Envisioning innovative post-COVID approaches toward LTCF design in dense urban areas: Exploring an evidence-based design prototype

The COVID-19 (coronavirus disease 2019) pandemic has posed greater challenges to older adults, especially those who live in congregated long-term care facilities (LTCFs) in dense urban settings. These facilities struggle with high rates of COVID-19 infections and other challenges that undermine LTCF residents' well-being. These challenges, including social isolation and limited access to nature and community, have been exacerbated by the pressures of the pandemic. This has led to feelings of loneliness, depression, and other mental health issues among residents and a higher risk of psychological stress and infection among nurses. The pandemic has challenged the existing built environment of LTCFs. Issues regarding physical and mental health, quality of life (QoL), infection control, and pandemic resiliency have been shown to be increasingly interwoven. This chapter envisions innovative approaches toward a post-COVID-19 environment for older adults and their caregivers. This chapter provides an extensive review and synthesis of the lessons learned from LTCFs during the pandemic, with a focus on how their experience was impacted by design. The authors also draw from current design trends to identify their potential to support residents', staff, and visitors' needs during and after pandemics. From these learnings, the following design principles were developed: (1) small household model, (2) biophilic design, (3) intergenerational community, and (4) multi-tier infection control strategies. These design principles were then translated to a prototype through a graduate capstone studio project, which provides a visual illustration of how these evidence-based design solutions can be applied within a dense urban environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Teaching and learning modalities for continuing professional development in the long-term care: A rapid synthesis review.

AIM: To describe the various teaching and learning modalities for the delivery of Continuing Professional Development activities for health care professionals in the long-term care sector. BACKGROUND: Continuing Professional Development is a key activity that organisations undertake to achieve effective workforce planning, recruitment, retention and upskilling strategies in long-term care settings. During the Covid-19 pandemic there was a rapid move to online modalities of Continuous Professional Development, but there is a paucity of evidence in relation to their effectiveness compared with face-to-face, or in-class learning. DESIGN: A rapid synthesis review. METHODS: MEDLINE, CINAHL and HEALTH BUSINESS ELITE databases were used to identify relevant articles that were published between 2016 and 2022. Original studies of any design investigating Continuing Professional Development activities, with or without a comparison between interventions or activities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. The Kirkpatrick model was adopted as a globally recognised method for evaluating training programmes. RESULTS: After a full text analysis, 34 papers were included in the review. Face to face was the most common method of delivery followed by online, while blended (a mix of face-to-face and online delivery) was the least common method used. The teaching modalities were not associated with specific learning contents, but were used for a range of content. Most studies obtained positive outcomes following implementation of the educational interventions. Kirkpatrick Level 4 (results) was the most commonly measured outcome. CONCLUSIONS: While blended learning was the least common method of delivery, it was found to be more beneficial for learners than face-to-face or online exclusively. There are now new spaces to learn and new technologies that allow us to 'reimagine' where, when and how we teach. This requires Continuing Professional Development providers to design and tailor their courses according to health professionals' learning needs and the clinical contexts where they work. We recommend that Continuing Professional Development providers involve employers when designing teaching and learning activities for Long Term Care workers, to decide which modalities enable effective knowledge translation.

Long-Term Care Homes: Carceral Spaces in Times of Crisis or Perpetually?

This article explores whether isolation and control observed during COVID-19 are a pandemic effect or a perpetual socio-spatial feature of long-term care (LTC) culture. We use narrative analysis to foreground the experiences of two women with dementia trying to leave LTC: one before and the other during the pandemic. Using the lens of affective citizenship, we argue that the spatial experiences of confinement for people living in LTC are routinely overlooked in popular discourse. We reflect upon how the segregation of older people with dementia in LTC contributes to discriminatory practices beyond these institutions and advocate for a policy of deinstitutionalization. © The Author(s) 2023.

Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic.

OBJECTIVES: Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic. BACKGROUND: LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue. METHODS: The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses. RESULTS: The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. CONCLUSIONS: This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.

Monitoring COVID-19 vaccine use in Italian long term care centers: The GeroCovid VAX study.

The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample.

