COVID-19 resources

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Protecting disabled people’s rights during COVID-19: good practice from across the Commonwealth

Commonwealth Forum of National Human Rights Institutions

This report aims to identify the key challenges and issues faced by disabled people during the COVID-19 pandemic, and their human rights implications; demonstrate how Commonwealth national human rights institutions (NHRIs) are using their unique powers to protect, promote and raise awareness of the rights of disabled people during the pandemic; identify common features in the responses of NHRIs, as well as areas where gaps may exist; and promote the work of Commonwealth NHRIs alongside that of other organisations, in documenting the experiences and challenges faced by disabled people during the COVID-19 pandemic. Despite the vastly different regional and national contexts in which they work, CFNHRI members share many of the same concerns about the threat that COVID-19 poses to disabled people and their rights. Recurring themes from the submissions covered in this report call attention to the importance of: dedicated processes to consult with and involve disabled people in decision-making; disaggregated data, particularly in areas of life where people may face multiple disadvantages because of their intersecting characteristics; and ensuring that policies and services are accessible by design, and that information is available in accessible formats. These issues are not unique to this pandemic, nor are they only relevant in emergency responses. Entrenched gaps in processes, data and design, where institutions have failed to examine the needs of disabled people, are longstanding and evident across many different sectors.

Last updated on hub: 03 May 2021

Retirement village and extra care housing in England: operators’ experience during the COVID-19 pandemic

St Monica Trust

This study explores how Covid-19 affected the housing-with-care operators, their staff and residents; how operators responded to the pandemic; their innovations and successes and the key ongoing challenges. The study sought information and insight via an online questionnaire survey, with a sampling frame provided by the Elderly Accommodation Counsel (EAC) and administered by the Housing Learning and Improvement Network (HLIN). The efficacy of retirement village (RV) and extra care housing (ECH) operators’ response to the pandemic is evident from the positive feedback and overall positive experiences of residents, and the level of protection afforded to them; resident COVID-19 death rates were lower than expected when compared to people of similar ages residing in the wider community. However, the COVID-19 pandemic has exerted a huge strain on operators. In common with care homes, many of the major operational pressures and challenges they faced related to anxiety, stress, numbers of staff off work self-isolating or shielding, staff burnout, staff shortages, managing expectations, lack of availability of PPE, and striving to protect health and well-being. The costs and losses incurred due to the pandemic have far outweighed any savings or funding received, and many costs are still on-going. Successful measures shared by operators focused on having a framework of emergency command, plans, processes, procedures and templates ready in place. Highlighted as being especially important were implementing comprehensive risk assessments, ensuring access to PPE, and the means for effective communication to all stakeholders (particularly residents, their relatives and staff). Consultation was considered very beneficial for keeping people included in the decision-making, up to date and on board with changes. There are major concerns for operators going forward regarding resident and staff well-being, loss of revenue and other financial pressures, especially if further lockdowns ensue.

Last updated on hub: 03 May 2021

Assessing England’s response to Covid-19: a framework

King's Fund

This paper aims to help with the assessment of England’s response to Covid-19 by setting out a framework to help untangle the complicated interactions between different elements of the response. It does not attempt to make a judgement itself on the successes and the failures of that response. Each individual element could and in many cases will be subject to a deep investigation into the successes, failures and the lessons that can be learnt, but those deep dives must recognise how each individual element was connected to others and contributed to the success or failure of the whole response. The framework is broken down into five key inter-related elements: the intrinsic risk to England, including its population demographics, health status, openness to international travel, and social structure – this would include, for example, the proportion of older people in the population and the rates of obesity and diabetes (two risk factors for the severity of illness with Covid-19); the public health response, including rules over international travel, the timing and extent of lockdowns, and the measures put in place to support and enable compliance with these measures; the health care system response, including the re-organisation of services to maximise acute hospital and critical care capacity, the clinical quality of care, services for non-covid-19 patients and the vaccination programme; the adult social care response, including support to social care providers and users including provision of testing, personal protective equipment (PPE), and staff training; measures in the wider economy and society to manage the impact of the measures taken to combat Covid-19, including macro-economic and tax measures, education and employment.

Last updated on hub: 03 May 2021

Coronavirus (COVID-19) testing for hospices

Department of Health and Social Care

Sets out how hospices can access COVID-19 testing for staff and patients on-site, for staff visiting patients in their own homes, and for visitors to hospices. NHS Test and Trace is making weekly COVID-19 testing available to all hospices in England, Wales and Northern Ireland. Separate arrangements are in place for hospices in Scotland. All registered hospices have been contacted with details of how to apply for test kits for their staff and patients. Hospices will be responsible for ordering test kits for both ‘inpatient’ and ‘community-based’ settings. Different testing routes apply depending on where the testing will be carried out, and these routes are described in detail in this document.

