COVID-19 resources on Infection control

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The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

Age and Ageing

Background: mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim: to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting: we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.Methodswe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results: survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions: the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Last updated on hub: 21 January 2021

The impact of Covid-19 on community health services

NHS Confederation

This report captures the community sector’s response during the pandemic and showcases the achievements of community providers and their staff. Community health services play a key role within the health and care system, supporting integration at place and neighbourhood level through their relationships across the spectrum of local health and care organisations, including primary care, social care, local authorities and voluntary, community and social enterprise (VCSE). They keep people well at home, or in community settings as close to home as possible, and support them to live independently. The report seeks to learn from community providers’ experiences of the pandemic to secure the necessary transformation for the longer term. It suggests that the expansion and transformation of community services’ capacity during the pandemic proved critical in supporting the NHS’s response. As the health and care sector moves to recover and reset after the first peak of the outbreak, community service providers are now embedding innovative practice. They will play a critical role in providing ongoing rehabilitation for people who have been most seriously ill from the virus. The paper calls for investing in public health and place the social care system on a sustainable footing as a priority; supporting investment in home-based community pathways as well as community rehabilitation beds; boosting the community workforce with a national recruitment campaign and increased deployment of returners before winter pressures hit; and creating a digital improvement strategy, robust national dataset and national performance standards to standardise and spread best practice.

Last updated on hub: 10 August 2020

The impact of COVID-19 on kinship care: evidence from the kinship care charity Grandparents Plus

Scottish Journal of Residential Child Care

The challenges faced by children in kinship care and their families have been regularly identified in research. Kinship carers look after for some of society’s most vulnerable children, usually whilst facing many adversities themselves. The COVID-19 global pandemic had a significant impact on kinship carers, placing additional stress on their already difficult situations. This article describes the work of Grandparents Plus, the leading charity for kinship care in England and Wales, to identify the impact of COVID-19 on kinship carers and ensure they continued to receive support. Data were gathered using three surveys of kinship carers in England and Wales, and through discussions with Grandparents Plus project workers and volunteers. Kinship carers reported feeling scared about catching the virus, and what would happen to the children if they fell seriously ill. They were exhausted caring for the children twenty-four hours a day without a break and they were worried about the uncertainties of living with a ‘new normal’. Grandparents Plus used this information to develop new and existing support services to meet kinship carers’ needs in the context of COVID-19. It is concluded that kinship carers need sustained support to develop resilience to protect against future unforeseen crises.

Last updated on hub: 06 October 2020

The impact of Covid-19 on nursing homes in Italy

Politecnico di Milano

This brief note examines the interplay between the institutional context of care homes in Italy and the spread of the pandemic. As they faced the pandemic, care homes had both internal and external problems. On the internal side, they had to face the entry of the virus into their structures with inadequate medical staff and insufficient resources and capacity to implement distancing and other preventive actions. They were also unable to provide adequate health care to their Covid-19 patients, and very often unable to send them to hospitals. On the external side, their situation was ignored for a long time by policy makers, who were mainly focused to face the emergency in hospitals. The national lockdown of nursing homes regarding the access of relatives and external visitors – a crucial measure in order to prevent possible transmission of infection – was established only on March 4, about two weeks later the spreading of the infection. Furthermore, for many weeks not adequate attention has been paid to testing and monitoring activities among healthcare staff and patients: a priority for the implementation of such preventive activities in nursing homes was established only at the beginning of April. The paper argues that most of the criticalities came from the pre-existent difficult condition of these institutions. The more nursing homes have specialised in the intensive-health treatment of seriously non-self-sufficient elderly, the more the quality of their services had been hampered by very precarious financial and organisational conditions, co-determined by the lack of public investment in these structures. The pandemic has acted as a “focusing event”, revealing the structural weakness of this sector and the main critical problems affecting it.

Last updated on hub: 11 November 2020

The impact of the coronavirus (Covid-19) on people who work as social care personal assistants

King's College London

This study addresses the impact of the Covid-19 pandemic on the work of social care Personal Assistants supporting people in need of care and support. Drawing from a sample of 105 PAs, researchers were able to interview 41. The findings show that regardless of whether they were paid, unless they were themselves ‘shielding’ to protect themselves or a family member, nearly all PAs were helping others in some way on a voluntary basis. However, other than limited, general guidance from the government which was not always thought useful by PAs, there were few other reliable sources of information about the virus, or about practical arrangements such as when and where to get tested, to obtain Personal Protective Equipment (PPE), and to learn safe practices. Most PAs wore masks, gloves, aprons and said it was likely to become routine practice for them now, but It was often difficult for them to obtain PPE. PAs were asked about what would be most helpful to them in responding and adapting to the Covid virus. Several suggestions were made, including ready access to sufficient quantities of good quality PPE; the implementation of easily accessible, reliable testing; effective mechanisms for contact tracing to help prevent the spread of the virus; a single source of contact for support and reliable and accurate advice; better pay, contracts and less precarious working conditions; and financial support to people who were unable to work, but were not being paid by the employer, and did not qualify for the government’s furlough scheme.

