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Brazier JF, White EM, Meehan A, Shield RR, Grabowski DC, Rahman M, Gadbois EA. Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:105071. [PMID: 38852611 DOI: 10.1016/j.jamda.2024.105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE To examine nursing home administrator perspectives of infection control practices in nursing homes at the height of the COVID-19 pandemic and characterize lessons learned. DESIGN Descriptive qualitative study. SETTING AND PARTICIPANTS Administrators from 40 nursing homes across 8 diverse health care markets in the United States. METHODS Semistructured interviews were conducted via telephone or Zoom with nursing home administrators. Interviews were repeated at 3-month intervals, for a total of 4 interviews per participant between July 2020 and December 2021 (n = 156). Qualitative analysis of interview transcripts used modified grounded theory and thematic analysis to identify overarching themes. RESULTS Three major themes emerged reflecting administrator experiences managing infection control practices and nursing home operations at the height of the COVID-19 pandemic. First, administrators reported that the more stringent infection control protocols implemented to manage and mitigate COVID-19 at their facilities increased awareness and understanding of the importance of infection control; second, administrators reported incorporating higher standards of infection control practices into facility-level policies, emergency preparedness plans, and staff training; and third, administrators said they and their executive leadership were reevaluating and upgrading their facilities' physical structures and operational processes for better infection control infrastructure in preparation for future pandemics or other public health crises. CONCLUSIONS AND IMPLICATIONS Insights from this study's findings suggest important next steps for restructuring and improving nursing home infection control protocols and practices in preparation for future pandemics and public health emergencies. Nursing homes need comprehensive, standardized infection control training and upgrading of physical structures to improve ventilation and facilitate isolation practices when needed. Furthermore, nursing home emergency preparedness plans need better integration with local, state, and federal agencies to ensure effective communication, proper resource tracking and allocation, and coordinated, rapid response during future public health crises.
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Affiliation(s)
- Joan F Brazier
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Elizabeth M White
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Amy Meehan
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Renee R Shield
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Momotazur Rahman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Emily A Gadbois
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Longacre ML, Redington S, Miller MF. Participation in a social cluster program among persons in residential living at a continuing care retirement community during COVID. Geriatr Nurs 2024; 59:181-186. [PMID: 39018962 DOI: 10.1016/j.gerinurse.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/19/2024]
Abstract
A Continuing Care Retirement Community (CCRC) initiated a voluntary cohort or "social cluster" (SC) program during the pre-vaccination phase of COVID. SCs are self-selected small groups of persons who decide about types of social interactions. The program began in April 2020, and a cross-sectional survey of residents was conducted in November 2020 to assess perceptions of COVID (e.g., worry and prevention) and of program participation. A secondary goal was to explore if program involvement was associated with perceptions of social isolation. Participants (n = 85) were "somewhat" (49 %) or "very" (11 %) worried about COVID, and 34 % participated in a SC. 89 % of the SC participants indicated that "Dining within 6ft" was most preferred. Improvement in boredom, social isolation, activity level, mental health, hope, and fear was noted among some SC participants (55 %, 52 %, 41 %, 38 %, and 14 %, respectively). Findings contribute to understanding social engagement needs amidst COVID.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038.
