COVID-19 resources

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Stimuli changes and challenging behavior in nursing homes during the COVID-19 pandemic

BMC Geriatrics

Background: COVID-19 restrictions in nursing homes resulted in a reduction in stimuli for residents. This study aimed to explore observed effects of changes in stimuli, both targeted (e.g., planned recreational activities) and untargeted (e.g., spontaneous noise), on challenging behavior in nursing home residents during COVID-19 anti-pandemic measures. Methods: In an online survey, nursing home healthcare professionals in the Netherlands provided their perspectives on the effects of the reduction in untargeted stimuli on residents with mild, advanced, or no dementia, and on different types of challenging behavior (i.e., psychotic, depressed, anxious, agitated, or apathetic behavior). Additionally, we asked participants’ opinions about strategies for limiting untargeted stimuli and for adjusting targeted stimuli for optimal management of challenging behaviours. Results: In total, 199 professionals completed the survey. Residents with advanced dementia and those with psychotic and agitated behavior seemed to benefit from the reductions in stimuli not specifically targeted at the resident. In contrast, residents without dementia and those with depressive and apathetic behavior seemed to be negatively affected by reductions in untargeted stimuli. Participants would like to continue reducing untargeted stimuli in the future (e.g., limiting the use of corridors adjacent to residents' rooms) and to adapt existing or introduce new initiatives involving targeted stimuli (e.g., small-scale, individually tailored activities). Responses to open-ended questions revealed additional initiatives that could be useful in nursing home care. Conclusions: This study provided lessons to learn from the COVID-19 measures in nursing homes. While many residents may have been negatively affected by the restrictions imposed during the pandemic, specific resident groups may have benefitted from the reduction in untargeted stimuli and from the adjustments made to daily activities. Various strategies and initiatives used in nursing homes during the pandemic seem promising for meeting individual needs in managing challenging behavior. These findings suggest that certain stimuli may affect specific resident groups differently. This underlines the importance of finding the right balance between stimuli and tranquillity, tailored to the needs of individual residents. It is important to consider the stimuli present in nursing homes, whether targeted or untargeted, when analysing and treating challenging behavior.

Last updated on hub: 21 April 2022

The influence of the down- and upscaling of activities in long-term care facilities during the COVID-19 visitor ban on caregivers’ exhaustion and ability to provide care and support: a questionnaire study

Geriatric Nursing

In the Netherlands, a national visitor-ban was in place in LTCFs during the first outbreak of COVID-19 in 2020. Meaningful activities were cancelled or downscaled, while others were performed more often. It is known that a lack of activities has several negative effects on residents, while the impact on caregivers remains largely unexplored. Here we investigate the influence of the down- and upscaling of activities on caregivers’ physical and emotional exhaustion and their perceived ability to provide care and support. Downscaling of activities for residents, in particular watching television and musical activities, had a negative impact on caregivers’ emotional exhaustion. The downscaling of watching television increased caregivers ‘physical exhaustion. Furthermore, the downscaling of both activities had a negative impact on caregivers’ perceived ability to provide ADL care and emotional support. This study triggers the need for more knowledge about the function of meaningful activities for residents, from a LTCF caregivers’ perspective.

Last updated on hub: 21 April 2022

The impact of COVID-19 and associated measures on health, police, and non-government organisation service utilisation related to violence against women and children

BMC Public Health

Background: Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children (VAWC) service utilisation across European countries. Methods: A rapid assessment design was used to compile data including a survey distributed across WHO Europe Healthy Cities Networks and Violence Injury Prevention Focal Points in WHO European Region member states, and a scoping review of media reports, journal articles, and reports. Searches were conducted in English and Russian and covered the period between 1 January 2020 and 17 September 2020. Data extracted included: country; violence type; service sector; and change in service utilisation during COVID-19. All data pertained to the period during which COVID-19 related public health measures were implemented compared to a period before restrictions were in place. Results: Overall, findings suggested that there was a median reported increase in VAWC service utilisation of approximately 20% during the COVID-19 pandemic. Crucially, however, change in service utilisation differed across sectors. After categorising each estimate as reflecting an increase or decrease in VAWC service utilisation, there was a significant association between sector and change in service utilisation; the majority of NGO estimates (95.1%) showed an increase in utilisation, compared to 58.2% of law enforcement estimates and 42.9% of health and social care estimates. Conclusions: The variation across sectors in changes in VAWC service utilisation has important implications for policymakers in the event of ongoing and future restrictions related to COVID-19, and more generally during other times of prolonged presence in the home. The increased global attention on VAWC during the pandemic should be used to drive forward the agenda on prevention, increase access to services, and implement better data collection mechanisms to ensure the momentum and increased focus on VAWC during the pandemic is not wasted.

