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“This report aims to provide an overview of data and policies in relation to COVID-19 vaccinations for people who use and provide long-term care. It is a “living report” that will be updated regularly, please email s.e.lauter@lse.ac.uk if you would like to contribute or aware of relevant sources of information.

  • The report shows data for populations that either use and provide long-term care or are likely to do so. So far very few countries routinely share data on the characteristics of people who are receiving vaccinations. In all other countries the data has been announced by official sources to the media.
  • On the 11th January we have found data on COVID-19 vaccinations in care homes for 8 countries, and for some regions/nations in Spain and the United Kingdom.
  • 2 countries (Denmark and Israel) and a region in Spain (Asturias) report having completed first doses of vaccination for all care home residents and staff. Over half of all care home residents are reported to have been given a first dose of vaccine in Catalonia (Spain), Northern Ireland and Scotland, and over a quarter in Croatia, Cyprus and Germany, and close to 15% in Italy and the United States.
  • The share of doses of vaccines given to people living in care homes ranges from 6% in Italy to 73% in Croatia.
  • We have not found official data, so far, on the share of care home residents who either refuse the vaccination, cannot consent or are excluded from vaccination due to other reasons.
  • Initial review of prioritization documents shows that all countries prioritise vaccinations for healthcare staff, and, with slight variations in order, care home residents and staff, older people and, less frequently, people who rely on care in the community and unpaid carers.
  • Indonesia is an exception in that the working age population is currently prioritised and not older people.
  • There are few mentions of people living with dementia or people with learning disabilities.”

The full report is available here

Authors: Shoshana Lauter, Klara Lorenz-Dant, Adelina Comas-Herrera (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science) and Eleonora Perobelli (Observatory on Long-Term Care, CERGAS SDA Bocconi)

“This guidance applies from 2 December 2020 and supersedes previous guidance on visiting policies for care homes.

Visiting is a central part of care home life. It is crucially important for maintaining health and wellbeing and quality of life for residents. Visiting is also vital for family and friends to maintain contact and life-long relationships with their loved ones and contribute to their support and care (often as essential carers).

Welcoming people into care homes from the community inevitably brings infection risk. But that is a risk that care homes can mitigate. It is a risk that should be balanced against the importance of visiting and the benefits it brings to care home residents and their families.

Visiting should be supported and enabled wherever it is possible to do so safely – in line with this guidance and within a care home environment that takes proportionate steps to manage risks.

This means finding the right balance between the benefits of visiting on wellbeing and quality of life, and the risk of transmission of COVID-19 to social care staff and clinically vulnerable residents.

We are distributing rapid (lateral flow) tests to care homes across the country to be used for visitors. Care Quality Commission (CQC) registered care homes will receive these tests during December and have sufficient quantities to test up to 2 visitors per resident, twice a week by Christmas. Visitors will need to arrange visiting with the care home in advance, and will need to be mindful of the additional workload for the care home and that the care home will need to make their own assessments and may develop further policies to ensure the safety of the residents they care for and their staff.

While rapid testing can reduce the risks around visiting it does not completely remove the risk of infection. In addition to using testing, care homes must use robust infection prevention and control (IPC) measures, visitors must continue to wear the appropriate personal protective equipment (PPE) (as described below), observe social distancing in general when in the care home and good hand hygiene, and follow any guidance the care home itself provides on physical contact with the person they are visiting.

This guidance has been developed for the purpose of supporting local system leaders, providers, staff, and families to plan and carry out visits that provide meaningful contact as safely as possible.

Each care home is unique in its physical layout, surrounding environment and facilities. Residents vary in their needs, health and current wellbeing. Care home managers are best placed to decide how visits should happen in their own setting in a way that meets the needs of their residents both individually and collectively.

The individual resident, their views, their needs and wellbeing should be considered for decisions about visiting, while recognising that the care home will need to consider the wellbeing of other residents as well.

These decisions should involve the resident, their family and friends and the provider and other relevant professionals such as social workers or clinicians where appropriate.

All decisions should be taken in light of general legal obligations, such as those under the Equality Act 2010 and Human Rights Act 1998, as applicable. Providers must also have regard to the DHSC ethical framework for adult social care.

We recognise how important visiting is as residents approach the end of their lives. As has been the case throughout the pandemic response, visits in exceptional circumstances such as end of life should continue in all circumstances.

 

For access to the publication click here

“The British Geriatrics Society has just published an update to their good practice guidance, COVID-19: Managing the COVID-19 pandemic in care homes for older people.

The COVID-19 pandemic raises particular challenges for care home residents, their families and the staff that look after them. This guidance has been developed to help care home staff and NHS staff who work with them to support residents through the pandemic. This is Version 4 of the document.