| | - Suzanne Redington
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038
| | - Melissa F Miller
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038; Inova Life with Cancer, Inova Schar Cancer Institute, Fairfax, VA 22031
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Goodwin JS, Xu H. COVID-19 in Nursing Homes-Learning the Hard Way. JAMA Intern Med 2024; 184:808-809. [PMID: 38829626 DOI: 10.1001/jamainternmed.2024.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- James S Goodwin
- Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston
| | - Huiwen Xu
- Department of Population Health and Health Disparities, The University of Texas Medical Branch at Galveston, Galveston
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston
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Garbin AJ, DeVone F, Bayer TA, Stevens-Lapsley J, Abul Y, Singh M, Leeder C, Halladay C, McConeghy KW, Gravenstein S, Rudolph JL. Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:105120. [PMID: 38945171 DOI: 10.1016/j.jamda.2024.105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/05/2024] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Examine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs). DESIGN Retrospective cohort study using Minimum Data Set (MDS) 3.0 assessments. SETTINGS AND PARTICIPANTS 12,606 Veterans in 133 VA CLCs between September 2019 and September 2020. METHODS Difference in physical function [MDS Activities of Daily Living Score (MDS-ADL)] and PT use (minutes in past 7 days) from admission to last assessment in a period were compared between the pre-CoVID-19 (September 2019 to February 2020) and early CoVID-19 (April 2020 to September 2020) period using mixed effects regression with multivariable adjustment. Assessments after a positive CoVID-19 test were excluded. Differences were examined in the sample and repeated after stratifying into short- and long-stay stratums. RESULTS Veterans admitted during early CoVID-19 had more comorbidities, worse MDS-ADL scores, and were more often long-stay residents compared with those admitted during pre-CoVID-19. In comparison to pre-CoVID-19, Veterans in VA CLCs during early CoVID-19 experienced greater improvements in their MDS-ADL (-0.49 points, 95% CI -0.27, -0.71) and received similar minutes of therapy (2.6 minutes, 95% CI -0.8, 6.0). Stratification revealed short-stay residents had relative improvements in their function (-0.69 points, 95% CI -0.44, -0.94) and higher minutes of PT (5.1 minutes, 95% CI 0.9, 9.2) during early CoVID-19 whereas long-stay residents did not see differences in functional change (0.08 points, 95% CI -0.36, 0.51) or PT use (-0.6 minutes, 95% CI -6.1, 4.9). CONCLUSIONS AND IMPLICATIONS During early CoVID-19, physical function improved while the amount of PT received was maintained compared with pre-CoVID-19 for Veterans in VA CLCs. Short-stay residents experienced greater improvements in physical function and increases in PT use. These findings may be partly due to selection bias relating to Veterans admitted to CLCs during early CoVID-19.
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Affiliation(s)
- Alexander J Garbin
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
| | - Frank DeVone
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer Stevens-Lapsley
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Yasin Abul
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ciera Leeder
- Department of Medicine and Geriatrics, Clifton Springs Hospital, Clifton Springs, NY, USA
| | - Christopher Halladay
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - Kevin W McConeghy
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
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Meehan A, Brazier JF, Grabowski DC, Rahman M, Shield RR, Gadbois EA. Administrator Perspectives on the Impact of COVID-19 on the Administration of the Patient Driven Payment Model in U.S. Skilled Nursing Facilities. Med Care Res Rev 2024; 81:223-232. [PMID: 38419595 DOI: 10.1177/10775587241233018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The Patient Driven Payment Model (PDPM) was implemented in U.S. skilled nursing facilities (SNFs) in October 2019, shortly before COVID-19. This new payment model aimed to reimburse SNFs for patients' nursing needs rather than the previous model which reimbursed based on the volume of therapy received. Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021, this qualitative study clarifies the impact of COVID-19 on the administration of PDPM at SNFs. Interview data were analyzed using modified grounded theory and thematic analysis. Our findings show that SNF administrators shifted focus from management of the PDPM to COVID-19-related delivery of care adaptations, staff shortfalls, and decreased admissions. As the pandemic abated, administrators re-focused their attention to PDPM. Policy makers should consider the continued impacts of the pandemic at SNFs, particularly on delivery of care, admissions, and staffing, on the ability of SNF administrators to administer a new payment model.
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Kunkle R, Xu H, Thomas LE, Webb LE, O'Brien EC, Geary CR. Nursing Home Workers' Experience During the COVID-19 Pandemic. Res Gerontol Nurs 2024; 17:131-140. [PMID: 38815218 DOI: 10.3928/19404921-20240423-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE To understand nursing home workers' experience during the coronavirus disease 2019 (COVID-19) pandemic and investigate the prevalence of health-related quality of life, emotional distress, job satisfaction, and the impact of the pandemic. METHOD The Healthcare Worker Exposure Response and Outcomes (HERO) Registry served as the data source for this descriptive cross-sectional analysis. Recruitment was conducted nationally. Eligible nursing home workers (N = 1,409) enrolled in the study online, self-reported demographic and employment characteristics, and completed electronic surveys. RESULTS Nursing home workers reported overall good physical health, frequent depressive symptoms, burnout, and a high prevalence of feeling tired, stressed, having trouble sleeping, and feeling worried. Age and race were found to be positively associated with the impact of the pandemic. CONCLUSION Findings demonstrate the difficulties and challenges nursing home workers faced during the COVID-19 pandemic. Future research needs to evaluate the relationships among nursing home workers' roles, mental health, depressive symptoms, and prevalence of burnout with a larger, more diverse sample. [Research in Gerontological Nursing, 17(3), 131-140.].