Last updated on hub: 03 May 2021

Life in lockdown: social isolation, loneliness and quality of life in the elderly during the COVİD-19 pandemic: a scoping review

Geriatric Nursing

Coronavirus disease-2019 (COVID-19) had an unprecedented effect all over the world, especially in older individuals. The aim is to evaluate the social isolation, loneliness and quality of life of elderly individuals during the COVID-19 pandemic and to map suggestions to reveal and improve the current situation. This was a scoping review. Articles since December 2019 to March 2021 published on PubMed, Scopus, ProQuest, Cochrane Library, CINAHL databases with the following MeSh terms (‘COVID-19’, ‘coronavirus’, ‘quality of life’ ‘aging’, ‘older people’, ‘elderly’, ‘loneliness’ and ‘social isolation) in English were included. The research, by consensus, resulted in seven studies selected for full reading, including three descriptive and cross-sectional studies, a quasi-experimental study, a pre-post pilot program, an editorial note and a correspondence. In generally, these recommendations were grouped as evaluating the current state of loneliness and isolation in elderly people, making more use of technology opportunities, using cognitive behavioral therapies and different individual intervention components.

Last updated on hub: 29 April 2021

Nursing home characteristics associated with resident COVID-19 morbidity in communities with high infection rates

JAMA Network Open

Introduction: Nursing home (NH) residents have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. Transmission rates in an NH’s surrounding community have been identified as a key risk factor associated with NH COVID-19 outbreaks.1 It is not known whether some NHs within communities are more successful at mitigating outbreaks among residents than others. This study examined NHs in communities with the highest COVID-19 prevalence to identify characteristics associated with resident infection rates. Methods: This cross-sectional analysis used data on COVID-19 cases in US NHs reported through October 11, 2020, in the Centers for Medicare and Medicaid Services Nursing Home COVID-19 Public File.2 The first week of COVID-19 data reporting from the Centers for Medicare and Medicaid ended May 24, 2020. However, NHs could opt to report data retrospectively back to January 1, 2020. This study merged these data with the 2017 Long-term Care: Facts on Care in the US (LTCFocus) database3 to obtain NH characteristics. This study also used the USAFacts website4 to obtain county-level infection rates and the 2017 American Community Survey5 to obtain community characteristics. The Weill Cornell Medical College Institutional Review Board determined this study to be exempt from review because it did not involve human participants. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The analysis was restricted to counties in the top quartile of COVID-19 prevalence (mean, 36.0; range, 28.3-164.9 per 1000 population) nationwide. Within these counties, this study compared facility characteristics by quartile of COVID-19 prevalence (cases per 1000 NH residents), including resident demographic characteristics (age, sex, and race), and activities of daily living score.6 The analysis also includes the number of NH beds, occupancy rate, for-profit status, chain membership, direct care staff hours, presence of an advanced practitioner (nurse practitioner or physician’s assistant), Alzheimer disease specialty unit presence, and the shares of residents covered by Medicare and Medicaid. County characteristics included median household income, percentage of individuals 75 years or older, and rural location. This study used 1-way analysis of variance for continuous variables and χ2 tests for categorical variables to test for statistical significance (2-sided P < .05) of differences in NH characteristics. Multivariable linear regression was used to examine characteristics associated with NH COVID-19 prevalence. This study included hospital referral region fixed effects to account for unobserved regional factors that may affect COVID-19 spread. Standard errors were adjusted for clustering at the state level. Stata/IC version 16.0 (StataCorp LLC) was used for analysis. Results: The sample included 3008 NHs (255 923 occupied beds). The full cohort had a mean (SD) age of 78.4 (7.3) years, 165 582 residents (64.7%) were female, 90 341 residents (35.3%) were male, and 158 160 residents (61.8%) were insured by Medicaid. The NHs had a mean (SD) of 6.7 (9.5) COVID-19 cases per 1000 residents in the lowest quartile (755 NHs) and a mean (SD) of 677.1 (146.2) cases per 1000 residents in the highest quartile (752 NHs). Adjusted estimates indicate that residents in NHs with more COVID-19 cases were older (regression coefficient, 2.2; 95% CI, 0.4-4.0; P = .02), the NHs had a lower proportion of White residents (−1.0; 95% CI, −1.7 to −0.2; P = .02), and residents had higher activities of daily living scores (7.1; 95% CI, 1.9-12.3; P = .009) (Table). In addition, a higher proportion of residents were insured by Medicaid (0.9; 95% CI, 0.1-1.7; P = .03), and the NHs had lower occupancy rates (−4.1; 95% CI, −5.1 to −3.0; P < .001) and fewer direct care hours per patient per day (−21.9; 95% CI, −32.7 to −11.0; P < .001). Nursing homes with more COVID-19 cases were more likely to have an advanced practitioner (33.7; 95% CI, 9.8-57.6; P = .007) compared with NHs with fewer COVID-19 cases among residents. Discussion: In communities with high COVID-19 prevalence, this study found significant inequities in infection rates among NHs with larger proportions of racial minority residents and Medicaid participants. In addition, facilities with fewer direct patient care hours were more susceptible to virus spread. Study limitations stem from the use of COVID-19 data reported by facilities and NH characteristics that may not reflect changes in patient demographic characteristics during the pandemic. Nevertheless, these data sets represent the most comprehensive accounting of NH COVID-19 cases and characteristics available as of October 11, 2020. Interventions such as increasing staff support and directing more resources toward NHs with disproportionate shares of racial minorities and Medicaid participants may reduce disparities in COVID-19 morbidity among NH residents.

