COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

The COVID-19 pandemic constitutes an exceptional risk to people living and working in nursing homes (NHs). There were numerous cases and deaths among NH residents, especially at the beginning of the pandemic when no vaccines had yet been developed. Besides regional differences, individual NHs showed vast differences in the number of cases and deaths: while in some, nobody was affected, in others, many people were infected or died. We examine the relationship between facility structures and their effect on infections and deaths of NH residents and infections of staff, while considering the influence of COVID-19 prevalence among the general population on the incidence of infection in NHs. Two nationwide German surveys were conducted during the first and second pandemic waves, comprising responses from n = 1067 NHs. Different hurdle models, with an assumed Bernoulli distribution for zero density and a negative binomial distribution for the count density, were fitted. It can be shown that the probability of an outbreak, and the number of cases/deaths among residents and staff, increased with an increasing number of staff and the general spread of the virus. Therefore, reverse isolation of NH residents was an inadequate form of protection, especially at the beginning of the pandemic.

Ambulante Pflege in den ersten beiden Wellen der COVID-19-Pandemie: Herausforderungen für Personal und Pflegebedürftige Home-care services in the first two waves of the COVID-19 pandemic: challenges for staff and care recipients

Einleitung In der COVID-19-Pandemie zählen Pflegebedürftige zu den besonders vulnerablen Bevölkerungsgruppen. Ambulante Pflegedienste befanden sich gerade zu Beginn der Pandemie in einer Ausnahmesituation. In dieser Arbeit sollen die Situation und die Probleme der Pflegedienste und der versorgten Pflegebedürftigen in den ersten beiden Wellen der Pandemie in Deutschland untersucht werden. Methoden Während der ersten beiden COVID-19-Wellen wurden zwei Querschnittstudien durchgeführt (erste Befragung: 28.04.–12.05.2020, zweite Befragung: 12.01.–07.02.2021). Insgesamt wurden Daten aus N = 1029 ambulanten Pflegediensten in die Analyse einbezogen. Die Analyse erfolgte anhand deskriptiver Maßzahlen. Ergebnisse Die Klient:innen von Pflegediensten waren in den ersten beiden Wellen der Pandemie stark belastet. Dies zeigt sich einerseits an einem erhöhten Erkrankungsrisiko und einer erhöhten Mortalität und andererseits am Wegfall verschiedener Versorgungs- und Unterstützungsangebote. Letzteres hat z. B. auch negative Auswirkungen auf die psychosoziale Verfassung der Pflegebedürftigen. Die Pflegedienste waren von hohen Personalausfällen und zusätzlicher Arbeit durch Schutzmaßnahmen betroffen. Diskussion Die COVID-19-Pandemie führte zu großen Belastungen von Pflegebedürftigen und ambulanten Pflegediensten und zu einer Reduzierung der Versorgungsangebote. Die Verschlechterung der Versorgung traf auf eine bereits angespannte Situation. Es zeigt sich, dass die Versorgung Pflegebedürftiger durch ambulante Pflegedienste nicht krisensicher gestaltet ist und dass zusätzliche Herausforderungen wie die einer Pandemie dramatische Folgen haben können. Zukünftig sollte es verlässliche Strukturen und schnell verfügbare Notfallpläne mit konkreten Handlungsanweisungen geben.

[Home-care services in the first two waves of the COVID-19 pandemic: challenges for staff and care recipients]. / Ambulante Pflege in den ersten beiden Wellen der COVID-19-Pandemie: Herausforderungen für Personal und Pflegebedürftige.

INTRODUCTION: During the COVID-19 pandemic, people in need of long-term care were among the most vulnerable population groups. Home-care services were under exceptional strain, especially at the beginning of the pandemic. The aim of this study is to examine the situation and problems of care services and the people in need of care during the first two waves of the pandemic in Germany. METHODS: Two cross-sectional studies were conducted during the first two COVID-19 waves (first survey 28 April to 12 May 2020, second survey 12 January to 7 February 2021). In total, data from N = 1029 outpatient care services were included in the analysis. Descriptive measures were used for the analysis. RESULTS: The clients of home-care services were severely burdened in the first two waves of the pandemic. This can be seen on the one hand in an increased risk of illness and increased mortality, and on the other in the loss of various care and support services. The latter also has negative effects on the psychosocial condition of those in need of care, for example. Care services were affected by high staff absenteeism and additional work due to protective measures. DISCUSSION: The COVID-19 pandemic led to immense burdens for people in need of care and home-care services and to a reduction in care services. The deterioration of care provision met with an already tense situation. It has become clear that the provision of care for those in need of care by outpatient care services is not crisis-proof, and that additional challenges such as a pandemic can have dramatic consequences. For the future, reliable structures and readily available emergency plans should be established with concrete instructions for action.