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Stone PW, Zhao S, Chastain AM, Perera UG, Shang J, Glance L, Dick AW. State- and Territory-Level Nursing Home and Home Health Care COVID-19 Policies and Disease Burden. JAMA Netw Open 2024; 7:e247683. [PMID: 38648063 PMCID: PMC11036140 DOI: 10.1001/jamanetworkopen.2024.7683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/17/2024] [Indexed: 04/25/2024] Open
Abstract
This cross-sectional study creates a dataset and dashboard of US state- and territory-level COVID-19 policies specific to nursing homes and home health care agencies.
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Affiliation(s)
- Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Suning Zhao
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Ashley M. Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Uduwanage G. Perera
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Laurent Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York
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Greindl S, Di Gangi S, Plate A, Senn O, Neuner-Jehle S. Perceived dilemma between protective measures and social isolation in nursing homes during the COVID-19 pandemic: a mixed methods study among Swiss nursing home directors. Front Public Health 2024; 12:1292379. [PMID: 38528858 PMCID: PMC10962325 DOI: 10.3389/fpubh.2024.1292379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/18/2024] [Indexed: 03/27/2024] Open
Abstract
Background Coronavirus pandemic (COVID-19) particularly affected older adults, with the highest risks for nursing home residents. Stringent governmental protective measures for nursing homes unintendedly led to social isolation of residents. Nursing home directors (NDs) found themselves in a dilemma between implementing protective measures and preventing the social isolation of nursing home residents. Objectives The objectives of this study were to describe protective measures implemented, to investigate NDs' perception of social isolation and its burden for nursing home residents due to these measures, and to explore experiences of NDs in the context of the dilemma. Methods Cross-sectional embedded mixed-method study carried out by an online survey between April 27 and June 09, 2022, among NDs in the German-speaking part of Switzerland. The survey consisted of 84 closed-ended and nine open-ended questions. Quantitative findings were analyzed with descriptive statistics and qualitative data were evaluated using content analysis. Results The survey was completed by 398 NDs (62.8% female, mean age 55 [48-58] years) out of 1'044 NDs invited.NDs were highly aware of the dilemma. The measures perceived as the most troublesome were restrictions to leave rooms, wards or the home, restrictions for visitors, and reduced group activities. NDs and their teams developed a variety of strategies to cope with the dilemma, but were burdened themselves by the dilemma. Conclusion As NDs were burdened themselves by the responsibility of how to deal best with the dilemma between protective measures and social isolation, supportive strategies for NDs are needed.
