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2.
Aging Clin Exp Res ; 33(11): 3151-3160, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1525638

ABSTRACT

BACKGROUND: The BNT162b2 SARS-CoV-2 mRNA vaccination has mitigated the burden of COVID-19 among residents of long-term care facilities considerably, despite being excluded from the vaccine trials. Data on reactogenicity (vaccine side effects) in this population are limited. AIMS: To assess reactogenicity among nursing home (NH) residents. To provide a plausible proxy for predicting vaccine response among this population. METHODS: We enrolled and sampled NH residents and community-dwelling healthcare workers who received the BNT162b2 mRNA vaccine, to assess local or systemic reactogenicity and antibody levels (immunogenicity). RESULTS: NH residents reported reactions at a much lower frequency and lesser severity than the community-dwelling healthcare workers. These reactions were mild and transient with all subjects experiencing more local than systemic reactions. Based on our reactogenicity and immunogenicity data, we developed a linear regression model predicting log-transformed anti-spike, anti-receptor-binding domain (RBD), and neutralizing titers, with a dichotomous variable indicating the presence or absence of reported reactions which revealed a statistically significant effect, with estimated shifts in log-transformed titers ranging from 0.32 to 0.37 (all p < 0.01) indicating greater immunogenicity in subjects with one or more reported reactions of varying severity. DISCUSSION: With a significantly lower incidence of post-vaccination reactions among NH residents as reported in this study, the BNT162b2 mRNA vaccine appears to be well-tolerated among this vulnerable population. If validated in larger populations, absence of reactogenicity could help guide clinicians in prioritizing vaccine boosters. CONCLUSIONS: Reactogenicity is significantly mild among nursing home residents and overall, subjects who reported post-vaccination reactions developed higher antibody titers.


Subject(s)
COVID-19 , Vaccines , COVID-19 Vaccines , Health Personnel , Humans , Nursing Homes , RNA, Messenger/genetics , SARS-CoV-2
3.
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
4.
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
5.
Healthc Pap ; 20(1): 78-81, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1524613

ABSTRACT

To date, 35% of coronavirus disease 2019 (COVID-19) deaths in the United States have occurred among nursing home populations (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2763666), compared with 14% in Japan (Werner et al. 2020). How did Japan manage such a low proportion of COVID-19 deaths in nursing homes? The similarity in case-fatality rates among patients with COVID-19 in nursing homes in the two countries (both approximately 16%) suggests that the infection rate in nursing homes in Japan was much lower than in the United States. Therefore, the pandemic unmasked long-standing problems with the quality and financing of US long-term care (LTC) services (Grabowski 2020; Werner et al. 2020). We compare differences between the LTC systems of Japan and the United States, focusing on the measures adopted to protect against COVID-19 in Japan.


Subject(s)
COVID-19 , Pandemics , Humans , Japan , Nursing Homes , Pandemics/prevention & control , SARS-CoV-2 , United States
6.
JAMA Netw Open ; 4(11): e2135379, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1520147

ABSTRACT

Importance: There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data. Objective: To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis. Design, Setting, and Participants: This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality. The cohort included the national population of Medicare patients receiving long-term dialysis in 2020, derived from clinical and administrative databases. COVID-19 was identified through Medicare claims sources. Data were analyzed on May 17, 2021. Main Outcomes and Measures: The 2 main outcomes were COVID-19 and all-cause mortality. Associations of claims-based risk factors with COVID-19 and mortality were investigated prediagnosis and postdiagnosis. Results: Among a total of 498 169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215 935 [43.1%] women and 283 227 [56.9%] men), 60 090 (12.1%) had COVID-19, among whom 15 612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21 787 of 165 830 patients [13.1%]) and Hispanic (13 530 of 86 871 patients [15.6%]) patients compared with non-Black patients (38 303 of 332 339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55 184 patients [14.0%]) and extended (ie, ≥90 days; 10 737 of 30 196 patients [35.6%]) nursing home stays in the prior year. Adjusting for all other risk factors, residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), as was residing in a nursing home for an extended stay (COVID-19: HR, 4.48; 95% CI, 4.37-4.59; mortality: HR, 1.12; 95% CI, 1.07-1.16). Black race (HR vs non-Black: HR, 1.25; 95% CI, 1.23-1.28) and Hispanic ethnicity (HR vs non-Hispanic: HR, 1.68; 95% CI, 1.64-1.72) were associated with significantly higher hazards of COVID-19. Although home dialysis was associated with lower COVID-19 rates (HR, 0.77; 95% CI, 0.75-0.80), it was associated with higher mortality (HR, 1.18; 95% CI, 1.11-1.25). Conclusions and Relevance: These results shed light on COVID-19 risk factors and outcomes among Medicare patients receiving long-term chronic dialysis and could inform policy decisions to mitigate the significant extra burden of COVID-19 and death in this population.


