care

This note has been created for care homes to simplify and clarify existing national guidance on discharge into care homes, particularly in relation to people who have tested positive for COVID-19. The current requirement is for hospitals to undertake a COVID-19 PCR test on all people discharged into a care home in the 48 hours prior to discharge. All individuals who test positive within this timeframe should be discharged into designated settings in the first instance. An exception to this process is for individuals who have tested positive for COVID-19 and are within 90 days of their initial illness onset or positive test date. If these individuals have already completed their 14-day isolation period from onset of symptoms or positive test result (if asymptomatic) and have no new COVID-19 symptoms or exposure, they are not considered to pose an infection risk. They therefore do not have to be re-tested and can move directly to a care home from hospital. The document sets out the key roles of care homes and hospitals and the steps for discharge into care homes for people who have tested positive for COVID-19.

Last updated on hub: 27 January 2021

Ethnic inequalities in COVID-19 mortality: a consequence of persistent racism

Runnymede Trust, The

This paper explores the impact of ethnic inequalities in COVID-19-related deaths. Ethnic minority people experience a much higher risk of COVID-19-related death, a stark inequality that impacts on all ethnic minority groups, including white minority groups such as Gypsies and Irish Travellers. Local authorities with higher proportions of ethnic minority residents are likely to have higher numbers of COVID-19-related deaths. These inequalities reflect increased risk of exposure to the virus because of where people live, the type of accommodation they live in, household size, the types of jobs they do and the means of transport they use to get to work. Ethnic inequalities in relation to COVID-19 mirror longstanding ethnic inequalities in health – a large body of evidence has shown that these inequalities are driven by social and economic inequalities, many of which are the result of racial discrimination. Ethnic minorities are also at increased risk of complications and mortality post COVID-19 infection; greater risk of serious illness with COVID-19 is more likely the result of pre-existing social and economic inequalities manifesting in the form of particular chronic illnesses. There is no evidence for genetic or genetically related biological factors underlying this increased risk, including vitamin D deficiency. The paper argues that unless racism is understood as a key driver of the inequalities which increase the chances of exposure to and mortality from COVID-19, government and public sector policy responses to the coronavirus pandemic risk further increasing ethnic inequalities in the UK.

Last updated on hub: 27 January 2021

The Prince’s Trust Tesco Youth Index 2021

Prince's Trust

The Youth Index, conducted by YouGov, gauges young people’s happiness and confidence levels across a range of areas, from their working life to their physical and mental health. This year’s report, which surveyed 2,180 16 to 25-year olds across the UK, suggests that the pandemic has taken a devastating toll on young people’s mental health. More young people are feeling anxious than ever in the 12-year history of the Index and more than half of young people (56 per cent) "always" or "often" feel anxious, rising to 64 per cent for NEET young people. Since the pandemic began one in five young people (21 per cent) have experienced suicidal thoughts, rising to 28 per cent of NEETs; ten per cent have self-harmed, increasing to 14 per cent of NEETs; and one in five (22 per cent) have experienced panic attacks, compared to 28 per cent of NEETs. Young people are among the hardest hit by the economic impact of the pandemic. As competition for training and job opportunities increases, fears for future work are having a significant impact on their wellbeing. The research also indicates that while the pandemic has taken its toll on young people’s mental health and wellbeing, many are also more motivated than ever to make a positive change for their future – three-quarters of young people (74 per cent) agree that “my generation can change our future for the better”.

Last updated on hub: 27 January 2021

Working for babies: lockdown lessons from local systems

Isos Partnership

Summarises the impacts on babies of COVID-19 and the Spring 2020 national lockdown. The report explores how local systems responded to the challenges presented by the pandemic. It seeks to understand the factors which have shaped the response by services which support babies and their families and to ensure that lessons are learned for the future of service provision for this age group. The report presents a varied picture across the UK, with evidence that: “hidden harms” of the Spring lockdown on 0-2s were broad and significant, and experienced unevenly depending on family circumstances and background; historically inadequate or insecure funding, and a rising tide of need, has inhibited the ability of some services and areas to respond to the coronavirus crisis; there were often ‘baby blind-spots’ where babies’ needs were overlooked in policy, planning and funding. The report also draws on a survey of 235 senior leaders of pregnancy and 0-2 services across the UK. The survey findings showed that: almost all (98%) of the survey respondents said babies their organisation works with had been impacted by parental anxiety, stress or depression which was affecting bonding and responsive care; 78% of respondents were clear that the government in their nation had not done enough for the under 2s, creating this ‘baby blind-spot’; the majority (80%) said that some babies they work with had experienced increased exposure to domestic conflict, child abuse or neglect, with 29% saying many babies they work with had been impacted.

Last updated on hub: 27 January 2021

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