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Takahashi PY, Thorsteinsdottir B, McCoy RG, Ramar P, Canning RE, Hanson GJ, Baumbach LJ, Chandra A, Philpot LM. Impact of Program Changes Including Telemedicine and Telephonic Care During the COVID-19 Pandemic in Preventing 30-Day Hospital Readmission for Patients in a Care Transitions Program. J Prim Care Community Health 2024; 15:21501319241226547. [PMID: 38270059 PMCID: PMC10812102 DOI: 10.1177/21501319241226547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION/OBJECTIVES To describe health outcomes of older adults enrolled in the Mayo Clinic Care Transitions (MCCT) program before and during the COVID-19 pandemic compared to unenrolled patients. METHODS We conducted a retrospective cohort study of adults (age >60 years) in the MCCT program compared to a usual care control group from January 1, 2019, to September 20, 2022. The MCCT program involved a home, telephonic, or telemedicine visit by an advanced care provider. Outcomes were 30- and 180-day hospital readmissions, emergency department (ED) visit, and mortality. We performed a subgroup analysis after March 1, 2020 (during the pandemic). We analyzed data with Cox proportional hazards regression models and hazard ratios (HRs) with 95% CIs. RESULTS Of the 1,012 patients total, 354 were in the MCCT program and 658 were in the usual care group with a mean (SD) age of 81.1 (9.1) years overall. Thirty-day readmission was 16.9% (60 of 354) for MCCT patients and 14.7% (97 of 658) for usual care patients (HR, 1.24; 95% CI, 0.88-1.75). During the pandemic, the 30-day readmission rate was 15.1% (28 of 186) for MCCT patients and 14.9% (68 of 455) for usual care patients (HR, 1.20; 95% CI, 0.75-1.91). There was no difference between groups for 180-day hospitalization, 30- or 180-day ED visit, and 30- or 180-day mortality. CONCLUSIONS Numerous factors involving patients, providers, and health care delivery systems during the pandemic most likely contributed to these findings.
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Affiliation(s)
| | | | - Rozalina G. McCoy
- Mayo Clinic, Rochester, MN, USA
- University of Maryland School of Medicine, Baltimore, MD
- University of Maryland Institute for Health Computing, Bethesda, MD, USA
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Meehan A, Gadbois EA, Brazier JF, Madrigal C, Grabowski DC, Shield RR. "It's Not a Sprint, It's a Marathon": Stages of Managing a Nursing Home Throughout the Pandemic. J Am Med Dir Assoc 2023; 24:1579-1585.e2. [PMID: 37268013 PMCID: PMC10226846 DOI: 10.1016/j.jamda.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/03/2023] [Accepted: 04/17/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To qualitatively examine the impact of COVID-19 on nursing homes over the course of the pandemic from the perspective of nursing home administrators. DESIGN In-depth, semi-structured interviews with nursing home administrators, repeated 3 months apart for a total of 4 each from July 2020 through December 2021. SETTINGS AND PARTICIPANTS Administrators from a total of 40 nursing homes from 8 health care markets across the United States. METHODS Interviews were conducted virtually or via phone. The research team identified overarching themes using applied thematic analysis, and iteratively coded transcribed interviews. RESULTS Nursing home administrators across the United States reported challenges of managing nursing homes during a pandemic. We found their experiences could generally be categorized into 4 stages, not necessarily coinciding with surge levels of the virus. The initial stage was characterized by fear and confusion. The second stage, by a "new normal," a term administrators used to report feeling better prepared for an outbreak and how residents, staff, and families began to adjust to life with COVID. Administrators started using the phrase "a light at the end of the tunnel" to describe the third stage, characterized by the hope associated with the availability of vaccinations. The fourth stage was marked by "caregiver fatigue" as nursing homes experienced numerous breakthrough cases. Some challenges, like staffing issues and uncertainty about the future, were reported throughout the pandemic, as was a continued mission to keep residents safe. CONCLUSIONS AND IMPLICATIONS As the ability of nursing homes to provide safe, effective care faces unprecedented and continued challenges, the insights reported here from longitudinal perspectives of nursing home administrators may help policy makers develop solutions to encourage high-quality care. Knowing how the needs for resources and support vary across the progression of these stages has the potential to be helpful in addressing these challenges.
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Affiliation(s)
- Amy Meehan
- Center of Gerontology and Healthcare Research at Brown University's School of Public Health, Providence, RI, USA.