[The situation of informal caregivers of working age in the COVID-19 pandemic-results of an online survey in Germany]. / Die Situation pflegender Angehöriger im erwerbsfähigen Alter in der COVID-19-Pandemie ­ Ergebnisse einer Onlinebefragung in Deutschland.

BACKGROUND: The consequences of the COVID-19 pandemic have posed major challenges to different groups. One of these are informal caregivers. This study investigates the changes the pandemic has caused for informal caregivers and the extent to which quality of life and burden of care have changed for specific subgroups. METHODS: Data for this cross-sectional study was gathered in the summer of 2020 in a convenient sample of informal caregivers (< 67 years of age, N = 1143). In addition to sociodemographic data, information on the care situation, compatibility of care and work, as well as stress and quality of life was collected in an online survey. The analysis of care situations and compatibility of care and work is done descriptively. Logistic regression models are used for a subgroup analysis of quality of life and care burden. RESULTS: The care situation has changed for 54.7% of participants and has become more time consuming. For 70.8% of respondents, the COVID-19 pandemic has made it even more difficult to balance care-giving and work. However, most respondents were satisfied with their employers' pandemic management (65.9%). A sharp decline in the quality of life and an increase in the burden of care for informal caregivers was ascertained. Both developments are stronger for young and female caregivers and for those caring for people with a greater need of support. DISCUSSION: The results indicate that living situations worsened for a substantial proportion of informal caregivers during the COVID-19 pandemic. Policymakers should recognize additional challenges that informal caregivers have faced since the outbreak of the COVID-19 pandemic and how they vary by subgroups. It is important to include home-based informal care as well as other care settings in future pandemic concepts.

Social Health among German Nursing Home Residents with Dementia during the COVID-19 Pandemic, and the Role of Technology to Promote Social Participation.

The COVID-19 pandemic severely impacted the social health of nursing home residents with dementia due to social isolation. Consequently, the frequency of Behavioral and Psychological Symptoms in Dementia (BPSD) might increase. Technological solutions might help safeguard the social health of nursing home residents with dementia. This study investigates the impacts of the COVID-19 pandemic on clinical outcomes and the availability of social activities and technology to promote social participation in nursing home residents with dementia. The study analyzed cross-sectional data from a follow-up questionnaire nested in a larger national survey of care facilities in Germany. A mixed-methods approach integrated statistical analyses of closed-ended responses and thematic analysis of free-text responses. A total of 417 valid individual responses were received, showing an overall increase in observed BPSD-with anxiety and depression most frequently occurring. Many nursing homes canceled all social activities for residents with dementia, though a few had established procedures to facilitate social participation using technology. Requirements to promote social participation in this population using technology were identified at the micro-, meso-, and macro levels. Technology requirements permeated all three levels. During and beyond the COVID-19 pandemic, technology-driven solutions to promote social health among nursing home residents with dementia should be integrated into caregiving procedures.

COVID-19 in German Nursing Homes: A Panel Study on Morbidity, Burden of Care, and Social Isolation

Germany was hit by the second wave of the pandemic much harder than by the first wave. The study aims to describe the extent to which nursing homes (NH) are affected by COVID-19. About 8,000 NHs were invited to participate in two waves of an online survey, with a share of 5-10% participating. The share of all deceased NH-residents with COVID-19 is about 50% (04/2020-02/2021). Factors that increase the risk of an outbreak in NH are the spread of the virus in the population, the size of the institution and staff-resident-ratio. The initial lack of protective equipment has decreased during the second wave, but the facilities have to cope with massive additional care needs with reduced staff. NHs have partly banned contacts between residents and relatives. As a conclusion the support of NH in their attempt to fight the impact of this and further pandemic situations requires highest attention.

Taking stock of COVID-19 policy measures to protect Europe’s elderly living in long-term care facilities

The current COVID-19 pandemic has come to impact all areas of life involving the health, psycho-social and economic wellbeing of individuals, as well as all stages of life from childhood to old age. Particularly, the frail elderly have had to face the gravest consequences of the disease;while reporting measures tend to differ between countries making direct comparisons difficult, national statistics worldwide point to a disproportionate and staggering share of COVID-19 related mortality coming from residential long-term care facilities (LTCFs). Still, the severity of the impact on the institutionalized elderly has not been uniform across countries. In an effort to better understand the disparities in impact on Europe?s elderly living in LTCFs, we review data on mortality outcomes seen during the first wave of the pandemic (months March to June 2020). We then set out to understand the role played by the following two factors: (1) the infection rate in the general population and (2) member state adherence to policy recommendations put forth by the European Centre for Disease Prevention and Control (ECDC) targeting the LTC sector. Regarding the latter, we compare the content of national policy measures in six countries ? Austria, Denmark, Germany, Ireland, Spain and Sweden ? with those of the ECDC. Our findings establish that infection rates in the general population accounted for most of the variation in mortality among member states, however adherence to EU policy helped to explain the residual variation between cases. This suggests that in order to best protect the institutionalized elderly from infectious disease of this kind, countries need to adopt a two-pronged approach to developing measures: one that aims at reducing transmission within the general population and one that specifically targets LTCFs.

