COVID-19 resources

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Meeting the transitional care needs of older adults with COVID-19

Journal of Aging and Social Policy

Older adults with COVID-19 who survive hospitalizations and return to their homes confront substantial health challenges and an unpredictable future. While understanding of the unique needs of COVID-19 survivors is developing, components of the evidence-based Transitional Care Model provide a framework for taking a more immediate, holistic response to caring for these individuals as they moved back into the community. These components include: increasing screening, building trusting relationships, improving patient engagement, promoting collaboration across care teams, undertaking symptom management, increasing family caregiver care/education, coordinating health and social services, and improving care continuity. Evidence generated from rigorous testing of these components reveal the need for federal and state policy solutions to support the following: employment/redeployment of nurses, social workers, and community health workers; training and reimbursement of family caregivers; widespread access to research-based transitional care tools; and coordinated local efforts to address structural barriers to effective transitions. Immediate action on these policy options is necessary to more effectively address the complex issues facing these older adults and their family caregivers who are counting on our care system for essential support.

Last updated on hub: 31 August 2020

Local government efforts to mitigate the novel coronavirus pandemic among older adults

Journal of Aging and Social Policy

As the coronavirus crisis spreads swiftly through the population, it takes a particularly heavy toll on minority individuals and older adults, with older minority adults at especially high risk. Given the shockingly high rates of infections and deaths in nursing homes, staying in the community appears to be a good option for older adults in this crisis, but in order for some older adults to do so much assistance is required. This situation draws attention to the need for benevolent intervention on the part of the state should older adults become ill or lose their sources of income and support during the crisis. This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic. It reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents, to ask how we can assess the success of municipalities in responding to the changing needs of older adults in the community due to COVID-19. It concludes with a discussion of what governmental and non-governmental leadership can accomplish in situations such as that brought about by the current crisis.

Last updated on hub: 31 August 2020

The demographics and economics of direct care staff highlight their vulnerabilities amidst the COVID-19 pandemic

Journal of Aging and Social Policy

An estimated 3.5 million direct care staff working in facilities and people’s homes play a critical role during the COVID-19 pandemic. They allow vulnerable care recipients to stay at home and they provide necessary help in facilities. Direct care staff, on average, have decades of experience, often have certifications and licenses, and many have at least some college education to help them perform the myriad of responsibilities to properly care for care recipients. Yet, they are at heightened health and financial risks. They often receive low wages, limited benefits, and have few financial resources to fall back on when they get sick themselves and can no longer work. Furthermore, most direct care staff are parents with children in the house and almost one-fourth are single parents. If they fall ill, both they and their families are put into physical and financial risk.

Last updated on hub: 31 August 2020

Covid-19 infection and attributable mortality in UK long term care facilities: cohort study using active surveillance and electronic records (March-June 2020)

medRxiv

This article is a preprint and has not been peer-reviewed. The lead researcher was Peter F Dutey-Magni. Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. This study used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. This study modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection.

Last updated on hub: 31 August 2020

COVID‐19 and care homes in England: What happened and why?

Social Policy and Administration

In the context of very high mortality and infection rates, this article examines the policy response to COVID‐19 in care homes for older people in the UK, with particular focus on England in the first 10 weeks of the pandemic. The timing and content of the policy response as well as different possible explanations for what happened are considered. Undertaking a forensic analysis of policy in regard to the overall plan, monitoring and protection as well as funding and resources, the first part lays bare the slow, late and inadequate response to the risk and reality of COVID‐19 in care homes as against that in the National Health Service (NHS). A two‐pronged, multidimensional explanation is offered: structural, sectoral specificities; political and socio‐cultural factors. Amongst the relevant structural factors are the institutionalised separation from the health system, the complex system of provision and policy for adult social care, widespread market dependence. There is also the fact that logistical difficulties were exacerbated by years of austerity and resource cutting and a weak regulatory tradition of the care home sector. The effects of a series of political and cultural factors are also highlighted. As well as little mobilisation of the sector and low public commitment to and knowledge of social care, there is a pattern of Conservative government trying to divest the state of responsibilities in social care. This would support an interpretation in terms of policy avoidance as well as a possible political calculation by government that its policies towards the care sector and care homes would be less important and politically damaging than those for the NHS.

