COVID-19 resources

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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

Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic

International Long-term Care Policy Network

This is a pre-print article (not yet peer-reviewed). The researchers carried out a rapid review of evidence to address three questions: What is the evidence on the impact of visitors in terms of infections in care homes? What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents? and What has been the impact of restricting visits on quality of care? Findings: the review found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions. The review also found that there is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans. In addition, there is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff. Conclusions: Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections. Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning. In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.

Last updated on hub: 02 November 2020

Rapid review update 1: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?

McMaster University

This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review is based on the most recent research evidence available at the time of release. A previous version was completed on October 16, 2020. This updated version includes evidence available up to November 30, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. At the organisational level, increased staffing, particularly Registered Nurse (RN) staffing was consistently associated with reduced risk of COVID-19 infections, outbreaks and mortality while for-profit status, facility size/density and movement of staff between facilities was consistently associated with increased risk of COVID-19 infections, outbreaks and mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies.

Last updated on hub: 22 December 2020

Rapid review: contact

What Works for Children's Social Care

Examines the evidence on how contact can be managed virtually and the implications for foster carers, adoptive parents, family members and children. In the context of the COVID-19 Pandemic, there is a desire by local authorities to ensure that contact between family members is maintained, but that, wherever possible, it does not pose an increased infection risk. The findings suggest that increased contact between children and relatives could be beneficial or detrimental – more clear evidence is needed on this and social workers should assess on a case-by-case basis; contact via technology between service users and social workers may be two-way, whereby service users may also reach out at times that are convenient for them – however, the social worker should also establish boundaries to avoid burnout and maintain professionalism; there may need to be more thought given around enabling families to facilitate video-calling during these times, particularly to people who are at risk of being technology-constrained; children placed in residential or foster care may be more likely to be separated from siblings, and therefore facilitating contact for these groups of children and young people should be prioritised.

Last updated on hub: 08 July 2020

Rapid review: home visits and remote social work

What Works for Children's Social Care

Summarises the evidence on how children’s social workers can safely conduct necessary home visits during the COVID-19 epidemic. While there is a limited body of research on home visiting in social work, the findings of this rapid review indicate that: therapeutic work can be conducted effectively remotely, but this is skilled work requiring training; relationship quality is an important determinant of the success of online work, and so should be considered alongside other risk/protective factors; video communication is likely to be more successful where possible than telephone conversations, as fewer non-verbal cues are lost; where home visits occur, they will be improved by clear decision making and the empowerment of social workers; professional boundaries and standards may be challenged by remote working with families, and supervision by managers should consider this.

Last updated on hub: 08 July 2020

Rapid review: supervision

What Works for Children's Social Care

A review of the literature on how supervision in child and family social work can be managed virtually and on the resulting implications for social workers, managers, children and families. Virtual supervision in social work is a relatively new and unfamiliar concept but the current COVID-19 pandemic has meant that it is now increasingly used as social work teams adapt. Behavioural science literature on virtual communications offers key insights, some of which are applicable to the context of virtual supervision, which include: management style matters (transformational leadership that motivates the workforce and generate new ideas); paying attention to building trust in a virtual setting; there may be gains to creative brainstorming – ideas and creative responses are generated more frequently in a virtual team setting, perhaps due to the less personal context; confirmation bias – the tendency to favour information that confirms one’s own values and beliefs – can be greater in virtual settings. The evidence appears to identify a number of approaches, actions and leadership styles that can promote effectiveness in virtual supervision. These include: encouraging the inclusion of preference-challenging information and structured conflict in decision-making; holding case discussions separate from the action-orientated, decision-making part of supervision to help find consensus on solutions; promoting employees’ competence, autonomy and relatedness; exploring opportunities for maintaining informal forms of supervision and ‘weak ties’ that could be lost in a virtual setting; and promoting trust.

Last updated on hub: 17 June 2020

Rapid review: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?

McMaster University

This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review includes evidence available up to October 5, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies.

Last updated on hub: 22 December 2020

Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19

Journal of the American Academy of Child and Adolescent Psychiatry

Objective: Disease containment of COVID-19 has necessitated widespread social isolation. This review aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents. Method: This rapid review, searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance. Results: A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time at which loneliness was measured and between 0.25 and 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness. Conclusion: Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.

Last updated on hub: 07 January 2021

Reaching up, down, in, and around: couple and family coping during the corona virus pandemic

Family Process

The worldwide corona virus (COVID‐19) has had profound effects on all aspects of life: physical health, the ability to travel locally or to more distant destinations, material and financial resources, and psychosocial wellbeing. Couples, families, and communities and individual persons in those relationships have struggled to cope with emerging depression, anxiety, and trauma, and the rise of relational conflict. This article, suggests that the existential nature of the pandemic’s challenges require more than just the usual psychosocial interventions. This paper proposes a taxonomy of responses to foster coping and resilience – “Reaching Up, Down, In, and Around”. “Reaching Up” includes accessing spiritual, religious, and ethical values. “Reaching Down” includes ideas and practices that foster a revised relationship with the Earth and its resources, and that engage families to participate in activities that aid the Earth’s recovery from decades of human‐caused damage. “Reaching In” represents a turn towards experiences available in the mind and in shared minds in relationships that provide pleasure, excitement, joy, and peace, given that external sources of these emotions are of limited availability due to quarantine. “Reaching Around” involves reframing the mandate for “social distancing” as fostering social connection and support while maintaining physical distancing. The challenges for family therapists, whose practices are confined largely to online therapy, and who are struggling with the same fears and constraints as those persons they are attempting to help, are also discussed.

Last updated on hub: 17 September 2020

React, respond, renew: responding to the workforce challenges of the COVID-19 pandemic and looking to the future

Local Government Association

This paper provides a summary of how COVID-19 initially affected local government from a workforce perspective, including the social care sector. It argues that there is a critical need to ensure a meaningful ’parity of esteem’ between the 1.5 million social care workforce and their counterparts in the NHS. The report sets the scene for the workforce having to respond, within an extremely short timescale, to a completely new way of working. It provides a narrative to the shared experience of working through the pandemic in 2020. The report flags the challenges and considerations for returning to a physical workplace; outlines the psychological impact of COVID-19; captures the issues councils might want to explore in considering renewal and provide links for various tips and guides; touches on recruitment and retention challenges, how COVID-19 might change what we mean by 'leadership', and sets out how equality, diversity and inclusion will run throughout these issues; and captures the issues and questions that councils might be asking themselves or might want to ask themselves, following this challenging period of time.

Last updated on hub: 24 September 2020

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