ENRICHEnabling Research in Care Homes
“The COVID-19 pandemic has disproportionately affected older people with 90% of deaths from COVID occurring in those aged over 65. It should therefore come as no surprise that BGS members – geriatricians, GPs, nurses, allied health professionals, care home staff and other healthcare professionals working with older people – have been among those most involved in the treatment of people with COVID, both in hospitals and in the community.
BGS members reflected on the practical elements of managing the pandemic, including variable access to personal protective equipment (PPE) and testing for staff and patients and the confusion caused by constantly changing guidance. Concern about the impact of COVID-19 in care homes was a source of anxiety, and the implication that discharge from hospitals to care homes early in the pandemic without negative COVID tests contributed to outbreaks.
More than three quarters (77%) of respondents stated that they had had a change in their job plan or rota due to the pandemic. This took the form of increased out-of-hours work, cancellation of scheduled clinics and treating all adults as opposed to older adults only. While some volunteered for these changes, others had them imposed and it will be important to ensure that regular rotas are restored as quickly as possible. Concerns about future careers were also expressed with many trainees describing a lack of training opportunities over the past year.”
Read more here
“Many older people in care homes report feeling lonely and socially isolated. Loneliness can have a negative impact on health outcomes and can lead to depression and increased confusion and memory loss (cognitive decline).
The internet, and video technologies such as Skype, FaceTime, or Zoom, can connect people to loved ones, or allow new social ties. But older people in care homes may be unfamiliar with the technology.
Many care homes run quizzes as a form of entertainment and mental stimulation. This research looked at virtual quizzes involving several care homes to improve socialisation. It explored whether the quizzes were feasible and beneficial.
This NIHR study is the first study to trial connecting care homes virtually via quiz sessions. Interviews revealed that residents felt more connected with each other, and with other care homes. They re-gained a sense of self and purpose and felt less lonely. Care home staff were eager to continue with the sessions, but they outlined barriers such as lack of staff support or time.
Unlike previous research into virtual socialising, this study included residents with dementia. It found that they benefited and remembered faces and conversations.
Four themes emerged from interviews with staff and residents:
- Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
- Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
- Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
- The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.
Staff were keen to run virtual quizzes following the end of the study but said a lack of available staff and support could be a barrier. They saw positive effects on residents and enjoyed the competitive nature of the quiz themselves. They liked being able to get to know staff from other homes, and felt that the quizzes could help care homes connect with each other.”
For more information this study click here
“Most countries have restricted visits to care homes to prevent COVID-19 infections, however, concern is increasing about the negative impact of these restrictions on the health and wellbeing of care home residents and their families.
We carried out a rapid review of evidence to address three questions:
- What is the evidence on the impact of visitors in terms of infections in care homes?
- We found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions.
- What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents?
- There is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans.
- What has been the impact of restricting visits on quality of care?
- There is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff.
Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections.
Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning.
In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.”
More more information click here for the LTC Covid website
This webinar produced by LTC Covid explores the experiences on safe visiting in care homes during COVID-19 in Australia, the Netherlands, Canada, the UK and USA, and presents evidence-base recommendations to inform care homes and government policies on visiting in care homes during this and future pandemics, building on a recent international report.
For access to the webinar click here
“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 email@example.com 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:
- Infection control
- Staff and resident testing
- Admissions to care homes
- Family visiting
- Diagnosing COVID-19 in care homes
- Management and treatment of COVID-19 in care homes
- Advance Care Planning
- End of life care
- 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:
- Our plan for adult social care this winter
- Preventing and controlling the spread of infection in care settings
- Collaboration across health and care services
- Technology and digital support
- Supporting people who receive social care, the workforce, and carers
- Supporting the system
- Care home support plans
For access to the full paper click here