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2.
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
3.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434765

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
7.
J Hosp Palliat Nurs ; 23(5): 455-461, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1328958

ABSTRACT

This discussion article highlights the challenges of providing hospice care in nursing homes since the start of the COVID-19 (coronavirus disease 2019) pandemic and illuminates practice changes needed in nursing homes. The article provides an overview of the expectations of hospice care, explains the differences in delivering hospice care during the COVID-19 pandemic, examines social isolation and emotional loneliness and the role of familial caregivers, and describes policy changes related to the COVID-19 affecting hospice care delivery in nursing homes. This article answers the following questions: (1) How did residents receiving hospice care have their needs met during the COVID-19 pandemic? (2) What areas of nursing home care need to be improved through governmental policy and restructuring? This article also summarized the lessons learned as a result of the COVID-19 pandemic and provided practical implications for nursing, specific to changes in hospice care deliveries for nursing home residents.


Subject(s)
COVID-19/prevention & control , Hospice Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Palliative Care/statistics & numerical data , Quality of Life , Aged , COVID-19/epidemiology , COVID-19/psychology , Female , Hospice Care/organization & administration , Humans , Loneliness/psychology , Male , Needs Assessment , Nursing Homes/organization & administration , Pandemics , SARS-CoV-2 , Social Isolation/psychology
9.
J Am Geriatr Soc ; 69(10): 2708-2715, 2021 10.
Article in English | MEDLINE | ID: covidwho-1301523

ABSTRACT

COVID-19 has exacted a disproportionate toll on the health of persons living in nursing homes. Healthcare providers and other decision-makers in those settings must refer to multiple evolving sources of guidance to coordinate care delivery in such a way as to minimize the introduction and spread of the causal virus, SARS-CoV-2. It is essential that guidance be presented in an accessible and usable format to facilitate its translation into evidence-based best practice. In this article, we propose the Haddon matrix as a tool well-suited to this task. The Haddon matrix is a conceptual model that organizes influencing factors into pre-event, event, and post-event phases, and into host, agent, and environment domains akin to the components of the epidemiologic triad. The Haddon matrix has previously been applied to topics relevant to the care of older persons, such as fall prevention, as well as to pandemic planning and response. Presented here is a novel application of the Haddon matrix to pandemic response in nursing homes, with practical applications for nursing home decision-makers in their efforts to prevent and contain COVID-19.


Subject(s)
COVID-19 , Civil Defense/organization & administration , Evidence-Based Practice , Homes for the Aged/organization & administration , Infection Control , Models, Organizational , Nursing Homes/organization & administration , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Evidence-Based Practice/methods , Evidence-Based Practice/trends , Health Services for the Aged/organization & administration , Health Services for the Aged/standards , Health Services for the Aged/trends , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Organizational Innovation , SARS-CoV-2 , United States
10.
Geriatr Nurs ; 42(4): 887-893, 2021.
Article in English | MEDLINE | ID: covidwho-1258372

ABSTRACT

BACKGROUND: First-line nursing staff are responsible for protecting residents, the most vulnerable population, from COVID-19 infections. They are at a high risk of being infected with COVID-19 and experience high levels of psychological distress. AIMS: To explore the challenges and coping strategies perceived by nursing staff during the COVID-19 pandemic in China. METHODS: In April,2020, we conducted a qualitative study using in-depth semi-structured interviews with nursing staff. Participants were selected from seven nursing homes in three cities in Hunan Province, China. RESULTS: A total of 21 nursing staff participated in the study, including seven nurse managers, seven registered nurses and seven nursing assistants. Three main themes were identified. Different groups encountered different sources of stress and adopted various coping strategies to fulfil their responsibilities. CONCLUSIONS: Nursing home staff were underprepared for dealing with COVID-19-related challenges. Educational programs to improve the ability to deal with COVID-19 prevention and control are needed.


Subject(s)
Adaptation, Psychological , Burnout, Professional/psychology , COVID-19/nursing , COVID-19/psychology , Nursing Homes/organization & administration , Nursing Staff/psychology , Stress, Psychological , COVID-19/epidemiology , China , Female , Humans , Interviews as Topic , Pandemics , Perception , Qualitative Research , SARS-CoV-2
11.
Med Anthropol ; 40(5): 389-403, 2021 07.
Article in English | MEDLINE | ID: covidwho-1246495

ABSTRACT

Over 80% of Canadian COVID-19 first wave deaths occurred in long-term care homes. Focussing on Ontario, I trace the antecedents of the COVID-19 crisis in long-term care and document experiences of frontline staff and family members of residents during the pandemic. Following Povinelli, I argue that the marginalization of both residents and workers in Ontario's long-term care system over two decades has eroded possibilities for recognition of their personhood. I also question broader societal attitudes toward aging, disability and death that make possible the abandonment of the frail elderly.