Financialization of housing from cradle to grave: COVID-19, seniors’ housing, and multifamily rental housing in Canada

This paper explores the links between housing, financialization, and inequality—as exposed by the COVID-19 pandemic. It focuses specifically on seniors’ housing (retirement and long-term care homes) and purpose-built rental housing, exploring how government cuts and retrenchment in the late 1990s created an opportunity for private profits for financial investors in housing that catalyzed a dramatic rise in “financialized” ownership of care homes, retirement properties, and multifamily rental housing in the province. Financial business strategies then generated a series of crises exacerbated by COVID-19. In rental housing, a crisis of affordability has led to displacement pressures and a COVID-related flood of evictions. In seniors’ housing, a crisis of care has been exposed by disproportionate deaths in long-term care and retirement homes nationwide. In Ontario, COVID-19 death rates were highest in financialized and corporate-owned for-profit homes, pointing to the downsides of prioritizing investor profits over housing, good jobs, and high-quality care. This paper is part of the SPE Theme on the Political Economy of COVID-19.

Migrant Care Labour, Covid-19, and the Long-Term Care Crisis: Achieving Solidarity for Care Providers and Recipients

Globally there is a care crisis in terms of the quantity of care needed for an aging population and the quality of both the care provided and work conditions of those providing this care. The COVID-19 pandemic has exposed and heighted this crisis of care. In this chapter we review the issue with a particular focus on long-term care (LTC) facilities and the type and skill mix of labour, including the degree to which immigrant workers are over-represented in this sector. We offer some conceptual reflections on elder care as a matter of social justice and ethics in terms of those needing and providing care. These concerns take on a specific global dimension when we understand the transnationalisation of care, or the care provisioning function of what are termed global care chains. We contextualise how this migrant labour is positioned within this sector through international comparisons of funding models for LTC, which also allows us to understand the structural conditions within which this globally-sourced workforce is positioned. We then highlight two significant contributing factors to the current LTC crisis that were intensified and exposed during the COVID-19 pandemic using Ontario, Canada, as an example: the role of the private sector and the unsustainable extraction of profits from this service, and the gendered and racialised devaluing of migrant labour so essential to the sector. © 2022, The Author(s).

Does COVID-2019 have an Impact on the Purchase Intention of Commercial Long-Term Care Insurance among the Elderly in China?

PURPOSE: As an important measure to alleviate long-term care (LTC) costs for the disabled due to the aging of the population, long-term care insurance (LTCI) system has been paid more attention in China. In addition to the government-led public LTCI system that has been piloted in cities such as Qingdao, Chongqing and Shanghai, health insurers such as the China Life Insurance Company are also experimenting with various types of commercial LTCI in the private market. However, the commercial LTCI market is developing very slowly due to public awareness and other reasons. On the other hand, COVID-2019 has had an impact on the cognition of the importance of long-term care for the elderly due to the fact that the death cases of COVID-2019 have been mainly concentrated in the elderly population with chronic diseases such as hypertension. Therefore, the purpose of this study is to explore the differences in the purchase intention of commercial LTCI among the elderly in two different periods: before and after the outbreak of COVID-2019. METHODS: By using the Andersen behavioral model and two investigations in two different periods before and after the outbreak of COVID-2019, this study explores the impacts of COVID-2019 on the purchase intention of commercial LTCI. RESULTS: Some significant discoveries were found. For example, 25.8% of interviewees showed purchase intention in LTCI in the time before the COVID-2019 outbreak, while this proportion increased to 37.6% after the COVID-2019 outbreak. People who were younger (OR = 2.128, before COVID-2019; OR = 1.875, after COVID-2019) or who had more education (OR = 1.502, before COVID-2019; OR = 2.218, after COVID-2019) were more interested in commercial LTCI. CONCLUSION: This study shows that COVID-2019 has had an obvious impact on the purchase intention of commercial LTCI, which provides some enlightenment for China to improve the LTCI system in the future, especially to accelerate the development of commercial LTCI. For example, it is essential to promote the importance of long-term care among the elderly in a focused and targeted way. In terms of the key target audience, it can be developed gradually from the groups with higher education levels and the middle elderly aged 45-64 years old.