| | - Emily A Gadbois
- Center of Gerontology and Healthcare Research at Brown University's School of Public Health, Providence, RI, USA
| | - Joan F Brazier
- Center of Gerontology and Healthcare Research at Brown University's School of Public Health, Providence, RI, USA
| | - Caroline Madrigal
- Center of Innovation for Long-term Services and Supports at the Providence VA Medical Center, Providence, RI, USA
| | - David C Grabowski
- Department of Health Care Policy at Harvard Medical School, Boston, MA, USA
| | - Renee R Shield
- Center of Gerontology and Healthcare Research at Brown University's School of Public Health, Providence, RI, USA
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Wong S, Ponder CS, Melix B. Spatial and racial covid-19 disparities in U.S. nursing homes. Soc Sci Med 2023; 325:115894. [PMID: 37060641 PMCID: PMC10080861 DOI: 10.1016/j.socscimed.2023.115894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/16/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
In many parts of the world nursing home residents have experienced a disproportionate risk of exposure to COVID-19 and have died at much higher rates than other groups. There is a critical need to identify the factors driving COVID-19 risk in nursing homes to better understand and address the conditions contributing to their vulnerability during public health crises. This study investigates the characteristics associated with COVID-19 cases and deaths among residents in U.S. nursing homes from 2020 to 2021, with a focus on geospatial and racial inequalities. Using data from the Centers for Medicare and Medicaid Services and LTCFocus, this paper uses zero-inflated negative binomial regression models, Kruskal-Wallis tests, and Local Moran's I to generate statistical and geospatial results. Our analysis reveals that majority Hispanic facilities have alarmingly high COVID-19 cases and deaths, suggesting that these facilities have the greatest need for policy improvements in staffing and financing to reduce racial inequalities in nursing home care. At the same time we also detect COVID-19 hot spots in rural areas with predominately White residents, indicating a need to rethink public messaging strategies in these areas. The top states with COVID-19 hot spots are Kentucky, Pennsylvania, Illinois, and Oklahoma. This research provides new insights into the socio-spatial contexts and inequities that contribute to the vulnerability of nursing home residents during a pandemic.
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Affiliation(s)
- Sandy Wong
- Department of Geography, Florida State University, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, United States.
| | - C S Ponder
- Department of Geography, Florida State University, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, United States
| | - Bertram Melix
- Department of Geography, Florida State University, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, United States
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Examining the Global Nursing Regulatory Response to the COVID-19 Pandemic. JOURNAL OF NURSING REGULATION 2023; 14:73-80. [PMID: 37035774 PMCID: PMC10074068 DOI: 10.1016/s2155-8256(23)00071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background During the COVID-19 pandemic, nursing regulatory bodies (NRBs) worldwide adopted a variety of measures to bolster the nursing workforce and ensure patient safety. Purpose To examine the plethora of actions undertaken by the global nursing community in response to the public health emergency so that NRBs can increase transparency and better prepare for future crises. Methods In early 2021, the National Council of State Boards of Nursing developed an online survey to capture data on the global regulatory response to the COVID-19 pandemic. The survey focused on five specific domains: (a) governance, (b) telehealth practices, (c) nurse mobility, (d) prelicensure education, and (e) the disciplinary process. The instrument was translated into 11 languages before being deployed to 150 non-U.S. regulatory representatives. Frequencies and proportions were generated for all fixed-item responses, and descriptive content analyses were applied to translated open-text responses. Results Regulators representing 27 jurisdictions provided valid responses to the survey. Most jurisdictions reported that components of nursing education were adapted in some way during the pandemic. More than half (53.8%, n = 14) of respondents indicated that changes were made to clinical and didactic curricula to ensure students graduated on time. About one-third (30.8%, n = 8) of representatives revealed that their jurisdiction had made changes to telehealth regulations, with many granting telehealth-specific nursing licenses. Most jurisdictions (88.5%, n = 23) also reported fewer or about the same number of regulatory complaints compared to before the pandemic. Conclusions The results of this study highlight the range of actions nursing regulators worldwide adopted, which may be drawn upon to inform best practices to ensure jurisdictions are ready for the next public health emergency.
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Ford JH, Jolles SA, Heller D, Crnich C. Characteristics of telemedicine workflows in nursing homes during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:301. [PMID: 36991421 PMCID: PMC10052227 DOI: 10.1186/s12913-023-09249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
The use of telemedicine increased dramatically in nursing homes (NHs) during the COVID-19 pandemic. However, little is known about the actual process of conducting a telemedicine encounter in NHs. The objective of this study was to identify and document the work processes associated with different types of telemedicine encounters conducted in NHs during the COVID-19 pandemic.
