COVID-19 resources on Infection control

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LESS COVID-19: Learning by Experience and Supporting the Care Home Sector during the COVID-19 pandemic: key lessons learnt, so far, by frontline care home and NHS staff

National Care Forum

This report sets out findings of a research study to capture the experiences of frontline care home and NHS staff caring for older people with COVID-19 and to share the lessons learnt about the presentation, trajectories, and management of the infection with care homes that have and have not yet experienced the virus. The research comprised two phases: interviews with frontline care home and NHS staff in June and July (n=35); and consultation with senior operational and quality managers in care homes in September (n=11). The findings are presented under the following themes: clinical presentation – COVID-19 does not always present as a cough and fever in older people; unpredictable illness trajectory; managing symptoms and providing supportive care; recovery and rehabilitation – promoting physical, cognitive and emotional well-being post-virus; end of life care; infection prevention and control; and promoting partnership through cross sector working and support. The research highlights the value of ongoing reflective learning and the importance of sharing collective expertise in care and in practice. However, it also reveals systemic issues associated with underfunding, limited integration across health and social care and a lack of wider recognition and value of the contribution of the care home sector and (importantly) its staff. The report concludes with a call to action, stressing the importance of sharing collective expertise, expanding the use of digital technology, and formally recognising and supporting care home staff. It also calls on the Government to ensure policy making, guidance, effective resourcing (including PPE), and plans for action are created in equal partnership with the care sector; to invest in the care sector to enable better reward and recognition of the care workforce; and to improve the testing capacity for social care to cover all care settings, including day services.

Last updated on hub: 08 October 2020

Lessons from lockdown: the experience of shielding

Bevan Foundation

Findings of a research study to examine the impact of shielding during the pandemic and the support needed as people emerged from shielding. The research team engaged with 12 stakeholders from charities which represent people affected by shielding they had been directly affected by the shielding policy in Wales. Most people were eager to talk about their experiences, not least because they felt they have been ignored. Many wanted to discuss their concerns about arrangements for the future to ensure shielding advice reflects their experiences. Many people were left to deal with lockdown alone and many of those advised to shield will have experienced the impact on their mental health, with some needing support to manage this. These restrictions also had negative effects on physical health, as many of those advised to shield reduced the amount of exercise they took, particularly as even normal routine activities like going to the local shop were restricted. Only a small number of people interviewed had received any form of intervention, either in the form of a welfare check via the phone or a more substantial intervention. but they had found this extremely helpful. The report identifies the further actions that should be undertaken to support people advice to shield, and also considers what needs to be in place should shielding be advised again. It covers the following issues; shielding policy in Wales; health and wellbeing; managing risk; impact on carers; managing shielding in the future.

Last updated on hub: 01 March 2021

Lessons Learned - outbreaks of COVID-19 in nursing homes

Letter to the editor published in the American Journal of Infection Control on 30 July 2020. Provides five key lessons learned and guidance for preventing the introduction of COVID-19 into the local nursing homes, and subsequently preventing its spread within these facilities. Citation: Kim, J. J. et al. (2020). Lessons learned - Outbreaks of COVID-19 in nursing homes. American Journal of Infection Control.

Last updated on hub: 13 November 2020

Lessons learned from Italian nursing homes during the COVID-19 outbreak: a tale of long-term care fragility and policy failure

Journal of Long-Term Care

The paper critically discusses policy implications and policy lessons from COVID-19 management in the Italian LTC sector. The aim of the paper is to highlight strengths and weaknesses of measures promoted to support nursing homes during the pandemic and after, so to discuss possible routes for future reforms in Italy and comparable countries. After having described the features of Italian LTC sector, the paper discusses 2020 pandemic events both by presenting administrative data and a policy analysis conducted in 9 out of 21 Italian regions so to assess policy interventions. The paper shows that the intrinsic features of Italian LTC sector played a major role in COVID-19 crisis and new policies enacted in 2020 were insufficient to manage the situation. Possible routes for policy reforms are presented in conclusion. Limitations of the analysis relies in the time frame, since COVID-19 effects are still ongoing, while the analysis ended in November 2020.

Last updated on hub: 30 July 2021

Life after lockdown: tackling loneliness among those left behind

British Red Cross

This report draws on findings from a collection of national-level polling, interviews and evaluations from British Red Cross services during COVID-19 to shed a light on how to refocus efforts on tackling loneliness and supporting those most affected by the crisis. Key findings include: there has been a significant increase in the number of people feeling lonely – since lockdown 41 per cent of UK adults report feeling lonelier; more than a quarter of UK adults agree that they worry something will happen to them and no one will notice; a third of UK adults haven’t had a meaningful conversation in the last week; some communities have been at greater risk of loneliness than others – people from Black, Asian and minority ethnic (BAME) communities, parents with young children, young people, those living with long term physical and mental health conditions, people on lower incomes and those with limited access to digital technology and the internet; COVID-19 has also meant a loss in social support for refugees and people seeking asylum. To meet the challenges ahead and ensure no one is left behind and feels alone, the report makes a number of recommendations: prioritise those most vulnerable to loneliness; secure sustained funding for tackling loneliness; continue to roll out social prescribing and ensure it delivers for loneliness; work collaboratively across sectors and specialisms, and with people with lived experience of loneliness.