Last updated on hub: 31 August 2020

A mindfulness mobile app for traumatized COVID-19 healthcare workers and recovered patients: a response to “the use of digital applications and COVID-19”

Community Mental Health Journal

A response to Alexopoulos et al. (2020) regarding their recommendation to repurpose the previously developed, refined, and tested mindfulness- and acceptance-based mobile app intervention for military veterans with posttraumatic stress disorder. The author welcomes the opportunity to expand the target population of our mobile app intervention to include to COVID-19 healthcare providers and patients who recovered from the disease.

Last updated on hub: 27 August 2020

The use of digital applications and COVID-19

Community Mental Health Journal

Mobile health apps are becoming increasingly popular amongst users who are turning to digital platforms to aid their mental wellbeing. As a result of the current COVID-19 pandemic, healthcare staff as well as recovering patients may suffer from PTSD. We have therefore suggested to Reyes et al. (“Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study”, 2020) the importance of repurposing their app to help these users to improve their emotional resilience and subsequently their ability to cope with the trauma of their experience. We have also discussed the most pertinent barriers to mobile health app uptake including data privacy concerns and the role of stigma.

Last updated on hub: 27 August 2020

Domestic violence and abuse, coronavirus, and the media narrative

Journal of Gender-Based Violence

Following lockdowns in countries around the world, reports emerged of a ‘surge’ or ‘spikes’ in the number of domestic violence and abuse cases. It is critical to contextualise this: more men are not starting to be abusive or violent; rather, the patterns of abuse are becoming more frequent. Spiking and surging make us think in terms of more one-off incidents but it is more likely that the pattern of abuse that is already there is increasing in terms of frequency and type because both parties remain together at all times. Amid such a crisis, it is imperative that we continue to see the dynamics of domestic violence and abuse as both a pattern of abusive behaviours and a product of gendered social and cultural norms, rather than a reaction to a specific factor or event, such as COVID-19.

Last updated on hub: 27 August 2020

Guidance for supporting vulnerable and disadvantaged learners

Welsh Government

This guidance provides specific advice for supporting vulnerable and disadvantaged learners returning to school setting in Wales. A wide definition of vulnerable and disadvantaged learners has been adopted, including learners who are in one or more of the following groups: learners with special educational needs (SEN); learners from minority ethnic groups who have English or Welsh as an additional language (EAL/WAL); care-experienced children, including looked after children; learners educated other than at school (EOTAS); children of refugees and asylum seekers; Gypsy, Roma and Traveller children; learners eligible for free school meals (eFSM); young carers; and children at risk of harm, abuse or neglect. The guidance covers: the legislative background; preparing an approach from September 2020; and preparing for a further lockdown or blended learning approach.

Last updated on hub: 27 August 2020

The experience of care home staff during Covid-19: a survey report by the QNI's International Community Nursing Observatory

The Queen's Nursing Institute

Findings of a survey a survey to understand more about the impact of Covid-19 on the care home nurse workforce within the UK. The survey was distributed online via the QNI Care Home Nurse Network (n~400 members), ranging from staff delivering care directly to residents, to leaders overseeing several homes. There was a total of 163 responses to the survey, equating to a response rate of 41%. The analysis shows that for the majority of respondents working through the pandemic resulted in very negative experiences such as not being valued, poor terms and conditions of employment, feeling unsupported/blamed for deaths, colleagues in other areas refusing help, feeling pressured to take residents from hospitals with unknown Covid-19 status and lack of clear guidance. 66% of respondents reported always having appropriate PPE and 75% reported that their employer had provided all their PPE. During March and April 2020, 21% reported receiving residents from the hospital sector who had tested positive for Covid-19 in hospital and 43% reported receiving residents from the hospital with an unknown Covid-19 status. Being able to access other services was an issue for some respondents. A significant proportion of respondents reported it was somewhat difficult or very difficult to access hospital care, GP services, District Nursing services, end of life medication/services. 56% of respondents felt worse or much worse in terms of their physical and mental wellbeing, while 36% reported no change. Only 62 respondents stated that they could take time off with full pay, while some felt pressure not to take time off at all.

Last updated on hub: 27 August 2020