Last updated on hub: 29 April 2021

The metrics matter: improving comparisons of COVID-19 outbreaks in nursing homes

Journal of the American Medical Directors Association

In the United States, nursing facility residents comprise fewer than 1% of the population but more than 40% of deaths due to Coronavirus Disease 2019 (COVID-19). Mitigating the enormous risk of COVID-19 to nursing home residents requires adequate data. The widely used Centers for Medicare and Medicaid Services (CMS) COVID-19 Nursing Home Dataset contains 2 derived statistics: Total Resident Confirmed COVID-19 Cases per 1000 Residents and Total Resident COVID-19 Deaths per 1000 Residents. These metrics provide a misleading picture, as facilities report cumulative counts of cases and deaths over different time periods but use a point-in-time measure as proxy for number of residents (number of occupied beds in a week), resulting in inflated statistics. This paper proposes an alternative statistic to better illustrate the burden of COVID-19 cases and deaths across nursing facilities. Design: Retrospective cohort study. Setting and Participants: Using the CMS Nursing Home Compare and COVID-19 Nursing Home Datasets, this study examined facilities with star ratings and COVID-19 data passing quality assurance checks for each reporting period from May 31 to August 16, 2020 (n = 11,115). Methods: This study derived an alternative measure of the number of COVID-19 cases per 1000 residents using the net change in weekly census. For each measure, this study compared predicted number of cases/deaths by overall star rating using negative binomial regression with constant dispersion, controlling for county-level cases per capita and nursing home characteristics. Results: The average number of cases per 1000 estimated residents using our method is lower compared with the metric using occupied beds as proxy for number of residents (44.8 compared with 66.6). This study found similar results when examining number of COVID-19 deaths per 1000 residents. Conclusions and Implications: Future research should estimate the number of residents served in nursing facilities when comparing COVID-19 cases/deaths in nursing facilities. Identifying appropriate metrics for facility-level comparisons is critical to protecting nursing home residents as the pandemic continues.

Last updated on hub: 29 April 2021

The adverse effects of the COVID-19 pandemic on nursing home resident well-being

Journal of the American Medical Directors Association

Objective: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being. Design: Quantitative analysis of resident-level assessment data Setting and participants: Long-stay residents living in Connecticut nursing homes Methods: This study used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (e.g., those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. This study compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017 to 2019. Results: this study found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March - representing a 15 percent increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March - representing a 150 percent increase. This study also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10 percent of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5 percent of residents in each week). Conclusions and implications: These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.

Last updated on hub: 29 April 2021

How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes - a qualitative study

PLoS ONE

Background: Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Medecins Sans Frontieres (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods: A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results: NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion: This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.

Last updated on hub: 29 April 2021

Lived experiences of frontline workers and leaders during COVID-19 outbreaks in long-term care: a qualitative study

American Journal of Infection Control

Background: Long-term care facilities across Canada have been disproportionately affected by the COVID-19 pandemic. This study aims to describe the experiences of frontline workers and leaders involved in COVID-19 outbreak management in these facilities, identify best practices, and provide recommendations for improvement. Methods: This is a qualitative study using key informant, semi-structured interviews. Key informants were defined as individuals with direct experience managing COVID-19 outbreaks in long-term care. Thematic content analysis of interview transcripts identified key themes important for outbreak management. Results: 23 interviews were conducted with key informants from the following categories: public health, health authority leadership for long-term care, infection prevention and control, long-term care operators, and frontline staff. Eight themes were identified as critical factors for outbreak management on thematic analysis, which included: (1) early identification of cases, (2) the suite of public health interventions implemented, (3) external support and assistance, (4) staff training and education, (5) personal protective equipment use and supply, (6) workplace culture, organizational leadership and management, (7) coordination and communication, and (8) staffing. Conclusions: Best practices and areas for improvement in outbreak response identified in this study can help to inform policy and practice to reduce the impact of COVID-19 in these settings.

Last updated on hub: 29 April 2021

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