Subject(s)
COVID-19/etiology , Kidney Diseases/mortality , Medicare , Renal Dialysis , Aged , COVID-19/epidemiology , COVID-19/mortality , Ethnic Groups , Female , Humans , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Male , Middle Aged , Nursing Homes , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2 , United States/epidemiology
7.
PLoS One ; 16(11): e0260055, 2021.
Article in English | MEDLINE | ID: covidwho-1518367

ABSTRACT

BACKGROUND: A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. METHODS: Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. RESULTS: Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. CONCLUSIONS: Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.


Subject(s)
COVID-19/epidemiology , Caregivers , Nursing Homes , Pandemics , Adult , Female , Health Facilities , Humans , Male , Middle Aged , Nursing Staff , Risk Factors , Young Adult
8.
Int J Environ Res Public Health ; 18(21)2021 11 01.
Article in English | MEDLINE | ID: covidwho-1512294

ABSTRACT

This study aimed to identify the terminologies of NANDA-I, NOC, NIC, and NNN linkages that have been used for nursing home (NH) residents. This study used a retrospective descriptive design. Data accrued from 57 registered nurses (RNs) in 25 Korean NHs. The RNs randomly selected one resident and assessed for applied NANDA-I, NOC, and NIC from the previous 7 days by reviewing nursing charts and records. Finally, the data of 57 residents in 25 NHs were collected. Results: We identified seven NNN linkages: risk for falls-fall prevention behavior-fall prevention; self-care deficit: bathing/hygiene-self-care: activities of daily living (ADL)-self-care assistance: bathing/hygiene; impaired memory-memory-cognitive stimulation; chronic confusion-neurological status: consciousness-medication management; chronic confusion-memory-medication management; impaired walking-mobility-exercise promotion: strength training; and impaired walking-ambulation-exercise promotion: strength training. The identified core NANDA-I, NOC, NIC, and NNN linkages for NH residents from this study provide a scope of practice of RNs working in NHs.


Subject(s)
Standardized Nursing Terminology , Activities of Daily Living , Humans , Nursing Diagnosis , Nursing Homes , Republic of Korea , Retrospective Studies
9.
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
10.
Int J Environ Res Public Health ; 18(21)2021 10 27.
Article in English | MEDLINE | ID: covidwho-1512285

ABSTRACT

The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents' ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents' abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.


Subject(s)
Dementia , Inpatients , Aged , Aged, 80 and over , Cross-Sectional Studies , Humans , Nursing Homes , Workforce
12.
BMC Geriatr ; 21(1): 610, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1486553

ABSTRACT

BACKGROUND: The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. METHODS: A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. RESULTS: 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. CONCLUSIONS AND IMPLICATIONS: 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.


Subject(s)
COVID-19 , Aged , Aged, 80 and over , Female , Geriatric Assessment , Humans , Male , Nursing Homes , Referral and Consultation , SARS-CoV-2
13.
BMC Health Serv Res ; 21(1): 1153, 2021 Oct 25.
Article in English | MEDLINE | ID: covidwho-1484313

ABSTRACT

INTRODUCTION: Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff's experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. METHODS: Semi-structured interviews and thematic analysis. RESULTS: We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. CONCLUSION: Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.


