ABSTRACT
Purposes: To understand the strategies used in care home settings during the COVID-19 pandemic and to identify contextual factors for developing sustainable pandemic responses. Methods: Qualitative interviews were conducted with a purposive sample of staff members between June and July 2020. The staff members were in different disciplines and ranks and worked for at least one month in any of the three care homes in Hong Kong and three care homes in Nanjing. The interviews were audio recorded and transcribed verbatim. Inductive data-driven thematic analysis was conducted. Results: 20 staff were included who were personal care workers (n=7), nurses (n=7), social workers (n=2), home administrator (n=1), and home managers (n=3). Three major challenges to provision of care home services during the pandemic were identified: how to implement measures to prevent an outbreak in the care home, how to minimise the detrimental effects of these control measures on the residents' psychosocial well-being, and how to prepare for the reopening of the care home. Three themes related to these care challenges were identified: libertarian paternalism versus paternalism, emerging versus established telecommunication, and selective versus blanket testing. Conclusions: Care home staff in both cities encountered similar challenges when providing care during the pandemic. The pandemic responses are complex interventions shaped by the social context, and thus the ways the staff addressed these challenges vary, affected by government policies on infection control measures, readiness of telecommunications infrastructure, and availability of testing facility to prevent another wave in post-peak period.