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1.
BMJ Open ; 12(1): e053894, 2022 01 03.
Article in English | MEDLINE | ID: covidwho-1603839

ABSTRACT

INTRODUCTION: Prior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics. METHODS AND ANALYSIS: We will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.


Subject(s)
COVID-19 , Pandemics , Aged , Humans , Loneliness , Long-Term Care , Pandemics/prevention & control , Research Design , Review Literature as Topic , SARS-CoV-2 , Social Isolation
2.
J Gerontol Nurs ; 48(1): 29-33, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1592944

ABSTRACT

Long-term care facility (LTCF) residents have been disproportionately affected by coronavirus disease 2019 (COVID-19), from increased mortality and restrictive public health measures. The current study aims to describe the experiences of residents relocating between LTCFs at the onset of the COVID-19 pandemic. Emphasis was placed on residents' sense of home and how the pandemic and ensuing isolation affected their transition. This qualitative study follows the principles of constructivist grounded theory. Seven of 10 residents interviewed had cognitive impairment (mean age = 84 years). Four primary themes were elicited from the interviews focusing on residents' perceptions of their environment and highlights the value placed on privacy and control, the multifaceted feeling of loss during the pandemic, the importance of relationships as a source of comfort and pleasure, and resilience shown by residents in times of hardship. Our study indicates that residents experienced dichotomy and paradox during the pandemic, attempting to strike a balance between isolation and camaraderie, infection risk and mental health, and loss and resilience. The need for familial contact and socialization must be balanced against infection control measures. [Journal of Gerontological Nursing, 48(1), 29-33.].


Subject(s)
COVID-19 , Aged , Aged, 80 and over , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2 , Skilled Nursing Facilities
3.
Can Fam Physician ; 67(12): 908-910, 2021 12.
Article in English | MEDLINE | ID: covidwho-1579151
4.
Infect Control Hosp Epidemiol ; 42(10): 1181-1188, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1575830

ABSTRACT

OBJECTIVE: A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. DESIGN: Quasi-experimental, segmented regression analysis. INTERVENTION: A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. METHODS: A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. RESULTS: The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05). CONCLUSIONS: Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.


Subject(s)
COVID-19 , Long-Term Care , Canada/epidemiology , Humans , SARS-CoV-2 , Skilled Nursing Facilities
5.
Front Public Health ; 9: 779410, 2021.
Article in English | MEDLINE | ID: covidwho-1572343

ABSTRACT

Introduction: The objective of this study is to investigate the COVID-19 outbreak and its successful containment in a long-term care facility, Qatar. Materials and Methods: It was a retrospective case series of 24 COVID-19 positive patients inclusive of elderly, patient attenders, and front-liners from 06th to 18th June 2020. Laboratory, radiological, and treatment findings were assessed from electronic records. Results: The outbreak management team concluded that despite all the pre-existing preventive measures implemented at the start of the pandemic, there was still evidence of lapses in infection control practices such as breach of infection control protocols like improper use of personal protective equipment. The infection prevention and control team promptly reassessed and implemented more stringent infection control methods and practices that successfully contained the outbreak on July 1, 2020. Among the seven elderly patients, the average age was 76.28 years ± SD25.5 and all were females. 57% of the patients were symptomatic. The most common comorbidities were Dementia (57%), Diabetes mellitus (43%), Coronary Artery Disease (43%), and Seizures (43%). Ground glass appearances in the lungs were found in 29% of the patients. Among the three deceased patients, Dementia and Coronary Artery Disease were the common comorbidities. Persistent elevation in blood glucose levels was observed among all patients during this period of infection. Conclusion: Elderlies in long-term care facilities are with certain pre-existing comorbidities which makes them more prone to develop COVID-19 complications. Thus, intensive infection control measures like ongoing education and awareness, staff compliance monitoring, quick contact tracing, visitor policy revision, ongoing patient and caregivers monitoring are inevitable recommendations for effective outbreak prevention and management.


Subject(s)
COVID-19 , Long-Term Care , Aged , Disease Outbreaks/prevention & control , Humans , Nursing Homes , Qatar/epidemiology , Retrospective Studies , SARS-CoV-2
7.
Euro Surveill ; 26(46)2021 11.
Article in English | MEDLINE | ID: covidwho-1526748

ABSTRACT

We describe the impact of changing epidemiology and vaccine introduction on characteristics of COVID-19 outbreaks in 330 long-term care facilities (LTCF) in England between November 2020 and June 2021. As vaccine coverage in LTCF increased and national incidence declined, the total number of outbreaks and outbreak severity decreased across the LTCF. The number of infected cases per outbreak decreased by 80.6%, while the proportion of outbreaks affecting staff only increased. Our study supports findings of vaccine effectiveness in LTCF.