Subject(s)
COVID-19/epidemiology , Nursing Homes/organization & administration , Nursing Homes/standards , SARS-CoV-2 , Aged , Aged, 80 and over , Attitude to Health , Frail Elderly , Health Personnel/psychology , Humans , Nurses/supply & distribution , Nursing Homes/economics , Ontario/epidemiology , Workforce , Workload
12.
Nurs Older People ; 33(5): 20-25, 2021 Oct 05.
Article in English | MEDLINE | ID: covidwho-1234917

ABSTRACT

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older people were discharged from hospitals to care homes to release NHS beds. This influx of new residents whose COVID-19 status was largely unknown added to the many challenges already experienced by care homes, with serious consequences including an increased number of deaths among residents. The social care sector has been fragile for several years and the pandemic has brought the challenges experienced by care homes to the forefront, prompting renewed calls for improved funding and reform. This article describes the ongoing challenges and additional challenges caused by the pandemic in the care home sector. The authors argue for urgent reform to enhance the status and education of care home staff, move towards registration of the social care workforce in England, and achieve integration of health and social care services for older people.


Subject(s)
COVID-19/epidemiology , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Nursing Staff/education , Pandemics , Aged , England/epidemiology , Humans , State Medicine/organization & administration
15.
J Soc Work End Life Palliat Care ; 17(2-3): 173-185, 2021.
Article in English | MEDLINE | ID: covidwho-1177220

ABSTRACT

Comfort care homes are community-run, residential homes that provide end-of-life care to terminally ill individuals who lack safe, secure housing and a reliable caregiver system. As nonprofit, non-medical facilities, these homes have faced both new and magnified challenges due to the COVID-19 pandemic. This article highlights the value of collaborative interagency partnerships and shares reflections on the unique pandemic pressures faced by comfort care homes. Innovative ideas for improving community-based end-of-life care and implications for social work practice are included.


Subject(s)
COVID-19/therapy , Caregivers/psychology , Nursing Homes/organization & administration , Patient Comfort/methods , Terminal Care/methods , COVID-19/psychology , Clinical Competence , Humans , Palliative Care/methods , Terminal Care/psychology
17.
J Aging Health ; 33(7-8): 607-617, 2021.
Article in English | MEDLINE | ID: covidwho-1166845

ABSTRACT

The COVID-19 pandemic has exerted a disproportionate effect on older European populations living in nursing homes. This article discusses the 'fatal underfunding hypothesis', and reports an exploratory empirical analysis of the regional variation in nursing home fatalities during the first wave of the COVID-19 pandemic in Spain, one of the European countries with the highest number of nursing home fatalities. We draw on descriptive and multivariate regression analysis to examine the association between fatalities and measures of nursing home organisation, capacity and coordination plans alongside other characteristics. We document a correlation between regional nursing home fatalities (as a share of excess deaths) and a number of proxies for underfunding including nursing home size, occupancy rate and lower staff to a resident ratio (proxying understaffing). Our preliminary estimates reveal a 0.44 percentual point reduction in the share of nursing home fatalities for each additional staff per place in a nursing home consistent with a fatal underfunding hypothesis.


Subject(s)
COVID-19/mortality , Capacity Building , Capital Financing , Nursing Homes , Aged , Female , Health Services Needs and Demand , Humans , Long-Term Care/economics , Male , Mortality , Nursing Homes/organization & administration , Nursing Homes/standards , Nursing Homes/statistics & numerical data , Personnel Staffing and Scheduling/standards , SARS-CoV-2 , Spain/epidemiology
18.
Nurs Outlook ; 69(5): 735-743, 2021.
Article in English | MEDLINE | ID: covidwho-1164278

ABSTRACT

COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents' care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Infection Control/organization & administration , Nursing Homes/organization & administration , Nursing Staff/organization & administration , Quality of Health Care/organization & administration , Aged , COVID-19/transmission , Humans , Personnel Staffing and Scheduling , United States
19.
J Am Med Dir Assoc ; 22(4): 886-892, 2021 04.
Article in English | MEDLINE | ID: covidwho-1155515

ABSTRACT

Long-term services and supports for older persons in the United States are provided in a complex, racially segregated system, with striking racial disparities in access, process, and outcomes of care for residents, which have been magnified during the Coronavirus Disease 2019 pandemic. These disparities are in large measure the result of longstanding patterns of structural, interpersonal, and cultural racism in US society, which in aggregate represent an underpinning of systemic racism that permeates the long-term care system's organization, administration, regulations, and human services. Mechanisms underlying the role of systemic racism in producing the observed disparities are numerous. Long-term care is fundamentally tied to geography, thereby reflecting disparities associated with residential segregation. Additional foundational drivers include a fragmented payment system that advantages persons with financial resources, and reimbursement policies that systematically undervalue long-term care workers. Eliminating disparities in health outcomes in these settings will therefore require a comprehensive approach to eliminating the role of systemic racism in promoting racial disparities.


Subject(s)
Healthcare Disparities , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Racism , Aged , Aged, 80 and over , COVID-19 , Humans , United States
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