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1.
Gerontologist ; 60(3): e200-e217, 2020 04 02.
Article in English | MEDLINE | ID: covidwho-1455299

ABSTRACT

BACKGROUND AND OBJECTIVES: In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS: A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS: The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS: Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.


Subject(s)
Homes for the Aged/standards , Nursing Homes/standards , Nursing Staff/statistics & numerical data , Personnel Staffing and Scheduling/statistics & numerical data , Quality of Health Care , Aged , Delivery of Health Care/standards , Humans , Long-Term Care , Workforce
3.
J Am Geriatr Soc ; 69(10): 2716-2721, 2021 10.
Article in English | MEDLINE | ID: covidwho-1325028

ABSTRACT

During the COVID-19 pandemic, frontline nursing home staff faced extraordinary stressors including high infection and mortality rates and ever-changing and sometimes conflicting federal and state regulations. To support nursing homes in evidence-based infection control practices, the Massachusetts Senior Care Association and Hebrew SeniorLife partnered with the Agency for Healthcare Research and Quality AHRQ ECHO National Nursing Home COVID-19 Action Network (the network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes, grouped into nine cohorts of 30-33 nursing homes. Eighty-three percent of eligible nursing homes in Massachusetts participated in the Network, and Hebrew SeniorLife's Training Center served the vast majority. Each cohort was led by geriatrics clinicians and nursing home leaders, and coaches trained in quality improvement. The interactive sessions provided timely updates on COVID-19 infection control best practices to improve care and also created a peer-to-peer learning community to share ongoing challenges and potential solutions. The weekly Network meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and well-being for nursing home staff.


Subject(s)
COVID-19 , Health Personnel , Nursing Homes , Online Social Networking , Resilience, Psychological , Skilled Nursing Facilities , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Education, Distance/methods , Evidence-Based Practice/education , Health Personnel/education , Health Personnel/psychology , Humans , Infection Control/methods , Massachusetts/epidemiology , Nursing Homes/standards , Nursing Homes/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Skilled Nursing Facilities/standards , Skilled Nursing Facilities/trends , Social Support
5.
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
8.
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
10.
Emerg Infect Dis ; 27(4): 1229-1231, 2021 04.
Article in English | MEDLINE | ID: covidwho-1147201

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Fomites/virology , Infection Control , SARS-CoV-2/isolation & purification , Aged , Basic Reproduction Number , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , COVID-19/virology , Child , Child Day Care Centers/standards , Decontamination/methods , Equipment Contamination/prevention & control , Hand Disinfection/methods , Humans , Infection Control/instrumentation , Infection Control/methods , Masks , Nursing Homes/standards , Schools/standards , United States/epidemiology
11.
Eur J Health Law ; 28(1): 81-101, 2021 01 04.
Article in English | MEDLINE | ID: covidwho-1112375

ABSTRACT

This article reflects on COVID-19 restrictions imposed on elders in Ireland through the lens of the right to private and family life (Article 8 ECHR), focusing on stay at home orders and recommendations advising elders to avoid social contact. Furthermore, we examine restrictions on visiting nursing homes given the high death toll in that setting. In our analysis, we zero in on the principles of foreseeability and proportionality, highlighting areas of concern and aspects that we submit should be considered in a proportionality assessment. Ultimately, we argue that it is a mistake to view the COVID-19 pandemic solely as an emergency. In this manner, the solutions suggested through the law - restrictions on movement and visitation bans - are too narrow and fail to address the underlying structures, such as, issues in the healthcare system, the limited home help for elderly and poor conditions in nursing homes.


Subject(s)
COVID-19/prevention & control , Disease Outbreaks/legislation & jurisprudence , Family , Patient Isolation/legislation & jurisprudence , Privacy , Visitors to Patients/legislation & jurisprudence , Aged , Freedom of Movement/legislation & jurisprudence , Homes for the Aged/standards , Humans , Ireland/epidemiology , Nursing Homes/standards
16.
Nurs Ethics ; 28(1): 46-57, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-978876

ABSTRACT

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a set of salient ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood - of residents and staff - are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued.


Subject(s)
COVID-19/epidemiology , Dementia/nursing , Homes for the Aged/standards , Nursing Homes/standards , Aged , Health Policy , Homes for the Aged/ethics , Humans , Male , Nursing Homes/ethics , Pandemics , Qualitative Research , SARS-CoV-2 , United Kingdom
19.
Health Educ Behav ; 47(6): 855-860, 2020 12.
Article in English | MEDLINE | ID: covidwho-885954

ABSTRACT

The concept of "double jeopardy"-being both older and Black-describes how racism and ageism together shape higher risks for coronavirus exposure, COVID-19 disease, and poor health outcomes for older Black adults. Black people and older adults are the two groups most affected by COVID-19 morbidity and mortality. Double jeopardy, as a race- and age-informed analysis, demonstrates how Black race and older age are associated with practices and policies that shape key life circumstances (e.g., racial residential segregation, family and household composition) and resources in ways that embody elevated risk for COVID-19. The concept of double jeopardy underscores long-standing race- and age-based inequities and social vulnerabilities that produce devastating COVID-19 related deaths and injuries for older Black adults. Developing policies and actions that address race- and age-based inequities and social vulnerabilities can lower risks and enhance protective factors to ensure the health of older Black Americans during the COVID-19 pandemic.


Subject(s)
African Americans/statistics & numerical data , Coronavirus Infections/ethnology , Health Status Disparities , Pneumonia, Viral/ethnology , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/mortality , Homes for the Aged/standards , Humans , Male , Middle Aged , Nursing Homes/standards , Pandemics , Pneumonia, Viral/mortality , Religion , SARS-CoV-2 , Social Isolation , Social Segregation/trends , Socioeconomic Factors
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