Last updated on hub: 23 September 2020

The impact of the Covid-19 pandemic on Approved Mental Health Professional (AMHP) services in England

British Association of Social Workers

Based on responses to a survey from 100 Approved Mental Health Professional (AMHP) services across England, which account for 75% of the local authorities across the country, this report explores the impact of the Covid-19 pandemic on mental health professionals and services. The survey questions focused on changes in demand for Mental Health Act (MHA) assessments both during the first lockdown and following the easing of restrictions, the possible reasons for the changes and the impact of the pandemic and the resulting restrictions on staff. Most respondents reported an increase in assessments overall, particularly during the lockdown period and into the post-lockdown period in summer. This amounts to a higher level of demand than prior to the pandemic. Many services identified a significant increase in ‘first-time presentations’ of people who had not been previously known to mental health services. Concern was expressed from many respondents that withdrawal of face-to-face visits and monitoring by community services, and reduction of contact to telephone only, led to requests for MHA assessments which would not otherwise have been made and which did not warrant consideration of detention in hospital. During the lockdown many professionals moved to working from home, raising a number of issues in relation to support, supervision and management, particularly in the context of MHA assessment referrals, which by definition entail high risk with a need for rapid information gathering and assessment. Many respondents reported greater difficulty in accessing admission beds, possibly due to the need to isolate patients who were COVID-positive or at risk of being. Many areas found section 12 approved doctors less available, due to shielding, isolation or redeployment to COVID duties. Some ambulance services reduced or stopped providing transportation for mental health patients, leading to some services starting or increasing their use of private ambulance services.

Last updated on hub: 22 December 2020

The need for improved discharge criteria for hospitalised patients with COVID-19 – implications for patients in long-term care facilities

Age and Ageing

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy—clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.

Last updated on hub: 21 January 2021

The need to include assisted living in responding to the COVID-19 pandemic

Journal of the American Medical Directors Association

The risk of complications and death from COVID-19 is markedly skewed toward older adults. In the United States and many other countries, nursing homes are not the only congregate setting that serves older adults with underlying chronic medical conditions. More so, they have been a shrinking component of the residential long-term care system, with some of the largest growth having been in assisted living. Assisted living communities are not the same as nursing homes. In fact, there are several distinct components of assisted living that make this a unique setting and one not to be ignored in relation to COVID-19 planning and response. This editorial summarises key differences between nursing homes and assisted living and their related implications for care during the coronavirus pandemic.

Last updated on hub: 05 May 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

The predictable crisis: why Covid-19 has hit Scotland’s care homes so hard

Common Weal

This paper considers how government in Scotland has managed the Covid-19 crisis, using what has happened at Home Farm Care Home on Skye to illustrate the issues but also, potentially, to point to the way forwards. It argues that much of the Covid-19 disaster in care homes was quite predictable and, as such, represents a failure by both care home providers and the public authorities. It then looks at these failures within the broader context of the development of the care home sector in the last 27 years, with a particular focus on how this has provided for the health of older people. It concludes with some recommendations, both for immediate action and for more fundamental reform of the sector and the role of public authorities within it. Key points include: based on quality ratings at the outset of the crisis more than one quarter of Scotland's care homes (those rated adequate or below) could have been expected to be unable properly to protect older people in the event of a pandemic; the Care Inspectorate, which has few enforcement powers, was incapable of brining care homes up to the standard required by the Covid crisis; the result is that six out of ten care homes in Scotland have had a case of Covid and about 45 per cent still have a current case (as of Monday 18 May); for the first eight weeks of the crisis the Scottish Government was adamant that the providers (and not the Scottish Government) were responsible for protecting care home residents – this effectively represented the privatisation of the responsibility for older people in care during the crisis and restricted adequate access to medical treatment; the repeated updating of guidelines created a confusing impact.

Last updated on hub: 21 October 2020

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