Subject(s)
COVID-19 , Vaccines , Disease Outbreaks/prevention & control , Humans , Long-Term Care , SARS-CoV-2
8.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2021 11 23.
Article in English | MEDLINE | ID: covidwho-1526252

ABSTRACT

PURPOSE: Long-term care (LTC) organizations have struggled to protect their vulnerable clients from the ravages of the COVID-19 pandemic. Although various suggestions on containing outbreaks in LTC facilities have gained prominence, ensuring the safety of residents is not just a crisis issue. In that context, the authors must reasses the traditional management practices that were not sufficient for handling unexpected and demanding conditions. The purpose of this paper is to suggest rethinking the underlying attributes of LTC organizations and drawing insight from the parallels they have to high-reliability organizations (HROs). DESIGN/METHODOLOGY/APPROACH: The authors analyzed qualitative data collected from a Canadian LTC facility to shed light on the current state of reliability practices and culture of the LTC industry and to identify the strengths and weaknesses of the traditional management approaches. FINDINGS: To help the LTC industry develop the necessary crisis management capacity to tackle unexpected future challenges, there is an urgent need for adopting a more systemic top-down approach that cultivates mindfulness, learning and resilience. ORIGINALITY/VALUE: This study contributes by applying the HRO theoretical lens in the LTC context. The study provides the LTC leaders with insights into creating a unified effort at the industry level to give rise to a high-reliability-oriented industry.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , Reproducibility of Results , SARS-CoV-2
9.
Healthc Q ; 24(3): 13-15, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1524628

ABSTRACT

The COVID-19 pandemic has disproportionately affected Canada's long-term care (LTC) sector, with residents of LTC and retirement homes accounting for 67% of all COVID-19-related deaths as of February 15, 2021. This study investigated the impact of the COVID-19 pandemic on LTC residents across Canada during the first six months of the pandemic, including how care changed for residents, using data from the Canadian Institute for Health Information's LTC and acute care databases. The results suggest that LTC residents received less medical care, with fewer physician visits and hospital transfers compared with the same period in 2019. They also had less contact with family/friends compared with the same period in 2019, which was associated with higher levels of depression. In provinces where it could be measured, the number of LTC resident deaths from all causes was higher than pre-pandemic years during the peak of the first wave, even in jurisdictions with few COVID-19-related deaths in LTC.


Subject(s)
COVID-19 , Pandemics , Canada/epidemiology , Humans , Long-Term Care , SARS-CoV-2
10.
Healthc Pap ; 20(1): 4-7, 2021 09.
Article in English | MEDLINE | ID: covidwho-1524621

ABSTRACT

Across Canada, the long-term care sector has received increased attention since the devastating impact of the COVID-19 pandemic. The now often-cited statistic - 80% of deaths in the first wave occurred among individuals residing in institutional long-term care - is tragic enough and is only compounded by the fact that the number of deaths in long-term care were still higher in the second wave in all but two provinces. Many have argued that the impact of the pandemic was amplified in the institutional long-term care sector because of a number of long-standing shortfalls in funding, space, staffing and infrastructure. For example, Canadian provinces had lower average direct hours of care (three hours per day) provided to residents in long-term care facilities than even the average of four hours per day provided in the United States (Hsu et al. 2016).


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2 , United States
11.
Healthc Pap ; 20(1): 10-14, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524620

ABSTRACT

Given our diversity, it is risky to talk about "Canadian values," but this examination of care for older people does reveal some prominent values evident in how we provide care for this population. Identifying eight of these values, this paper argues that these values are being challenged in the wake of the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Aged , Canada , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2
12.
Healthc Pap ; 20(1): 20-25, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524619

ABSTRACT

The experience of the COVID-19 pandemic has fuelled demands for national threshold standards of quality for long-term care in Canada. The federal government, however, lacks jurisdiction for and experience with the provision of long-term care, which rests constitutionally with the provinces. A creative approach to providing new funding and effective regulatory standard setting would seize the potential of an area of jurisdiction shared by federal and provincial governments - old age security - to establish a long-term care insurance program administered by the federal government and jointly governed by federal and provincial governments.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2
13.
Healthc Pap ; 20(1): 27-33, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524618

