COVID-19 resources on Care homes

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Temporary medical exemptions for COVID-19 vaccination of people working or deployed in care homes

Department of Health and Social Care

A letter from the Director of Adult Social Care Delivery to local authorities, directors of adult social services, care home providers, care home managers and agencies to highlight how, on a temporary basis, people working or volunteering in care homes who have a medical reason why they are unable to have a COVID-19 vaccine, will be able to self-certify that they meet the medical exemption criteria.

Last updated on hub: 21 September 2021

Beyond the control of the care home: a meta-ethnography of qualitative studies of infection prevention and control in residential and nursing homes for older people

Health Expectations

Objective: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design: This study had a meta-ethnography design. Data Sources: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods: A meta-ethnography was performed. Results: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

Last updated on hub: 01 September 2021

Visiting and the law: a guide for care homes during COVID-19

The Relatives & Residents Association

This guide provides a summary of the current Government guidance on visiting inside care homes in England and the relevant legal duties on care providers. It provides an overview of the legal duties on care providers relevant to visiting, including the Care Act, Mental Capacity Act and Human Rights Act. Aiming to be practical, accessible and user-friendly, the guide also contains worked examples and pointer questions. The guide is not legal advice, but we hope it will help care homes to explore their visiting policies and practice, to help respect and protect the rights of residents.

Last updated on hub: 23 August 2021

Protecting nursing homes and long term care facilities from COVID-19: a rapid review of international evidence

Journal of the American Medical Directors Association

Objectives: The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design: Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants: Residents and staff in care settings such as nursing homes and long term care facilities. Methods: PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results: Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications: High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.

Last updated on hub: 18 August 2021

“We are saving their bodies and destroying their souls.”: family caregivers’ experiences of formal care setting visitation restrictions during the COVID-19 pandemic

Journal of Aging and Social Policy

This study aims to explore the experiences of family caregivers during the COVID-19 pandemic-imposed visitation restrictions at formal care settings (FCS) such as assisted living centers and traditional nursing homes. Participants (N = 512) were recruited from an international caregiving social media site that was developed at the beginning of the COVID-19 pandemic. Descriptive data was collected on the family caregivers, the care recipient and facility. Respondents also provided a single feeling word describing their experience and an open-ended question allowed for further exploration. Caregivers were predominantly daughters (n = 375). The most common reported feeling words were sadness (n = 200), trauma (n = 108), anger (n = 65), frustration (n = 56), helplessness (n = 50), and anxiety (n = 36). Thematic analysis revealed four overarching themes: 1) isolation 2) rapid decline 3) inhumane care and 4) lack of oversight. This study highlights the importance of addressing the mental, emotional and physical needs of both care recipient and family caregiver during this challenging time. Caregiver visitation policy reform that includes the care recipient and family caregiver is also discussed.

Last updated on hub: 17 August 2021

Impact of the COVID-19 pandemic on end of life care delivery in care homes: a mixed method systematic review

Palliative Medicine

Background: Current evidence suggests that COVID-19 is having a negative impact on the delivery of end of life care in care homes around the world. There is a need to collate current evidence to provide a comprehensive overview to assess extent of the problem. Aim: To describe and evaluate the impact of the COVID-19 pandemic on end of life care delivery in care homes. Design: Systematic review and narrative synthesis of studies reporting qualitative and quantitative data. Data sources: The databases MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and March 2021. Results: Nine studies were included. For care home staff, challenges included significant increases in responsibility and exposure to death, both of which have taken an emotional toll. Results indicate that staff tended not to be offered adequate emotional support or afforded the time to grieve. For those receiving end of life care, results indicate that the end of life care that they tended to receive, especially in the form of advance planning, was disrupted by the pandemic. Conclusion: The effect of the pandemic has been to exacerbate existing problems in the provision of end of life care in care homes for both service providers and users, making that which was previously opaque starkly visible. Future research is needed to explore the effects of the pandemic and its management on those receiving end of life care in care homes and their significant others.

Last updated on hub: 17 August 2021

Technology recommendations to support person-centered care in long-term care homes during the COVID-19 pandemic and beyond

Journal of Aging and Social Policy

The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.

Last updated on hub: 17 August 2021

Impact of visitation and cohorting policies to shield residents from COVID-19 spread in care homes: an agent-based model: controlling COVID-19 in care homes

American Journal of Infection Control

Background: This study examines the impact of visitation and cohorting policies as well as the care home population size upon the spread of COVID-19 and the risk of outbreak occurrence in this setting. Methods: Agent-based modelling Results: The likelihood of the presence of an outbreak in a care home is associated with the care home population size. Cohorting of residents and staff into smaller, self-contained units reduces the spread of COVID-19. Restricting the number of visitors to the care home to shield its residents does not significantly impact the cumulative number of infected residents and risk of outbreak occurrence in most scenarios. Only when the community prevalence where staff live is considerably lower than the prevalence where visitors live (the former prevalence is less than or equal to 30% of the latter), relaxing visitation increases predicted infections much more significantly than it does in other scenarios. Maintaining a low infection probability per resident-visitor contact helps reduce the effect of allowing more visitors into care homes. Conclusions: Our model predictions suggest that cohorting is effective in controlling the spread of COVID-19 in care homes. However, according to predictions shielding residents in care homes is not as effective as predicted in a number of studies that have modelled shielding of vulnerable population in the wider communities.

Last updated on hub: 17 August 2021

Evaluation of the mental health of care home staff in the Covid-19 era. What price did care home workers pay for standing by their patients?

International Journal of Geriatric Psychiatry

Background: The characteristics of this pandemic increase the potential psychological impact on care homes workers (CHWs). The aims of this study were to analyze the mental health and health-related quality of life (HRQoL) of a broad sample of CHWs in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. Method: This descriptive study comprised 210 CHWs who completed the Generalized Anxiety Disorder 7-item Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, the Insomnia Severity Index, and the Health-related Quality of Life Questionnaire. Sociodemographic and clinical data in relation to COVID-19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. Results: 86.19% of participants were female; 86.67% were aged under 55 years; 11% were physicians and 64.19% were nurses or auxiliaries; 77.62% have themselves tested positive for Covid-19, and 67.94% of CHWs have directly treated patients with Covid-19. 49.28% had clinical depression; over half (58.57%) had clinical anxiety; 70.95% had clinical stress; and 28.57% had clinical insomnia. Increased use of tranquilizers/sedatives appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our CHWs. Conclusions: This study confirms that symptomatology of anxiety, depression, stress, insomnia and HRQoL were affected amongst CHWs during the Covid-19 pandemic.

Last updated on hub: 17 August 2021

Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data

International Journal of Population Data Science

Background: Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. Objectives: To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. Methods: Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May 2020 and primary admission reasons for this period were compared across years. Results: Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions). Conclusions: This is the first study showing that care home residents' hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

Last updated on hub: 13 August 2021

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