COVID-19 resources on care homes

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The Coronavirus and the risks to the elderly in long-term care

Journal of Aging and Social Policy

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

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This article is a preprint and has not been peer-reviewed.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

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

The neglect of adult social care during Covid-19

British Medical Association

An examination of the impact of Covid-19 on social care, focusing on failings in testing, namely hospital discharges of untested patients into care homes, and the inadequate provision of personal protective equipment. The article recognises the complex and fragmented structure of adult social care but argues that these complexities cannot be resolved by the NHS “taking over” social care; rather efforts should be renewed to achieve a lasting settlement for social care, understanding and valuing it in its own right, not just as an adjunct to the NHS.

Last updated on hub: 20 August 2020

Care homes innovate to reunite residents and families during lockdown

Care Home Professional

From drive-throughs to visitor pods, garden and window visits to cuddle curtains, this article looks at the innovative ways care home providers have been going about bringing care residents and relatives back together during Covid-19 lockdown.

Last updated on hub: 20 August 2020

Care Provider Alliance Coronavirus (COVID-19) directory

Care Provider Alliance

The Care Provider Alliance (CPA) are collating and signposting to the latest guidance and advice from reliable sources on their website. The resource includes news, guidance and information. The site is updated frequently.

Last updated on hub: 20 August 2020

National Care Forum COVID-19 guidance and resources

National Care Forum

The COVID-19 section of the National Care Forum (NCF) website is a good source for government guidance and information relevant to the care sector. The resource includes links to information about: infection control, CPA Visitors’ Protocol, clinical guidance, regulation, information governance, workforce, supported housing and homeless, volunteering wellbeing and other practical resources.

Last updated on hub: 20 August 2020

Delirium: a missing piece in the COVID-19 pandemic puzzle

Age and Ageing

This editorial argues that delirium is an important missing component in the assessment and management of older people for COVID-19. Guidelines should include delirium as a presenting feature, screening should be a standard of care, and non-pharmacological approaches for delirium prevention and management need to be implemented as early and often as possible. Resources to assist healthcare providers should be built into electronic medical records, order sets and protocols. Key points raised in this paper include: older people are most vulnerable to severe COVID-19 infections and mortality; current guidance for diagnosis does not routinely include delirium, which may lead to under-detection of COVID-19; the care home population is particularly at risk, as failure to promptly detect COVID-19 may lead to outbreaks; non-pharmacological approaches to management of delirium may be more difficult to implement but remain the priority.

Last updated on hub: 18 August 2020

Care homes and supported living: Learning and sharing following the COVID-19 lockdown

Social Care Institute for Excellence

Practice examples and resources to support care home and supported living staff.

Last updated on hub: 11 August 2020

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