"My Biggest Fear Is She'll Die Alone": Care Partner Perspectives of Institutional COVID-19 Visitor Restrictions in Ontario, Canada.

In March 2020, the Government of Ontario, Canada implemented public health measures, including visitor restrictions in institutional care settings, to protect vulnerable populations, including older adults (> 65 years), against COVID-19 infection. Prior research has shown that visitor restrictions can negatively influence older adults' physical and mental health and can cause increased stress and anxiety for care partners. This study explores the experiences of care partners separated from the person they care for because of institutional visitor restrictions during the COVID-19 pandemic. We interviewed 14 care partners between the ages of 50 and 89; 11 were female. The main themes that emerged were changing public health and infection prevention and control policies, shifting care partner roles as a result of visitor restrictions, resident isolation and deterioration from the care partner perspective, communication challenges, and reflections on the impacts of visitor restrictions. Findings may be used to inform future health policy and system reforms.

[Les personnes âgées immigrantes et leurs proches à Montréal : des vies oubliées durant la pandémie].

Malgré l'attention renouvelée de plusieurs médias sur la question des risques liés à la COVID-19 au sein de diverses communautés marginalisées au Québec, nous entendons encore très peu parler des personnes âgées immigrantes et de leurs proches. Dans cette note sur les politiques et pratiques, nous aborderons l'expérience du contexte pandémique chez les personnes âgées immigrantes montréalaises et leurs réseaux. Nous présenterons d'abord quelques données sociodémographiques sur les immigrants âgés montréalais. Nous exposerons ensuite nos constats sur les impacts de la COVID-19 sur les personnes âgées immigrantes, en particulier en ce qui concerne l'accès aux soins de la santé et aux services sociaux, la proche-aidance, l'emploi et le logement, à partir de nos travaux et de la littérature en gérontologie sociale. Nous terminerons en proposant quelques recommandations qui permettraient d'améliorer l'inclusion sociale des personnes âgées immigrantes et de leurs proches, autant en matière de politiques publiques que de pratiques sur le terrain.

Respecting older people's rights and freedoms during a health crisis

The major restrictions on rights and freedoms imposed by the management of the COVID-19 crisis have caused significant psychological, and sometimes physical, suffering for older people with decreased independence living in collective housing. Without calling into question the decisions made by these housing establishments, which for the most part were motivated by a desire and need to protect their residents, the aim of this contribution is to question the processes that led—and still lead—to decisions restricting freedom, the proportionality of which may be questioned. In fact, those managing such establishments have had to make decisions in an ambiguous legal and social context, marked by the proliferation of non-decisive guidelines and recommendations (soft law acts), which has led to practical difficulties in the implementation of health standards within the establishments and has had a considerable impact on residents' individual freedoms. Some of these restrictions could be described as forms of abuse. © 2022 Fondation Nationale de Gerontologie. All rights reserved. Les restrictions majeures de droits et libertés imposées par la gestion de la crise épidémique de Covid-19 ont engendré des souffrances psychiques et parfois physiques importantes pour les personnes âgées vivant en établissement d'hébergement pour personnes dépendantes. Sans remettre en cause les décisions des établissements qui, pour une large majorité, ont été motivées par la volonté et la nécessité de protéger leurs résidents, l'objectif de cette contribution vise à interroger les processus qui ont conduit – et conduisent encore – à des décisions restrictives de liberté dont la proportionnalité peut être discutée. En effet, les directions d'établissement ont dû prendre des décisions dans un contexte juridique et social ambigu, marqué par le foisonnement d'orientations et de recommandations non décisoires (actes de droit souple), ce qui a engendré des difficultés pratiques dans la mise en œuvre des normes sanitaires au sein des établissements et a eu un impact considérable sur l'exercice des libertés individuelles des résidents dont certaines restrictions pourraient être qualifiées de forme de maltraitance. © 2022 Fondation Nationale de Gerontologie. All rights reserved.

Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic's persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents' quality of life, while ensuring the well-being of staff and residents' families.

Co-Designing Together through Crisis: Development of a Virtual Care Guidance Document to Support Providers, Older Adults, and Caregivers.

COVID-19 has had a disproportionate and devastating impact on older adults. As health care resources suddenly shifted to emergency response planning, many health and community support services were cancelled, postponed, or shifted to virtual care. This rapid transformation of geriatric care resulted in an immediate need for practical guidance on decision making, planning and delivery of virtual care for older adults and caregivers. This article outlines the rapid co-design process that supported the development of a guidance document intended to support health and community support services providers. Data were collected through consultation sessions, surveys, and a rapid literature review, and analyzed using appropriate qualitative and quantitative methods. Although this work took place within the context of the COVID-19 pandemic, the resulting resources and lessons learned related to collective impact, co-design, population-based planning, and digital technologies can be applied more broadly.

COVID-19: Pandemic Risk, Resilience and Possibilities for Aging Research

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic,” which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts – from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

The “elderly” during the covid-19 crisis: a convenient scapegoat or a revelation of social dysfunction?