Subject(s)
COVID-19 , Long-Term Care , Humans , Nursing Homes , Qualitative Research , SARS-CoV-2
14.
Int J Environ Res Public Health ; 18(21)2021 Oct 23.
Article in English | MEDLINE | ID: covidwho-1480767

ABSTRACT

Evaluating the use and impact of telemedicine in nursing homes is necessary to promote improvements in the quality of this practice. Even though challenges and opportunities of telemedicine are increasingly becoming well documented for geriatrics (such as improving access to healthcare, patient management, and education while reducing costs), there is still limited knowledge on how to better implement it in an inter-organizational context, especially when considering nursing homes. In this regard, this study aimed first to describe the telemedicine activity of nursing homes when cooperating with a general hospital; and then understand the behavioral differences amongst nursing homes while identifying critical factors when implementing a telemedicine project. We conducted a sequential, explanatory mixed-method study using quantitative then qualitative methods to better understand the results. Three years of teleconsultation data of twenty-six nursing homes (15 rural and 11 urban) conducting teleconsultations with a general hospital (Troyes Hospital, France) were included for the quantitative analysis, and eleven telemedicine project managers for the qualitative analysis. Between April 2018 and April 2021, 590 teleconsultations were conducted: 45% (n = 265) were conducted for general practice, 29% (n = 172) for wound care, 11% (n = 62) for diabetes management, 8% (n = 47) with gerontologist and 6% (n = 38) for dermatology. Rural nursing homes conducted more teleconsultations overall than urban ones (RR: 2.484; 95% CI: 1.083 to 5.518; p = 0.03) and included more teleconsultations for general practice (RR: 16.305; 95% CI: 3.505 to 73.523; p = 0.001). Our qualitative study showed that three critical factors are required for the implementation of a telemedicine project in nursing homes: (1) the motivation to perform teleconsultations (in other words, improving access to care and cooperation between professionals); (2) building a relevant telemedicine medical offer based on patients' and treating physicians' needs; and (3) it's specific organization in terms of time and space. Our study showed different uses of teleconsultations according to the rural or urban localization of nursing homes and that telemedicine projects should be designed to consider this aspect. Triggered by the COVID-19 pandemic, telemedicine projects in nursing homes are increasing, and observing the three critical factors presented above could be necessary to limit the failure of such projects.


Subject(s)
COVID-19 , Telemedicine , Hospitals, General , Humans , Nursing Homes , Pandemics , SARS-CoV-2
15.
Acta Biomed ; 92(S6): e2021445, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1478882

ABSTRACT

INTRODUCTION: Nursing home residents were the most vulnerable population to be affected by Coronavirus disease 2019 (COVID-19) in Italy. The Italian vaccination strategy decided to indicate them as the target population in the first phase of the massive vaccination campaign. We carried out an analysis on an outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection which occurred in a nursing home in northern Italy (Cremona) after the administration of the complete vaccination cycle affecting most of the guests of the structure. METHODS: Data relating to the outbreak were obtained through the Regional Surveillance System for Infectious Diseases of Lombardia Region. RESULTS: During the outbreak, among the 61 guests, 56 were vaccinated. Thirty four were found positive for COVID-19: 22 were asymptomatic, 12 were symptomatic and 4 died. The observed difference in the number of deaths between vaccinated and non-vaccinated subjects was significant. During the outbreak 104 healthcare workers (HCWs) were employed in the nursing home, only 66 were vaccinated. Eight HCWs were found COVID-19 positive, 4 of them were vaccinated and of female gender. CONCLUSIONS: Similarly to data reported in literature for described outbreaks, we observed that the vaccine is able to protect from the symptomatic form and a valid antibody response protect from a symptomatic disease. The low number of HCWs found positive indicates a correct use of individual protective devices.


