COVID-19 resources on care homes

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Visits out of care homes

Department of Health and Social Care

This document sets out how care homes can support residents of working age on visits outside of the care home. Outward visits are an important part of life for many in residential care. However, spending time with others outside the care home will increase risk of exposure to COVID for the resident and potentially to other vulnerable residents on their return. These risks are usually significantly greater for older people than for those of working age. As such, visits out of care homes should only be considered for care home residents of working age. Care homes should, however, support visits out for older people in exceptional circumstances, such as to visit a friend or relative at the end of their life. This guidance explains how visits out of a care home can take place; the role of the provider in supporting outward visiting; and the need for individual risk assessments.

Last updated on hub: 03 December 2020

Proposal to regulate to stop movement of staff between care settings

Department of Health and Social Care

This consultation seeks views from the adult social care sector on the proposal to stop staff movement between different care settings and between health and care settings is critical to minimise the risk of infection of COVID-19. The findings of a study on the impact of coronavirus in care homes in England indicated one of the common factors in care homes with higher levels of infection among staff was the extent to which those homes employed staff who worked across multiple sites. The requirement would apply to Care Quality Commission (CQC) registered residential and nursing care home providers in England. These providers would be required not to use staff to provide nursing or personal care who are carrying on, or who have carried on within the previous 14 days, a regulated activity in another setting and/or for another health or social care provider subject to certain exceptions. The consultation closes on Wednesday 25 November 2020.

Last updated on hub: 25 November 2020

How care homes managed infection prevention and control during the coronavirus pandemic 2020

Care Quality Commission

Effective infection prevention and control (IPC) is essential to protect people from COVID-19. This report sets out the learning relating to IPC from CQC inspections across 440 care home in August and at the beginning of September 2020. Inspectors looked at assurance overall and across 8 questions: Are all types of visitors prevented from catching and spreading infection? Are shielding and social distancing rules complied with? Are people admitted into the service safely? Does the service use PPE effectively to safeguard staff and people using services? Is there adequate access and take up of testing for staff and people using services? Do the layout of premises, use of space and hygiene practice promote safety? Do staff training, practices and deployment show the service can prevent and/or manage outbreaks? Is the IPC policy up-to-date and implemented effectively to prevent and control infection? Across the 440 care homes, the inspectors found: a high level of assurance in the 8 questions; assurance in all 8 questions at 288 of the 440; the 2 areas with the most gaps in assurance were effective use of personal protective equipment (PPE) and having up-to-date policies.

Last updated on hub: 25 November 2020

Covid-19 Insight: issue 5

Care Quality Commission

The report explores some of the learning about good practice in infection prevention and control, and shares some of the good examples in understanding how providers are taking action to minimise the risk of cross-infection. In particular, the report looks at infection prevention and control in care homes, revealing that effective use of personal protective equipment (PPE) and having up-to-date policies in place were the two areas with the most gaps in assurance; and the experiences of hospital inpatients during the early stage of the pandemic, showing that while people’s experiences remained positive, in line with previous inpatient surveys, discharge and care after leaving hospital were the most problematic aspects of care. The report also updates regular data including outbreaks and deaths in homecare services; numbers of deaths of people detained under the Mental Health Act; deaths of people with learning disabilities; and deaths of people from Black and minority ethnic groups in adult social care settings.

Last updated on hub: 25 November 2020

The COVID-19 long-term care situation in England

International Long-term Care Policy Network

This report provides an overview of the impact of COVID-19 so far on people who use and provide long-term care in England and of the policy and practice measures adopted to mitigate its impact. The report finds that the impact of the COVID-19 pandemic has been severe in England and has affected disproportionally people who use and provide long-term care. Since the beginning of the pandemic and until the 6th November, 15,659 people had died in the care home and their deaths were linked to COVID-19 in the death register. An estimate of the deaths of care home residents (including those who died in hospital) suggests that, until the 13th November, 20.799 care home residents died whose deaths were attributed to COVID-19. An estimate of excess deaths in care homes suggests that 22,948 more people died until the 30th October, compared to the previous 5 years. This would represent around 5% all care home residents. With the initial response almost entirely focused on the NHS, too little consideration was given to the fragmented social care system, which was already in a fragile state prior to the pandemic, and into which many people were being discharged from hospital. Since the first wave, there has been improvement in terms of availability of guidance, access to Personal Protection Equipment and testing. In the second wave, care providers continue to face challenges with testing capacity (and speed), visiting policies and the financial implications of the additional costs of the pandemic and decreases in revenue. The pandemic has laid bare long-standing problems in the long-term care system in England, such as the fragmentation of responsibilities, funding and workforce pressures, as well as the unequal relationship between the health and social care systems and the invisibility of groups such as working age adults with disabilities and unpaid carers in social care planning.