ABSTRACT

The COVID-19 pandemic has driven home the serious vulnerabilities plaguing Canada's long-term care system. We argue for significant new federal investments tied to clear, enforceable quality standards (particularly around staffing); new investments in home care so that more people can "age in place"; and additional support for informal care providers, including respite programs and cash benefits. We explore how to achieve these reforms within the framework of Canadian federalism and call for the creation of a national governance framework - overseen by experts independent of federal and provincial governments - tasked with establishing evidence-based standards for the quality, safety and timeliness of long-term care services.


Subject(s)
COVID-19 , Long-Term Care , Canada , Humans , Pandemics , SARS-CoV-2
14.
Healthc Pap ; 20(1): 34-39, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524617

ABSTRACT

For-profit ownership of long-term care (LTC) homes for the elderly is linked to worse outcomes for residents. In Canada, there has been an increase in financialized ownership in which seniors' housing (LTC homes and retirement residences) is run as products for investors. The top 10 firms have doubled their holdings from 2003 to 2020, and currently 33% of seniors' housing (including 22% of LTCs and 42% of retirement homes) is owned by private equity, institutions or other financial firms. The business strategies of these firms drive profits not only from real estate but also from domestic and care operations. During the COVID-19 pandemic, for-profit and financialized operators in Ontario have stood out for having higher death rates in their LTC homes. A radical remaking of the sector is necessary to take the profit out of care.


Subject(s)
COVID-19 , Long-Term Care , Aged , Humans , Nursing Homes , Ontario , Pandemics , SARS-CoV-2
15.
Healthc Pap ; 20(1): 40-50, 2021 09.
Article in English | MEDLINE | ID: covidwho-1524616

ABSTRACT

A coherent workforce strategy and consensus on essential staffing requirements are needed to ensure quality in long-term care (LTC) homes. We have neither in Canada. No Canadian studies, investigator driven or commissioned, exist to guide us. We generally rely on 20-year-old US recommendations, although we have never actually implemented them. During, and in the wake of the COVID-19 pandemic, it is clear that an insufficient workforce was at the root of much of the failure in LTC to manage the pandemic. This commentary frames research on staffing and LTC homes and the impact of COVID-19. It then outlines key ingredients, such as knowledge of residents, the workforce and the care environment, that are needed in order to estimate staffing needs. Recommendations for decision makers are provided.


Subject(s)
COVID-19 , Long-Term Care , Adult , Canada , Humans , Nursing Homes , Pandemics , SARS-CoV-2 , Workforce , Young Adult
16.
Healthc Pap ; 20(1): 59-65, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524615

ABSTRACT

For decades, there have been calls for innovative care solutions to address the growing numbers of people living with complex health and social needs, including dementia. In 2020-2021, the toll of the COVID-19 pandemic on vulnerable populations exposed many of the same issues and spurred renewed calls for transformative change. As we look forward, it is imperative to consider options not just for improving residential long-term care but also for integrating it into broader continuums of health and social care, where people can receive supports and services in the most appropriate setting. This commentary spotlights campuses of care as one homegrown solution to address individuals' and system needs and contexts.


Subject(s)
COVID-19 , Long-Term Care , Humans , Pandemics , SARS-CoV-2 , Social Support
17.
Healthc Pap ; 20(1): 66-77, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524614

ABSTRACT

The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically present to participate in their loved ones' care. There is growing evidence that such policies resulted in harm to residents, family members and staff. The path forward highlights the need for balanced policies and practices to ensure that compassionate, person-centred and partnered care is not lost, whether in times of calm or crisis.


Subject(s)
COVID-19 , Caregivers , Humans , Long-Term Care , Pandemics/prevention & control , SARS-CoV-2
18.
Int J Environ Res Public Health ; 18(21)2021 10 28.
Article in English | MEDLINE | ID: covidwho-1512287

ABSTRACT

Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.


Subject(s)
Long-Term Care , Nursing Homes , Delivery of Health Care , Humans , Quality of Health Care
19.
BMJ ; 374: n2242, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1495341
20.
Int Psychogeriatr ; 33(10): 1005-1007, 2021 10.
Article in English | MEDLINE | ID: covidwho-1492960
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