Last updated on hub: 29 June 2020

Life in lockdown: a telephone survey to investigate the impact of COVID-19 lockdown measures on the lives of older people (≥75 years)

Age and Ageing

Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, the UK government introduced social distancing measures and identified specific populations at high risk from the virus. People ≥70 were deemed ‘Clinically Vulnerable’. Distancing measures were introduced to reduce the risk of contracting COVID-19. However, these may have a negative impact on older people who are vulnerable to social isolation and may have challenges accessing services and provisions. Objectives: To investigate the impact of COVID-19 lockdown measures on the lives of older people. Study design and setting: Cross-sectional telephone survey. Participants: Community-dwelling older people, 76–97 years. Outcomes: Health anxiety; General health (RAND Short-form 36 Survey); Physical activity; Depression (PHQ-8); Anxiety (GAD-2); Loneliness; Access to services; Challenges, concerns and positive experiences. Data analysis: Counts (%), means (SDs). Thematic analysis was used to identify themes from open questions. Results: n = 142. 52% did not worry about their health; 76% rated their health as ‘good’, ‘very good’ or ‘excellent’; <10% met the criteria indicative of depression (PHQ-8), or anxiety (GAD-2); 42% were less active than before lockdown; and 27% were lonely at least some of the time. Over half of participants identified positive aspects. Conclusions: Most participants reported good health with low levels of health anxiety, anxiety and depression. Many were able to identify positive aspects to lockdown and may be better equipped to deal with lockdown than anticipated. Strategies may be required to ameliorate the negative impact of loneliness for a minority of older people, and help some resume previous activity levels and pursuits.

Last updated on hub: 17 March 2021

Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England

BMC Geriatrics

Background: The impact of COVID-19 restrictions on people living with dementia and their carers is an emerging focus of recent research determining how we can best support this population. People living with dementia have faced service curtailment, increased risk for COVID-19, as well as potential heightened deterioration. This study reports the experiences of people living with dementia and their family carers during the early months of the COVID-19 pandemic in England and the impact on them. Methods: We recruited and remotely interviewed 30 people living with dementia in their own homes and 31 family carers, via video or telephone call in mid-2020. Data were transcribed and analysed using thematic analysis. Results: People living with dementia often had a basic understanding of COVID-19 restrictions but could have difficulty translating this into personalised risk-appraisal of their own actions. Managing COVID-19 risks facing people living with dementia at home was largely done by family carers, exemplified by changes to living arrangements, which could strain or sustain caring relationships. Well-established familial caring relationships contributed to the wellbeing of the person living with dementia and their carer, as well as keeping to simple routines that included leaving the home for exercise and stimulation. People living with dementia reported some negative psychological and cognitive effects due to the imposed restrictions, such as increased apathy, irritability, or anxiety, which were fuelled by lack of social engagement. Conclusions: Structuring routine (remote) social interactions where possible could increase social engagement and improve wellbeing for people living with dementia, especially those with limited familial support in a post-COVID-19 context. As some care relationships had been restructured to manage COVID-19 risks, additional carer strain may emerge as a result of the impact on the independence of the person living with dementia and come to the attention of professionals in health and care services. People living with dementia and their carers highlighted the importance of maintaining or adapting routines which may be useful learning for professionals, although additional support may be necessary for those who are impacted by more severe or worsening symptoms of dementia.

Last updated on hub: 20 May 2021

Lifting lockdown: how to approach a coronavirus exit strategy

Institute for Government

This report warns that the government’s five tests for starting to lift the coronavirus lockdown are not a good enough guide to the longer-term exit strategy. It argues that the government must set out new tests which explain how it will balance economic and health concerns against each other in lifting the restrictions. The paper also recommends providing enough capacity to test those who might be infected and trace anyone with whom they have come into contact; lifting restrictions first for those businesses that are best able to implement social distancing in the workplace and for those sectors where the longer-term harms from the shutdown are likely to be most severe; and introducing encouragement and incentives, such as tax incentives or reducing support for furloughed workers, to bring people and businesses out of lockdown.

Last updated on hub: 12 June 2020

Limiting staff movement and cohorting of residents to reduce the transmission of Covid-19 in care homes: a rapid review

Public Health England

Findings from a review of the evidence to examine the effectiveness of strategies to restrict staff movement and isolate groups of residents showing symptoms of Covid-19 (‘cohorting’) in reducing the transmission of the virus. The review found low-level evidence from three Covid-19 outbreaks in North America suggesting that restricting staff movement and cohorting of residents could help to reduce the transmission of Covid-19 within care homes. To fully understand the effectiveness of these two types of intervention in relation to Covid-19, more high-quality research is needed. Indirect evidence from the management of influenza and other outbreaks in care home settings may help to supplement understanding of effectiveness.

Last updated on hub: 12 October 2020

Lived experience: voices of older people on the COVID-19 pandemic 2020

Age NI

This report highlights the experiences of older people in Northern Ireland living through the COVID-19 pandemic. Drawing on feedback from the Consultative Forum at Age NI, it reflects key concerns and experiences through four key themes: support, health and care; communication and connection; loneliness and isolation; and grief and loss. The report finds that the pandemic and lockdown forced changes to many of the everyday care and support systems older people depend upon –restrictions on acute and community services made managing existing health concerns more difficult for many older people. Accessing sources of clear, up to date information has been very important during the lockdown – older people would like to access support and services online; they have concerns about using public transport for getting out and about again; and want safe ways to get back to their interests and activities. Older people are especially vulnerable to the effects of loneliness – older people shielding and not able to maintain movement and activity lost physical and cognitive fitness rapidly; and lack of connection and being unable to visit care homes caused some to worry about the risk of abuse and neglect. The COVID-19 pandemic is responsible for a significant increase in the number of excess deaths in Northern Ireland and older people feature disproportionately among them – families were distressed and concerned when advanced care planning was raised during the early stages of the pandemic; and people were worried and anxious about older people living in residential and nursing homes. The report provides a set of specific action points to help improve older people’s experience in relation to each of the four themes.

Last updated on hub: 28 September 2020

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