Last updated on hub: 24 November 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: 24 November 2020

Psychosocial impact of COVID-19 nursing home restrictions on visitors of residents with cognitive impairment: a cross-sectional study as part of the engaging remotely in care (ERiC) project

Research published in Frontiers in Psychiatry by O'Caoimh, R. et al., October 2020. Background: COVID-19 has disproportionately affected older people. Visiting restrictions introduced since the start of the pandemic in residential care facilities (RCFs) may impact negatively on visitors including close family, friends, and guardians. This study examined the effects of COVID-19 visiting restrictions on measures of perceived loneliness, well-being, and carer quality of life (QoL) amongst visitors of residents with and without cognitive impairment (CI) in Irish RCFs. Methods: This study created a cross-sectional online survey. Loneliness was measured with the UCLA brief loneliness scale, psychological well-being with the WHO-5 Well-being Index and carer QoL with the Adult Carer QoL Questionnaire (support for caring subscale). Satisfaction with care (“increased/same” and “decreased”) was measured. A history of CI was reported by respondents. Sampling was by convenience with the link circulated through university mail lists and targeted social media accounts for 2 weeks in June 2020. Results: In all, 225 responses were included of which 202 noted whether residents had reported CI. Most of the 202 identified themselves as immediate family (91%) and as female (82%). The majority (67%) were aged between 45 and 64 years. Most (80%) reported that their resident had CI. Approximately one-third indicated reduced satisfaction (27%) or that restrictions had impaired communication with nursing home staff (38%). Median loneliness scores were 4/9, well-being scores 60/100 and carer QoL scores 10/15. Visitors of those with CI reported significantly lower well-being (p = 0.006) but no difference in loneliness (p = 0.114) or QoL (p = 0.305). Reported CI (p = 0.04) remained an independent predictors of lower WHO-5 scores, after adjusting for age, sex, RCF location, and dementia stage (advanced), satisfaction with care (reduced), and perception of staff support measured on the Adult Carer QoL Questionnaire. Conclusion: This survey suggests that many RCF visitors experienced low psychosocial and emotional well-being during the COVID-19 lockdown. Visitors of residents with CI report significantly poorer well-being as measured by the WHO-5 than those without. Additional research is required to understand the importance of disrupted caregiving roles resulting from visiting restrictions on well-being, particularly on visitors of residents with CI and how RCFs and their staff can support visitors to mitigate these.

Last updated on hub: 18 November 2020

COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

medRxiv

This article is a preprint and has not been peer-reviewed. Background: Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC. Methods: We report findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 26 June 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively. Findings: A total of 54 study reports for 49 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 0.4% and 64.0% among staff at affected facilities. Mortality rates varied from 0.0% to 17.1% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies of outbreaks, no LTC staff members had died. Studies of wider LTC populations found that between 0.4% and 40.8% of users, and between 4.0% and 23.8% of staff were infected, although the generalisability of these studies is limited. There was limited information on the impact of COVID-19 on LTC in the community. Interpretation: Long-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.

Last updated on hub: 17 November 2020

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

medRxiv

The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

Last updated on hub: 17 November 2020

Dealing with COVID-19 outbreaks in long-term care homes: a protocol for room moving and cohorting

Article published in the journal Infection Control & Hospital Epidemiology by Kain, D. et al, October 2020. A letter to the editor that sets out some principals of room movements in long-term care homes during the COVID-19 in the context of Canadian care homes.

Last updated on hub: 13 November 2020

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