Pflege in Zeiten von Corona: Zentrale Ergebnisse einer deutschlandweiten Querschnittsbefragung vollstationärer Pflegeheime.

Long-term care during the Corona pandemic - Main results from a nationwide online survey in nursing homes in Germany Abstract. Background: As a highly vulnerable group, people in need of long-term care are particularly affected by the COVID-19 pandemic. Due to their care-dependency, measures of social distancing can only be carried out to a very limited extent. In addition, the social and health consequences of reduced contacts are particularly high for nursing home residents. AIM: The study aims to describe the extent to which nursing homes are affected, the human and material resources of nursing homes, the organizational handling of the situation, and their requests for public support. METHODS: More than 7,000 nursing homes were invited to participate in an online survey with quantitative and qualitative elements. Data analysis applies descriptive statistics. RESULTS: 824 nursing homes participated in the survey. One in five nursing homes has at least one confirmed case of SARS-CoV-2 among its residents and / or employees. The initial lack of protective equipment has now decreased, but the facilities still have to cope with additional corona-related care needs with reduced staff. Nursing homes have banned contacts between residents and relative to an extent that now has to be reduced again. Nursing homes demand the provision and external financing of protective equipment as well as the systematic and regular testing of nursing staff and the provision of uniform guidelines for action throughout Germany. CONCLUSIONS: As about half of all deceased people with COVID-19 have been living in nursing homes, the support of nursing homes in their attempt to restrict the pandemic requires highest attention.

[Needs of long-term nursing in the COVID-19 pandemic]. / Bedarfe der Langzeitpflege in der COVID-19-Pandemie.

The SARS-CoV­2 virus and the associated disease COVID-19 pose major challenges to healthcare systems worldwide. Especially the vulnerable group of people in need of long-term care is at risk of suffering a severe course of the disease or of dying from the infection.In a nationwide cross-sectional study the situation and needs of inpatient and outpatient long-term care facilities during the SARS-CoV­2 pandemic were assessed and analyzed using an online survey.Participants from 531 institutions postulated the need for uniform recommendations for action on SARS-CoV­2, adequate and affordable protective and hygiene materials, serial tests in the institutions, well-founded advice on the implementation of interventions, a specific pandemic plan and supporting public relations work by the media. This calls for higher nursing remuneration, better staffing levels and greater appreciation of the nursing profession.In order to protect the vulnerable group of people in need of nursing care from a SARS-CoV­2 infection, long-term care must be given a stronger focus in health policy measures during the pandemic.

Pflege in Zeiten von Corona: Ergebnisse einer deutschlandweiten Querschnittbefragung von ambulanten Pflegediensten und teilstationären Einrichtungen.

Care in times of Corona: Results of a cross-sectional study in German home care services Abstract. Background: People in need of care are particularly affected by the COVID-19 pandemic due to their age and previous illnesses. At the same time, a large number of daily contacts between nursing staff and those in need of care increase the risk of transmission of the disease. AIM: The study aims to illustrate (I) to what extent home care services and semi-residential care facilities are affected by COVID-19, (II) human and material resources, (III) the care situation of those in need of care and (IV) the organizational handling of the situation and outline support requests to politicians. METHODS: More than 12,000 home-care nursing services and semi-residential care facilities were invited to participate in an online survey with quantitative and qualitative elements, 701 nursing services (response rate 7,3 %) and 96 semi-residential facilities (response rate 3,5 %) took part. RESULTS: Almost a third (30,1 %, 189 / 627) of the nursing services surveyed are affected by confirmed or suspected cases of COVID-19 among clients. About half of the services report a reduced use of SGB V (47,6 %, 288 / 605) or SGB XI services (59,7 %, 375 / 628). Two thirds of the semi-residential facilities (65,6 %, 63 / 96) say they are currently closed due to the pandemic. Likewise, half of the nursing services (45,8 %, 253 / 552) reported that care with reduced use of services was at risk / unstable or even not ensured. CONCLUSIONS: The results show that the situation of care-dependent people served by home-care services in the present pandemic - and also with a view to a possible second wave - should receive increased attention particularly with regard to unstable / risky care arrangements.