With the arrival of the coronavirus disease 2019 (covid-19) pandemic, the French society has been deeply shaken in its overall functioning. The proliferation of patients and the increased demand for care, particularly in hospitals and intensive care units, have particularly disrupted the health and social functioning of French society. In this particular context of crisis, the latter played the role of “social analyzer” in the sense given to it by sociologists, that is to say, it shed new light on the social practices instituted normally. We have chosen for this article to examine the way in which a particular category of people “the elderly” had been treated on three registers which appeared to us to be emblematic of the social treatment of these “elderly people” during the covid-19 crisis. First there was the reactivation of what some have called “the struggle of ages” or even the war of generations. Then, this crisis has particularly highlighted the situation of elderly people residing in nursing homes: their increased mortality, their problematic confinement and their priority vaccination. Finally, this crisis raised the question of the relevance of setting up specific confinement according to age. Our conclusion is that crises are conducive to simplistic explanations and the search for scapegoats, but that they are also a formidable indicator of social dysfunctions that predate the crisis. In this sense, the crisis has brought to light an obvious fact in French society of the primacy of “life course inequalities” as a major vector of social exclusion. © 2022 Elsevier Masson SAS Avec l'arrivée de la pandémie de coronavirus disease 2019 (covid-19), la société française a été profondément ébranlée dans son fonctionnement global. La multiplication des malades et l'augmentation de la demandes de soins notamment hospitaliers et en services de réanimation ont particulièrement perturbé le fonctionnement sanitaire et social de la société française. Dans ce contexte particulier de crise, cette dernière a joué le rôle d’ « analyseur social » au sens que lui donnent les sociologues, c'est-à-dire qu'elle a été porteuse d'un éclairage nouveau sur les pratiques sociales instituées en temps normal. Nous avons choisi pour cet article d'examiner la façon dont avait été traitée une catégorie particulière de personnes « les personnes âgées » et ce sur trois registres qui nous sont apparus emblématiques du traitement social de ces « personnes âgées » pendant la crise covid-19. D'abord il y a eu la réactivation de ce que d'aucuns ont appelé « la lutte des âges » ou encore la guerre des générations. Ensuite cette crise a particulièrement mis en lumière la situation des personnes âgées résidant en EHPAD : leur mortalité accrue, leur confinement problématique et leur vaccination prioritaire. Enfin cette crise a posé la question de la pertinence d'une mise en place d'un confinement spécifique en fonction de l’âge. Notre conclusion est que les crises sont propices aux explications simplistes et à la recherche de boucs émissaires, mais qu'elles sont aussi un formidable révélateur des dysfonctionnements sociaux antérieurs à la crise. En ce sens la crise a remis en lumière une évidence, dans la société française, la primauté des « inégalités de parcours de vie » comme vecteur majeur de l'exclusion sociale. © 2022 Elsevier Masson SAS

Les « personnes âgées » pendant la crise du Covid-19: un bouc émissaire commode ou un révélateur des dysfonctionnement sociaux?

Résumé Avec l’arrivée de la pandémie Covid-19, la société française a été profondément ébranlée dans son fonctionnement global. La multiplication des malades et l’augmentation de la demandes de soins notamment hospitaliers et en services de réanimation ont particulièrement perturbé le fonctionnement sanitaire et social de la société française. Dans ce contexte particulier de crise, cette dernière a joué le rôle d’ « analyseur social » au sens que lui donnent les sociologues, c’est-à-dire qu’elle a été porteuse d’un éclairage nouveau sur les pratiques sociales instituées en temps normal. Nous avons choisi pour cet article d’examiner la façon dont avait été traitée une catégorie particulière de personnes « les personnes âgées » et ce sur trois registres qui nous sont apparus emblématiques du traitement social de ces « personnes âgées » pendant la crise Covid-19. D’abord il y a eu la réactivation de ce que d’aucuns ont appelé « la lutte des âges » ou encore la guerre des générations. Ensuite cette crise a particulièrement mis en lumière la situation des personnes âgées résidant en EHPAD : leur mortalité accrue, leur confinement problématique et leur vaccination prioritaire. Enfin cette crise a posé la question de la pertinence d’une mise en place d’un confinement spécifique en fonction de l’âge. Notre conclusion est que les crises sont propices aux explications simplistes et à la recherche de boucs émissaires, mais qu’elles sont aussi un formidable révélateur des dysfonctionnements sociaux antérieurs à la crise. En ce sens la crise a remis en lumière une évidence, dans la société française, la primauté des «  inégalités de parcours de vie » comme vecteur majeur de l’exclusion sociale. Summary With the arrival of the Covid-19 pandemic, French society has been deeply shaken in its overall functioning. The proliferation of patients and the increased demand for care, particularly in hospitals and intensive care units, have particularly disrupted the health and social functioning of French society. In this particular context of crisis, the latter played the role of "social analyzer" in the sense given to it by sociologists, that is to say, it shed new light on the social practices instituted normally. We have chosen for this article to examine the way in which a particular category of people "the elderly" had been treated on three registers which appeared to us to be emblematic of the social treatment of these "elderly people" during the Covid-19 crisis. First there was the reactivation of what some have called “the struggle of ages‿ or even the war of generations. Then, this crisis has particularly highlighted the situation of elderly people residing in nursing homes: their increased mortality, their problematic confinement and their priority vaccination. Finally, this crisis raised the question of the relevance of setting up specific confinement according to age. Our conclusion is that crises are conducive to simplistic explanations and the search for scapegoats, but that they are also a formidable indicator of social dysfunctions that predate the crisis. In this sense, the crisis has brought to light an obvious fact in French society of the primacy of “life course inequalities‿ as a major vector of social exclusion.

