The impact of the COVID-19 pandemic on the residential aged care sector, responses and recommendations: A systematic scoping review (preprint)

ABSTRACT

Objective: This systematic scoping review sought to identify the impact of the COVID-19 pandemic on the residential aged care (RAC) sector, its system components, and the range of COVID-19 response strategies across the sector.  Methods: ProQuest, PubMed, CINAHL, Google Scholar and Cochrane Central were searched April-August 2022 for peer reviewed articles and grey literature. One hundred and forty six articles on the impact of the COVID-19 pandemic on the RAC sector and sector interventions/policy responses are included in this review.  Results:The World Health Organization’s (WHO) six building blocks of health systems were used to categorise impacts and interventions. The COVID-19 pandemic generally highlighted poor resourcing of the RAC sector and exacerbated workforce shortages; led to increased workload, changes in job demand and declines in worker mental health; revealed poor integration across health and aged care sectors and reduced advance care and palliative care planning. Social restriction measures led to declines in the physical, mental health and cognitive decline of residents in RACFs, in particular those with cognitive impairment. Innovative care models included the introduction of outreach teams and primary care models for RACFs and increased use of telehealth and videoconferencing for social engagement, although there was mixed evidence on the use of telehealth for people with cognitive impairment. Discussion: Additional funding of the RAC sector is required to boost workforce numbers and training, and support worker mental health, along with policies which attract, maintain and support workers from culturally and linguistically diverse (CALD) backgrounds. COVID-19 response strategies in RACFs need to ensure that all residents have access to resources such as telehealth for health and social engagement, including residents with cognitive impairment. Clear guidelines and additional resourcing are required for utilisation of telehealth during a pandemic. Additional research on appropriate COVID-19 responses for residents with cognitive impairment is required, along with a balance between infection prevention and control and social engagement strategies.