COVID-19 resources on Home care

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Deaths involving COVID-19 in the care sector, England and Wales: deaths occurring up to 1 May 2020 and registered up to 9 May 2020

The Office for National Statistics

Provisional figures on deaths involving the coronavirus (COVID-19) within the care sector, in England and Wales. The report shows that since the beginning of the coronavirus (COVID-19) pandemic (between the period 2 March and 1 May 2020) there were 45,899 deaths of care home residents (wherever the death occurred). COVID-19 was the leading cause of death in male care home residents and the second leading cause of death in female care home residents, after Dementia and Alzheimer disease. Between 10 April 2020 and 8 May 2020 there were 3,161 deaths of recipients of domiciliary care in England – this was 1,990 deaths higher than the three-year average (1,171 deaths).

Last updated on hub: 25 June 2020

Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study

BMC Geriatrics

Background: The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. Methods: Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. Results: Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. Conclusions: This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.

Last updated on hub: 13 November 2020

Delivering care at home and housing support services during the COVID-19 pandemic: Care Inspectorate inquiry into decision making and partnership working

Care Inspectorate Scotland

This report draws together the views of health and social care partnerships and service providers in Scotland about their experience of care at home and housing support services during the first phase of this pandemic. It sets out the findings of a Care Inspectorate’s inquiry which investigated how these services were prioritised to help ensure service delivery continuity; what were the known impacts on people who experience care; how the risks to service delivery were mitigated; how effective were the partnership working arrangements; and what were the recovery plans for services. The inquiry found that the most robust responses to the challenges and uncertainties of the pandemic involved an integrated approach and included: targeting resources to meet gaps and pressures as they occurred and reviewing and refining approaches as new information came to light; maintaining a focus on how staff remained confident, safe and secure by addressing the challenges of PPE, guidance and testing; responding quickly with additional financial support and guarantees to ensure services remained viable and that the commitment was not undermined by unpredictable reductions in income and additional costs; investing in staff terms and conditions to reduce disincentives to testing and self-isolating when required; and working together across health and social care, service providers and the community.

Last updated on hub: 30 September 2020

Dementia and COVID-19: social contact

Alzheimer's Society

This briefing sets out the evidence for action to support social contact for people living with dementia and what the Government need to do next. It covers: the impact of COVID-19 on people with dementia in the UK; the importance of social contact for people living with dementia; maintaining social contact in care homes; supporting the delivery of home care services. The briefing observes that as well as the severe impact of COVID-19 itself, restrictions under lockdown have imposed a lack of social contact and interaction which are known to be contributing factor in the decline of people with dementia. The paper calls on the Government to lead a task force with Local Authorities and expert groups to address how they will support people with dementia as the country emerges from the lockdown over the next 6-12 months, with social contact at the heart of the solution. Specific recommendations for both care homes and home care are included.

Last updated on hub: 10 August 2020

Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study

BMC Geriatrics

Background: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure. Methods: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers’ corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness. Results: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19. Conclusion: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

Last updated on hub: 21 April 2022

Evidence summary: the use of information and communications technology and data sharing in long-term care settings

International Long-term Care Policy Network

This evidence summary covers emerging evidence on the use of information and communications technology (ICT) and data sharing in long-term care settings (both in facilities and in the community) in response to the COVID-19 pandemic. It summarises evidence from 21 studies, distinguishing between interventions to provide or maintain care, monitor COVID-19 patients remotely, provide training and guidance to informal and professional carers, combat isolation, track COVID-19 exposure, as well as other applications. The use of information and communications technology and data sharing in LTC settings has been deployed during the pandemic for several purposes. This includes those focused on the continuation of care, such as using technology to monitor patients, replace face-to-face consultations, and enable contact with families. Additionally, technology has been used for data sharing purposes, to provide training and guidance, to model outbreaks, and predict outcomes for patients. However, these interventions have generally only been described in case studies and other descriptive reports. Robust empirical evaluations of information and communications technology and data sharing during the COVID-19 pandemic in LTC facilities remains largely missing.

