COVID-19 resources on Infection control

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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

The courage to be kind: reflecting on the role of kindness in the healthcare response to COVID-19

Carnegie UK Trust

Findings from reflective conversations of a cluster of doctors in leadership programmes on the experience and new ways of working as a result of the pandemic. The five participants in the project were able to reflect on the COVID response from roles within Scottish Government, local health board management, hospital medicine, emergency department and general practice. This report presents a thematic analysis of what was heard across these reflective conversations. It is structured chronologically and, in doing so, it tells a story of people’s experiences of change across the NHS through three distinct phases: lockdown (April-May), lifting lockdown (June-July), and remobilising (August-September). Each phase is broken down into key themes, with the voice of participants woven between. The report finishes with a discussion that summarises what has been learnt about kindness and relationships in the first six months of COVID, and considers what this might mean for the future. Although they reflected shifting dynamics, pressures and emotions, the three phases of conversations present a clear focus on what is important, and an indication of what should be valued and prioritised in health and social care renewal, in order to build a system that looks after the wellbeing of patients and staff: a meaningful conversation about staff wellbeing – too often the individual can be overlooked in conversations about the system; sustaining a common purpose – the clear focus on COVID-19 demanded and enabled a more relational approach and, more widely, kindness became a feature of interactions among staff and leadership; shifting the emphasis on targets – the experience of COVID-19 may open up a much wider conversation about how best to fit targets to a system in a way that delivers the best for both patients and staff.

Last updated on hub: 10 December 2020

The COVID-19 long-term care situation in England

International Long-term Care Policy Network

This report provides an overview of the impact of COVID-19 so far on people who use and provide long-term care in England and of the policy and practice measures adopted to mitigate its impact. The report finds that the impact of the COVID-19 pandemic has been severe in England and has affected disproportionally people who use and provide long-term care. Since the beginning of the pandemic and until the 6th November, 15,659 people had died in the care home and their deaths were linked to COVID-19 in the death register. An estimate of the deaths of care home residents (including those who died in hospital) suggests that, until the 13th November, 20.799 care home residents died whose deaths were attributed to COVID-19. An estimate of excess deaths in care homes suggests that 22,948 more people died until the 30th October, compared to the previous 5 years. This would represent around 5% all care home residents. With the initial response almost entirely focused on the NHS, too little consideration was given to the fragmented social care system, which was already in a fragile state prior to the pandemic, and into which many people were being discharged from hospital. Since the first wave, there has been improvement in terms of availability of guidance, access to Personal Protection Equipment and testing. In the second wave, care providers continue to face challenges with testing capacity (and speed), visiting policies and the financial implications of the additional costs of the pandemic and decreases in revenue. The pandemic has laid bare long-standing problems in the long-term care system in England, such as the fragmentation of responsibilities, funding and workforce pressures, as well as the unequal relationship between the health and social care systems and the invisibility of groups such as working age adults with disabilities and unpaid carers in social care planning.

Last updated on hub: 24 November 2020

The COVID-19 pandemic and long-term care: what can we learn from the first wave about how to protect care homes?

Eurohealth

The COVID-19 pandemic has highlighted and exacerbated pre-existing problems in the long-term care sector. Based on examples collected from the COVID-19 Health System Response Monitor (HSRM) and the International Long-term care Policy Network (LTCcovid), this article aims to take stock of what countries have done to support care homes in response to COVID-19. By learning from the measures taken during the first wave, governments and the sector itself have an opportunity to put the sector on a stronger footing from which to strengthen long-term care systems.

Last updated on hub: 15 January 2021

The difficult balance between ensuring the right of nursing home residents to communication and their safety

International Journal of Environmental Research and Public Health

The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.

Last updated on hub: 15 June 2021

The doctor will Zoom you now: getting the most out of the virtual health and care experience: insight report

National Voices

Findings of a rapid, qualitative research study designed to understand the patient experience of remote and virtual consultations. The study engaged 49 people using an online platform, with 20 additional one to one telephone interviews. Participants were also invited to attend an online workshop on the final day of the study. All participants had experienced a remote consultation during the lockdown period of the COVID-19 pandemic. The report suggests that remote consultations and the use of technology offer some great opportunities to make significant improvements to general practice, hospital outpatient and mental health appointments, but making the most of this opportunity means understanding the patient experience. For many people, remote consultations can offer a convenient option for speaking to their health care professional. They appreciate quicker and more efficient access, not having to travel, less time taken out of their day and an ability to fit the appointment in around their lives. Most people felt they received adequate care and more people than not said they would be happy with consultations being held remotely in future. However, there is no one size that fits all solution. Key to a successful shift to remote consultations will be understanding which approach is the right one based on individual need and circumstance. The report argues that a blended offer, including text, phone, video, email and in-person would provide the best solution and an opportunity to improve the quality of care. By focusing on the needs of people receiving care and using a combination of communication tools a more equal space for health care providers and patients to interact can be created.

