COVID-19 resources

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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

New ways of working? A rapid exploration of emerging evidence regarding the care of older people during COVID19

International Journal of Environmental Research and Public Health

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. The objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. This study conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, this study undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, this study undertook a systematic scoping of newspapers using the Nexis UK database. This study undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.

Last updated on hub: 13 November 2020

Disability rights during COVID-19: emergency law and guidelines in England

Disabled people may be disproportionately impacted by the response to the COVID-19 outbreak because of the kinds of countermeasures needed to tackle it, and serious disruptions to the services on which they rely. There are reports from the disability community in England and elsewhere that measures taken to contain the spread of COVID-19 impact negatively on their human rights and experiences. This commentary focuses on the healthcare and social care systems in England and describes how laws and practices have changed under the COVID-19 pandemic, and how these changes affect the rights of disabled people. Citation: Ivanka Antova, Disability Rights During COVID-19: Emergency Law and Guidelines in England, Medical Law Review, , fwaa026, https://doi.org/10.1093/medlaw/fwaa026.

Last updated on hub: 13 November 2020

A study of universal SARS-CoV-2 RNA testing of residents and staff in a large group of care homes in South London

Corrected proof first published 5 September 2020. Background: Care homes have experienced a high number of coronavirus disease 2019 (COVID-19)–related deaths among residents since the onset of the pandemic. However, up to May 2020, there has been a lack of information about the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes and limited testing in this setting. Methods: Combined nose and throat swab testing for SARS-CoV-2 RNA was carried out in 2455 residents and staff across 37 care homes in the London Borough of Bromley across a 3-week period. Results were reported within 24 hours of sample delivery, and data were collected on the presence or absence of symptoms. Results: Overall, the point prevalence of SARS-CoV-2 infection was 6.5%, with a higher rate in residents (9.0%) than in staff (4.7%). A key finding was the high proportion of asymptomatic infection detected in staff (69%) and residents (51%), with evidence of underdetection of symptoms by care home staff. Conclusions: The high proportion of asymptomatic infection combined with underdetection of symptoms by care home staff indicates that offering a test to all residents and staff in care homes with rapid reporting of results would assist accurate identification of infected individuals, facilitating prompt infection prevention and control action. Citation: Marossy, A. et al. (2020). A Study of Universal Severe Acute Respiratory Syndrome Coronavirus 2 RNA Testing Among Residents and Staff in a Large Group of Care Homes in South London. The Journal of Infectious Diseases.

Last updated on hub: 13 November 2020

Confinement of staff with residents in nursing homes: a solution against COVID-19?

The Coronarovirus disease 2019 (Covid-19) epidemic strongly affected accommodation establishments for dependent elderly people (Ehpad) and was responsible for high mortality. During the March-May 2020 pandemic, 17 nursing homes in France organized periods of staff confinement with residents 24 hours a day, 7 days a week, to reduce the risk of the SARS-CoV-2 virus entering their homes. establishments, in a context where visits to residents were prohibited. By means of a telephone survey of the directors of these nursing homes, this study observed that 16 nursing homes (94%) had no cases of Covid-19 among the residents, and that the mortality from Covid-19 was very low. compared to that recorded at national level by Public Health France (p <10 -4). In addition, the number of Covid-19 cases among the staff of these nursing homes was also lower than that recorded by Public Health France (p <10 -4 ). These establishments have experienced certain difficulties that the directors have managed to overcome and the investment of these teams has been widely appreciated by the families of the residents and through the press. Full citation: Joel Belmin, Nathavy Um Din, Sylvie Pariel, Carmelo Lafuente-Lafuente. Containment of nursing home staff with residents: a solution against Covid-19 ?. Geriatrics and Psychology Neuropsychiatry of Aging. 2020; 18 (3): 238-240. doi: 10.1684 / pnv.2020.0885.

Last updated on hub: 13 November 2020

“It's about how much we can do, and not how little we can get away with”: Coronavirus-related legislative changes for social care in the United Kingdom

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. This article provides a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. The article also critiques the immediate and longer term implications for adult social care, including mental health and mental capacity. At the time of publication several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services. Citation: Vicary S. et al. (2020) “It's about how much we can do, and not how little we can get away with”: Coronavirus-related legislative changes for social care in the United Kingdom. International Journal of Law and Psychiatry, 72, 101601.

Last updated on hub: 13 November 2020