This guidance is written as the United Kingdom moves into the second wave of the COVID-19 pandemic. It is designed to be applicable to care home residents across all four nations of the UK. Residents of care homes for older people have been particularly affected by COVID-19. Across the four nations 28-50% of all COVID-related deaths occurred in care home residents.

This guidance covers the following issues that care home staff are likely to come across when managing COVID-19 in a care home environment:

  1. Infection control
  2. Staff and resident testing
  3. Admissions to care homes
  4. Family visiting
  5. Diagnosing COVID-19 in care homes
  6. Management and treatment of COVID-19 in care homes
  7. Advance Care Planning
  8. End of life care
  9. Continuing routine healthcare

The intended audience includes, but is not limited to, care home staff, primary care teams including general practitioners (GPs), community teams providing care for older people including Hospital At Home teams, hospital discharge teams, and those providing advice on infection control to care homes.

To access this publication click here

A new report published by the Department of Health and Social Care.  Social Care Sector COVID-19 Support Taskforce report on first phase of COVID-19 pandemic. It sets out the progress and learning from the first phase of the COVID-19 pandemic in informing advice and recommendations to government and the social care sector.

“In response to COVID-19, a taskforce for the social care sector was commissioned, beginning its work on 15 June 2020 and completing its work at the end of August 2020. Taskforce membership consisted of leaders from every part of the social care sector and across government.

This report sets out the progress and learning from the first phase of the COVID-19 pandemic in informing advice and recommendations to government and the social care sector.

The report also sets out the action that will need be taken to reduce the risk of transmission of COVID-19 in the sector, both for those who rely on care and support, and the social care workforce.

It details how we can enable people to live as safely as possible while maintaining contacts and activity that enhance the health and wellbeing of service users and family carers”

For access to this report please click here

 

New guidance published on the 25th September by NHS England and NHS Improvement aims to help address the needs of people with dementia in the COVID-19 pandemic. It complements the existing dementia wellbeing pathway and identifies specific actions to be taken at each stage. In addition to identifying key considerations, it also provides links to a wide range of resources, including those developed by NHS England and NHS Improvement, regional dementia clinical networks, the voluntary, community and social enterprise (VCSE) sector and the Department for Health and Social Care.

“This resource is primarily for clinicians working with people with dementia, but can also be used by carers and people with dementia. This document takes the wellbeing pathway and sets out the adjustments and amendments needed to respond to the COVID-19 pandemic. It highlights key priorities and actions for each step in the pathway.”

If you would like to send feedback or have any questions please send them to ENGLAND.DomainTeam@nhs.net.

To read more click here

The Department of Heath and Social Care published the Adult Social Care Policy paper setting out the key elements of national support available for the social care sector for winter 2020 to 2021.  The paper also sets out the main actions to take for NHS organisations, local authorities, and social care providers,  including the voluntary and community sector.

“Working together will ensure that high-quality, safe and timely care is provided to everyone who needs it, whilst protecting people who need care, their carers and the social care workforce from COVID-19.”

The policy paper covers the following:

  1. Our plan for adult social care this winter
  2. Preventing and controlling the spread of infection in care settings
  3. Collaboration across health and care services
  4. Technology and digital support
  5. Supporting people who receive social care, the workforce, and carers
  6. Supporting the system
  7. Care home support plans

For access to the full paper click here

 

In 2019 The Kings Fund published the eight key problems facing social care

These included

  • means testing: social care is not free at point of use like the NHS
  • catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care
  • unmet need: many people go without the care and support they need
  • quality of care: a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control
  • workforce pay and conditions: staff are underpaid, leading to high vacancy rates and turnover
  • market fragility: care providers go out of business or hand back contracts
  • disjointed care: health and care is not integrated around the individual and causes issues such as delayed transfers of care from hospital
  • the ‘postcode lottery’: there is unwarranted variation between places in access to care and its quality

“Now, the Covid-19 pandemic has shone an uncompromising light on the sector, its staff and the people of all ages who use its services. As the sector emerges slowly into a new normal, fearful of a second wave while still trying to make sense of the first, it’s time to take stock.  Analysis is difficult because of the  lack of up-to-date, quantitative data and the ongoing nature of the pandemic.  Nonetheless, in six of those eight areas, Covid-19 has brought significant change and, if anything, exacerbated these challenges.”

To access this publication click here

“In May and June of 2020, a survey of the QNI’s Care Home Nurses Network was carried out by the QNI International Community Nursing Observatory (ICNO) to understand more about the impact of Covid-19 on the Care Home Nurse workforce within the UK. This survey was launched in the early weeks of the pandemic in response to grave concerns about the safety of the workforce and the gaps in provision that it was facing. The survey responses confirm that for the majority of respondents, the pandemic has been a very challenging experience. They indicated that their work and wellbeing has been worse or much worse than at normal times, during the survey period.