Last updated on hub: 30 July 2020

The experience of older people instructed to shield or self-isolate during the COVID-19 pandemic

English Longitudinal Study of Ageing

19 pandemic A vital weapon in the fight against COVID-19 has been the shielding of clinically extremely vulnerable individuals at high risk, and instructions to clinically vulnerable people at moderate risk to stay at home and avoid face-to-face contact as far as possible. The consequences of this advice for mental health and well-being are not well understood. The English Longitudinal Study of Ageing COVID-19 Substudy provided an opportunity to evaluate impact on mental health, quality of life, social connectedness, worries, and health-related behaviour in more than 5,800 older men and women (mean age 70 years). We found that although most individuals instructed by the NHS or their GPs to isolate and avoid face-to-face contact stayed at home as far as possible (defined as high risk), only 60% were strictly isolating. The high risk participants experienced higher levels of depression, anxiety, and loneliness, and reduced quality of life compared with others, and this was particularly marked among those who were isolating. Poor mental health was not related to reductions in social contacts, but there were higher levels of worry about obtaining food and other essentials. Physical activity was reduced and sleep impaired among high risk participants. The advice to people at risk may have saved lives and reduced infection, but it has come at a cost. If future outbreaks of COVID-19 require the reintroduction of shielding and avoidance of face-to-face contact, efforts should be made to allay concerns and encourage health promoting behaviour so as to avoid further impairment of the quality of life and mental health.

Last updated on hub: 15 October 2020

The experience of older people with multimorbidity during the COVID-19 pandemic

English Longitudinal Study of Ageing

The risk of severe COVID-19 disease is known to be higher in older individuals with multiple long-term health conditions (multimorbidity). In this briefing, we report the latest findings from the English Longitudinal Study of Ageing COVID-19 Substudy on the experiences of older people with multimorbidity during the pandemic. Not all people with multimorbidity would be classified as clinically vulnerable. We found that 35% of older individuals with multimorbidity were instructed by the NHS or their GP to shield (staying at home at all times and avoiding any face-to-face contact) on account of their vulnerability, and the majority were largely compliant with this advice. Relative to study members without multimorbidity, respondents with multimorbidity were more likely to report poor sleep quality, eating less, and being worried about not having enough food and other essentials. Unhealthy behaviours (sitting time, physical inactivity etc), poor mental health, and loneliness deteriorated considerably during the lockdown and in the two months following the lockdown. Access to medications among people with multimorbidity was not a problem, however, a fifth of individuals with multimorbidity did not have access to community health, social care services and support from other health professionals (e.g., dentist, podiatrist). When considering policies which advise people to shield or self-isolate because of their COVID-19 risk, it is important for policymakers to acknowledge that older people with multiple long-term health conditions are at higher risk of experiencing greater mental distress and worry, of engaging in unhealthy behaviours and are less likely to access health services when needed; all these factors together could potentially influence disease progression.

Last updated on hub: 15 October 2020

The experience of people approaching later life in lockdown: the impact of COVID-19 on 50-70-year olds in England

Ipsos MORI

Explores how people in their 50s and 60s experienced the COVID-19 pandemic; the future expectations and intentions of this age group, and how have these been shaped by the pandemic; and the implications of this for a future policy agenda. The report, which focuses on home and community, health and wellbeing and work and money, draws on a literature review exploring the latest evidence in relation to these policy areas; a survey of 1,000 people aged 50-70-years within England; and a longitudinal qualitative research with 19 purposively selected participants designed to reflect a range of different experiences. The findings highlight the correlation between age and health outcomes during the pandemic – there was a decline in physical health for one in five respondents while more than a third said their mental health got worse. Overall, the report finds that the lockdown has been tough on some – many people have seen their health deteriorate with more unhealthy behaviours, and more than two in five fear their finances will worsen in the year to come. But there have also been some positive changes, with many appreciating the time spent with family, helping their communities, a better work-life balance, and time to reflect on their careers and future. The report stresses that as the lockdown restrictions ease it will still take time for things to get back to normal – the data shows that two in five respondents think that it will take at least one to two years or longer.

Last updated on hub: 03 August 2020

The Government’s response to the Joint Committee on Human Rights report: the Government’s response to COVID-19: human rights implications

Department of Health and Social Care

The government’s formal response to the 55 recommendations made by the Joint Committee on Human Rights in its report ‘The government’s response to COVID-19: human rights implications’. The original recommendations and this response focus on: the lockdown regulations; health and care; detention; contact tracing; children and the right to education; access to justice; procedural obligations to protect the right to life; accountability and scrutiny. The document reiterates that while the Care Act easements were intended as a tool to help local authorities continue to meet the most urgent and acute needs in the face of COVID-19, public safety remains a top priority, including for those who need care and support – Local Authorities remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights.

Last updated on hub: 15 December 2020

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