Last updated on hub: 21 April 2022

Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study

BMC Geriatrics

Background: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure. Methods: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers’ corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness. Results: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19. Conclusion: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

Last updated on hub: 21 April 2022

Working in a care home during the COVID-19 pandemic: How has the pandemic changed working practices? A qualitative study

BMC Geriatrics

Background: The pandemic has significantly affected care homes’ residents and families through the national visiting restrictions. However, less is known on the impact these changes have had on the care home workforce. The aim of this research was to explore the impact of COVID-19 on the working practices of care home staff, caring for people living with dementia. Methods: Remote qualitative, semi-structured interviews were conducted with care home staff caring for people living with dementia (PLWD) in the UK. Results: Participants were recruited to the larger programme of research via convenience sampling. Interviews were conducted via telephone or online platforms. This research employed inductive thematic analysis. Sixteen care home staff were included in this study. Three overarching themes were developed from the analysis that conveyed changes to the everyday working practices of the care home workforce and the impact such changes posed to staff wellbeing: (1) Practical implications of working in a care home during the COVID-19 pandemic; (2); Staff values and changes to the staff roles (3): Impact to the care home staff and concerns for the care sector. Conclusions: The COVID-19 pandemic has significantly disrupted the daily working practices of care home staff, with staff forced to adopt additional roles on top of increased workloads to compensate for the loss of external agencies and support. Support and guidance must be offered urgently to inform care home staff on how to best adapt to their new working practices, ensuring that they are adequately trained.

Last updated on hub: 21 April 2022

A view from the other side: a senior’s view of participating in online groups during the pandemic

Social Work with Groups

While Covid-19 has taken a heavy toll on the 1.3 million residents in nursing facilities, there are five times the number of elders who live in the community. This story highlights the perspectives and experiences of an active senior in an independent living facility in Toronto who transitioned to online groups during the pandemic. A positive experience in an online group, together with her own resilience and tenacity, introduced her to a whole new world of online groups, enabling her to stay healthy, active, and connected beyond the confines of her studio apartment. As the pandemic and winter leave seniors living in the community indoors for the foreseeable future, there is need to draw attention to online recreational/leisure groups and build capacity for them.

Last updated on hub: 16 April 2022

Infection prevention and control in social care (Social care transition plan)

Welsh Government

Guidance on infection prevention and control measures for social care in Wales. This document is intended to provide the social care sector with an outline summary of changes to the Test, Trace, Protect (TTP) arrangements and infection prevention control (IPC) guidance as the Covid-19 alert level is eased. It incorporates advice on care homes, visiting care homes, care home residents, declaring and outbreak and outbreak management in care homes. This document signposts to more detailed Welsh Government and Public Health Wales guidance. A quick reference guide to the key messages can be found at Annex 1.

Last updated on hub: 13 April 2022

COVID-19 testing in adult social care

UK Health Security Agency

This guidance outlines the COVID-19 testing available for testing staff, residents and visitors for all adult social care settings. The guidance covers: eligibility for free testing in adult social care; symptomatic testing for staff and residents; asymptomatic staff testing; rapid response testing in care homes and high-risk extra care and supported living; outbreak testing in care homes; and step by step testing process for all adult social care. This page also brings together testing guidance documents on specific aspects of testing, including: how to use your rapid lateral flow test; testing terms and conditions; and self-test for staff, service users and visitors in adult social care settings: privacy notice. [First published 24 March 2021. Last updated 31 March 2022]

Last updated on hub: 07 April 2022

COVID-19 supplement to the infection prevention and control resource for adult social care

Department of Health and Social Care

This supplement provides additional information regarding safe working when caring for people with COVID-19 in the provision of adult social care services. This guidance sets out how to reduce the spread of COVID-19 in adult social care settings in England. It includes guidance under the following headings: staff IPC considerations - vaccination, personal protective equipment (PPE), staff movement, testing; IPC considerations for people receiving care: vaccination, testing, environmental considerations, ventilation and waste management; considerations specific to care homes - admissions, testing, visiting and outbreak management. The guidance is for people responsible for setting and maintaining standards of IPC within adult social care in England, such as care managers. It should be read with the infection prevention and control (IPC) resource for adult social care, which should be used as a basis for any IPC response. This supplement should also be read with the adult social care testing guidance, which details the testing regimes for all staff, as well as any resident and outbreak testing where applicable. This guidance applies from 4 April 2022. [First published 31 March 2022. Last updated 3 May 2022]

Last updated on hub: 06 April 2022

Infection prevention and control: quick guide for care workers

Department of Health and Social Care

This quick guide aimed at care workers working in adult social care, sets out general infection prevention and control guidance in relation to hand hygiene; respiratory hygiene; personal protective equipment; cleaning; laundry and waste disposal. It is published alongside guidance for managers setting out l infection prevention and control principles to be used in combination with guidance on managing specific infections. The guidance applies from 4 April 2022. [First published 31 March 2022]

Last updated on hub: 06 April 2022

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