Having to accept patients from hospitals with unknown Covid-19 status, being told about plans not to resuscitate residents without consulting families, residents or care home staff, lack of guidance on issues like personal protection and issues of poor access to pay if they became ill were some of the major issues the care home workforce faced during March and April 2020.

While two thirds of respondents said they ‘always’ had access to appropriate personal protective equipment (PPE) and most others said that it was usually available, a small minority were not provided with PPE and had to improvise, by obtaining it themselves or by making it. The need for appropriate PPE in care homes is of critical importance in staff and resident safety: 21% of respondents said that their home accepted people discharged from hospital who had tested positive for Covid-19.

The majority of survey respondents found it easy to access hospital care for their residents when this was required; however, a substantial minority found this difficult or very difficult. Additionally, a substantial number found it difficult to access District Nursing and GP services, which are universal parts of the National Health Service.  In addition, many indicated that they were not able to access essential training from other health professionals at this time.

Some respondents refocused work to consider how they could improve on their approach to end of life care. Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.”

Dr Crystal Oldman CBE, the QNI’s Chief Executive commented:

“The care being delivered in a home can at times be as intensive as in a hospital – in particular for end of life care – and it is hugely skilled work. As the majority of respondents to this survey indicate, the people living in their care homes need a combination of support for complex physical and cognitive needs.

“Overall, as would be expected, the picture presented is of an extremely stressful and anxious period for professionals working to care for and protect their residents. The positives represent a silver lining to this cloud and there are numerous testaments to the skill, dedication, professionalism and teamwork that Care Home Nurses have displayed in 2020. In addition, this brief insight into the experiences of the nurses provides an opportunity to consider and plan for the support systems that may be needed in the anticipated second wave of Covid-19.

“More needs to be done to understand the effect of Covid-19 on the workforce and residents in care homes. Urgent attention must be paid to the sector if the workforce is to withstand the additional demands of the pandemic, particularly in planning, guidance and employment practices.”

For access to the full report click here

 

In a new report Aida Suárez-González, Gill Livingston, Lee-Fay-Low, Suzanne Cahill, Niamh Hennelly, Walter D. Dawson, Wendy Weidner, Martina Bocchetta, Cleusa P. Ferri, Jordi A Matias-Guiu, Suvarna Alladi, Christine Wayua Musyimi, Adelina Comas-Herrera bring together “international evidence on the impact of the COVID-19 pandemic on people living with dementia and an overview of international policy and practice measures to mitigate the impact of COVID-19 among people living with dementia.

The key findings of the cross-country report are:

  • “We have collected data on impact and mortality of COVID-19 in people living with dementia in 9 countries: The United Kingdom (UK), Spain, Ireland, Italy, Australia, the United States (US), India, Kenya and Brazil.
  • The share of people whose deaths were linked to COVID-19 in care homes who had dementia ranges from 29% to 75% across those countries. Within countries, people with dementia account for 25% of all COVID-19 related deaths in England and Wales, 31% in Scotland and 19% in Italy. We did not find nation-level data for the rest of the countries. The high rates of deaths in people living with dementia seem to be linked to death rates in care homes, where many residents have dementia.
  • Direct comparison between countries is not possible due to differences in systems of information: the types of data collected and ways in which they are reported, metrics used and varying definitions of COVID-19 cases and care home facilities. The different approaches to collecting and reporting data across different administrative or autonomous regions within the same nation also hinders the extraction of national-level figures in some countries (e.g. the 4 countries in the UK, the 17 Autonomous Communities in Spain and the different administrative regions in Italy).
  • In many places, the basic human rights of people with dementia may have been compromised during the pandemic. These rights include access to Intensive Care Units, hospital admissions, health care and palliative care. The controversial ban on visits (including spouses and care partners) to care homes across the world, have kept people with dementia detached from essential affective bonds and provision of family care for many months. There is now a pressing need and also an opportunity for innovation, looking at new ways of providing services such as allowing visits to care homes and access to healthcare. Excellent examples of both are contained in this report.
  • Guidelines and tools to support institutions and practitioners to respond better to the needs of people with dementia during the pandemic are needed as a matter of urgency. Confinement, isolation and many of the challenges brought about by the pandemic are detrimental to the cognitive and mental health symptoms in people with dementia across the world, both those living in the community and care homes[1].
  • This report offers a list of short-term and long-term actions needed to ensure that people with dementia are not being left behind in this pandemic or future ones.”

For full access to the report click here

 

The Social Care Institute for Excellence have provided a new resource offering “a dynamic set of practice examples with links to quality-checked guidance and resources” These are designed to support care home and supported living staff to both find and share examples of COVID-19-related good practice.

To access this resource please click here