Aligning Virtual Care in Canada with the Needs of Older Adults.

Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.

The Experience of Older Adults Socially Distancing during the Early Stages of the COVID-19 Pandemic.

During the early stages of the COVID-19 pandemic, individuals were asked to stay home and restrict outings to limit the spread of the virus. Physical isolation was particularly emphasized for older adults over the age of 60 who, because of their age and related medical conditions, were at increased risk of severe disease and death from the virus. This led to reduced spread of the virus but also to social and emotional health challenges for older adults. Protecting the physical health of older adults was of the utmost importance during the pandemic but supporting social and mental health must not be overlooked. This patient-oriented qualitative study involved 40 interviews with older adults, conducted in the early stages of the pandemic, followed by a thematic analysis. Three themes were derived from the findings: subverted life plan, emotional impacts, and creating a path forward. The findings from this study will help inform current physical and social distancing guidelines during the ongoing COVID-19 pandemic. Moreover, findings indicate that social and emotional challenges with ongoing physical and social isolation must be taken into consideration for future pandemics.

(Dis)Connecting Through COVID-19: Experiences of Older Persons in the Context of a Volunteer-Client Relationship.

The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer-client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons' vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer-client relationships during times when physical visiting is not possible.

Challenges and Strategies to Adapt the Provision of Support Services to Older Adults and Caregivers During the COVID-19 Pandemic: The Perspective of Community Organizations.

This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults' needs.

A SHARP Response: Developing COVID-19 Research Aims in Partnership with the Seniors Helping as Research Partners (SHARP) Group.

COVID-19 has disproportionally impacted older adults, and has highlighted many issues, including extreme deficiencies in Canadian long-term care homes and gaps in home and community care services for older adults. In recent years, there has been a push towards better patient and family engagement in health system research, and with the onset of the pandemic, engaging older adults in research and policy planning is more important than ever. In this article, we describe the Seniors Helping as Research Partners (SHARP) approach to engagement with older adults as an example of how partnerships that engage older adults in the development of research aims and processes can help to ensure that future research meets the needs of older adults. SHARP members highlighted a number of areas for future COVID-19 research such as improvements to long-term care, enhancing access to home and community care, and a focus on aging and social isolation.

[COVID-19, deployment of antigenic tests in EHPAD]. / Covid-19, déploiement des tests antigéniques en Ehpad.

During the second epidemic wave of COVID-19 in the fall of 2020, residents of accommodation facilities for dependent elderly people were not totally confined. They were able to continue to receive visits from their families under a strict health protocol. But these facilities are very fragile, and many have been affected. The marketing of rapid detection tests for severe acute respiratory syndrome coronavirus 2 using an antigenic method has made it possible to carry out massive screening campaigns for staff in these facilities since the beginning of November.

[COVID pandemic in accommodation facilities for dependent elderly]. / Pandémie de Covid dans les Ehpad.

During the coronavirus outbreak, accommodation facilities for dependent elderly (Ehpad) had to adapt quickly to an unknown and dangerous situation for residents, putting all the resources of these places to the test. Caregivers faced clinical and organizational emergencies with the coordinating doctors and nurse, going through different individual and collective phases. The directors, who are legally responsible for Ehpad, had to make room for the "we", anticipate, apprehend and evaluate the crisis but also deal with paradoxical recommendations.

[COVID-19, impact on residents and caregivers]. / Covid-19, impact sur les résidents et les soignants.

Following the COVID-19's entry into France, in order to protect the residents, the doors of the accommodation facilities for dependent elderly have been closed and a complete reorganization has been necessary. This confinement and restructuring behind closed doors has many consequences both for the residents and for the staff who accompany them on a daily basis. For the resident, the physical and/or psychological impact will be different depending on his degree of autonomy. The staff fear for their health, their families health, and the one of the elderly they accompany.

[COVID-19 in accommodation facilities for dependent elderly, testimony from a healthcare executive]. / La Covid-19 en Ehpad, témoignage d'un cadre de santé.

Sunday, day of rest in a pavilion of Seine-Saint-Denis in this so particular period of confinement because of the coronavirus disease 2019. Time seems to stand still. A healthcare executive shares his experiences at the "Les 4 Saisons" accommodation facility for dependent elderly, located in Bagnolet.