Last updated on hub: 19 April 2021

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

Journal of Interprofessional Care

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Last updated on hub: 01 November 2020

Factors associated with COVID-19 in care homes and domiciliary care, and effectiveness of interventions: a rapid review

Public Health England

The purpose of this rapid review was to identify and assess direct evidence from the COVID-19 pandemic on factors associated with COVID-19 in care homes and domiciliary care, and interventions to minimise the extent of COVID-19. 22 studies were identified, 13 (4 preprints) examining factors associated with the transmission of COVID-19 in care homes and 9 (3 preprints) examining the effectiveness of interventions (search up to 31 August 2020). No studies reported on domiciliary care. The review shows that multiple observational studies have consistently reported the use of temporary staffing and the movement of staff between different care homes, lack of sick pay provision for care home staff, ‘for profit’ ownership (US-based studies), lower quality ratings, and lower levels of trained nurses (amongst other factors) as being associated with increased levels of COVID-19. There is limited evidence on the effectiveness of interventions, and available evidence is weak. Routine testing with early intervention (1 study) and voluntary staff confinement (1 study) were associated with lower COVID-19 and descriptive studies reported the use of multiple consecutive strategies. Further research is needed, and studies that better infer causality.

Last updated on hub: 02 February 2021

Guidance: Adult Social Care Infection Control Fund

Department of Health and Social Care

This document sets out the infection control measures that the infection control fund will support and aims to answer questions received from local government and care providers about the Fund. The main purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission in and between care homes. A smaller percentage of the fund can be used to support domiciliary care providers and wider workforce resilience to deal with COVID-19 infections. Information on the distribution of grant allocations to local authorities and reporting requirements are included as annexes.

Last updated on hub: 10 June 2020

Healthcare leaders’ use of innovative solutions to ensure resilience in healthcare during the Covid-19 pandemic: a qualitative study in Norwegian nursing homes and home care services

BMC Health Services Research

Background: The Covid-19 pandemic introduced a global crisis for the healthcare systems. Research has paid particular attention to hospitals and intensive care units. However, nursing homes and home care services in charge of a highly vulnerable group of patients have also been forced to adapt and transform to ensure the safety of patients and staff; yet they have not received enough research attention. This paper aims to explore how leaders in nursing homes and home care services used innovative solutions to handle the Covid-19 pandemic to ensure resilient performance during times of disruption and major challenges. Methods: A qualitative exploratory case study was used to understand the research question. The selected case was a large city municipality in Norway. This specific municipality was heavily affected by the Covid-19 pandemic; therefore, information from this municipality allowed us to gather rich information. Data were collected from documents, semi-structured interviews, and a survey. At the first interview phase, informants included 13 leaders, Head of nursing home (1 participant), Head of Sec. (4 participants), Quality manager (4 participants), Head of nursing home ward (3 participants), and a Professional development nurse (1 participant), at 13 different nursing homes and home care services. At the second phase, an online survey was distributed at 16 different nursing homes and home care services to expand our understanding of the phenomenon from other leaders within the case municipality. Twenty-two leaders responded to the survey. The full dataset was analysed in accordance with inductive thematic analysis methodology. Results: The empirical results from the analysis provide a new understanding of how nursing homes and home care leaders used innovative solutions to maintain appropriate care for infected and non-infected patients at their sites. The results showed that innovative solutions could be separated into technology for communication and remote care, practice innovations, service innovations, and physical innovations. Conclusion: This study offers a new understanding of the influence of crisis-driven innovation for resilience in healthcare during the Covid-19 pandemic. Nursing home and home care leaders implemented several innovative solutions to ensure resilient performance during the first 6–9 months of the pandemic. In terms of resilience, different innovative solutions can be divided based on their influence into situational, structural, and systemic resilience. A framework for bridging innovative solutions and their influence on resilience in healthcare is outlined in the paper.

Last updated on hub: 01 September 2021

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