Subject(s)
COVID-19 , Disease Outbreaks , Female , Health Personnel , Humans , Nursing Homes , SARS-CoV-2
16.
PLoS One ; 16(3): e0249098, 2021.
Article in English | MEDLINE | ID: covidwho-1477519

ABSTRACT

BACKGROUND: Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. METHODS: A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. RESULTS: NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling 'trapped' between IPC and the residents' wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. CONCLUSION: This study revealed the insights of residents' and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents' mental health impact and to enhance their quality of life.


Subject(s)
COVID-19/pathology , Nursing Staff/psychology , Quality of Life , Vulnerable Populations/psychology , Aged , Aged, 80 and over , Anxiety/etiology , COVID-19/virology , Depression/etiology , Female , Focus Groups , Humans , Interviews as Topic , Male , Middle Aged , Nursing Homes , Personal Autonomy , Protective Devices/supply & distribution , Quarantine , SARS-CoV-2
17.
BMC Geriatr ; 21(1): 588, 2021 10 22.
Article in English | MEDLINE | ID: covidwho-1477265

ABSTRACT

BACKGROUND: To protect nursing home residents, many governments around the world implemented blanket visitor bans in March and April 2020. As a consequence, family caregivers, friends, and volunteers were not allowed to enter nursing homes, while residents were not allowed to go out. Up until now, little is known on the long-term consequences and effects of visiting bans and re-opening of nursing homes. The aim of the study was to assess the long-term effects of the pandemic on residents, family members, and staff, and their preparedness for the next coronavirus wave. METHODS: A mixed-methods approach was used, consisting of a questionnaire and analyses of documentation (local visiting protocols). Of the 76 nursing home locations that participated in a Dutch national pilot on welcoming visitors back into nursing homes, 64 participated in this follow-up study. Data were collected in September/October 2020. For each nursing home, one contact person completed the questionnaire. Descriptive statistics were calculated for quantitative questionnaire data. Data on open-ended questions, as well as data from the documentation, were analyzed thematically. RESULTS: The study demonstrated that the consequences of strict visiting bans do not disappear at the moment the visiting ban is lifted. Although in October 2020, daily life in nursing homes was more "back to normal," more than one-third of the respondents indicated that they still applied restrictions. Compared to the situation before the pandemic, fewer volunteers were working in the nursing homes, grandchildren visited their relative less often, and visits differed. CONCLUSIONS: Five months after the visiting ban in Dutch nursing homes had been lifted, it still had an impact on residents, family members, and staff. It is questionable whether nursing homes feel prepared for welcoming visitors in the case of new COVID-19 infections. Nursing homes indicated that they felt prepared for the next wave, while at the same time, they were particularly concerned about staff well-being and vitality. It seems wise to invest in staff well-being. In addition, it seems desirable to think about how to support nursing homes in seeking a balance between infection prevention and well-being of residents, family members, and staff.


Subject(s)
COVID-19 , Follow-Up Studies , Humans , Nursing Homes , Pandemics , SARS-CoV-2
18.
BMJ Open ; 11(10): e047012, 2021 10 18.
Article in English | MEDLINE | ID: covidwho-1476597

ABSTRACT

OBJECTIVES: The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. SETTING: Long-term care facilities. PARTICIPANTS: Residents, staff and visitors of facilities. PRIMARY AND SECONDARY OUTCOME MEASURES: Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. RESULTS: The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents. CONCLUSIONS: Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF. PROSPERO REGISTRATION NUMBER: CRD42020191569.


Subject(s)
COVID-19 , Aged , Humans , Long-Term Care , Nursing Homes , Pandemics , SARS-CoV-2
19.
Am J Nurs ; 121(11): 69, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1475857

ABSTRACT

According to this study: A higher number of nursing home staff members was associated with a higher number of COVID-19 cases, independent of the size of the facility.Decreasing the number of staff members but not the number of direct care hours could help improve patient safety.


Subject(s)
COVID-19/epidemiology , Nursing Homes/organization & administration , Nursing Staff/organization & administration , COVID-19/prevention & control , COVID-19/transmission , Humans
20.
N Engl J Med ; 385(20): e71, 2021 11 11.
Article in English | MEDLINE | ID: covidwho-1467181
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