Methods
A mixed methods convergent study was utilized. The study was conducted in a convenience sample of two NHs that had newly adopted telemedicine during the COVID-19 pandemic. Participants included NH staff and providers involved in telemedicine encounters conducted in the study NHs. The study involved semi-structured interviews and direct observation of telemedicine encounters and post-encounter interviews with staff and providers involved in telemedicine encounters observed by research staff. The semi-structured interviews were structured using the Systems Engineering Initiative for Patient Safety (SEIPS) model to collect information about telemedicine workflows. A structured checklist was utilized to document steps performed during direct observations of telemedicine encounters. Information from interviews and observations informed the creation of a process map of the NH telemedicine encounter.
Results
A total of 17 individuals participated in semi-structured interviews. Fifteen unique telemedicine encounters were observed. A total of 18 post-encounter interviews with 7 unique providers (15 interviews in total) and three NH staff were performed. A 9-step process map of the telemedicine encounter, along with two microprocess maps related to encounter preparation and activities within the telemedicine encounter, were created. Six main processes were identified: encounter planning, family or healthcare authority notification, pre-encounter preparation, pre-encounter huddle, conducting the encounter, and post-encounter follow-up.
Conclusion
The COVID-19 pandemic changed the delivery of care in NHs and increased reliance on telemedicine services in these facilities. Workflow mapping using the SEIPS model revealed that the NH telemedicine encounter is a complex multi-step process and identified weaknesses related to scheduling, electronic health record interoperability, pre-encounter planning, and post-encounter information exchange, which represent opportunities to improve and enhance the telemedicine encounter process in NHs. Given public acceptance of telemedicine as a care delivery model, expanding the use of telemedicine beyond the COVID-19 pandemic, especially for certain NH telemedicine encounters, could improve quality of care.
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Hackett SE, Peterson LJ, Vogel CE, Dobbs D. "We Did More Damage": How COVID-19 Collapsed the Care Convoys of Residents Living With Dementia. J Appl Gerontol 2023:7334648231162360. [PMID: 36905348 PMCID: PMC10009498 DOI: 10.1177/07334648231162360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
COVID-19 regulations have posed challenges for long-term care (LTC). However, few studies have examined how such regulations influenced the care of residents living with dementia. Our objective was to gain an understanding of LTC administrative leaders' perceptions regarding the impact of the COVID-19 response on this population. Using the convoys of care framework, we conducted a qualitative descriptive study. Forty-three participants, representing 60 LTC facilities, completed one interview where they described how COVID-19 policies shaped care for residents living with dementia. Results from deductive thematic analysis revealed that participants believed the care convoys of residents living with dementia were strained. Participants emphasized how diminished family involvement, increased staff responsibilities, and the industry's heightened regulatory climate contributed to disrupted care. Further, they highlighted how pandemic-focused safety guidelines did not always consider the unique needs of those living with dementia. Consequently, this study may inform policy by outlining considerations for future emergencies.
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Affiliation(s)
- Sara E. Hackett
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | | | - Carlyn E. Vogel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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15
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Visual Positioning of Nasal Swab Robot Based on Hierarchical Decision. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE) 2023; 28:323-329. [PMID: 36846270 PMCID: PMC9942022 DOI: 10.1007/s12204-023-2581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/28/2022] [Indexed: 02/23/2023]
Abstract
This study focuses on a robot vision localization method for coping with the operational task of automatic nasal swab sampling. The application is important in the detection and epidemic prevention of Corona Virus Disease 2019 (COVID-19) to alleviate the large-scale negative impact of individuals suffering from pneumonia owing to COVID-19. In this method, the idea of a hierarchical decision network is used to consider the strong infectious characteristics of the COVID-19, which is followed by processing the robot behavior constraint condition. The visual navigation and positioning method using a single-arm robot for sampling is also planned, which considers the operation characteristics of medical staff. In the decision network, the risk factor for potential contact infection caused by swab sampling operations is established to avoid the spread among personnel. A robot visual servo control with artificial intelligence characteristics is developed to achieve a stable and safe nasal swab sampling operation. Experiments demonstrate that the proposed method can achieve good vision positioning for the robots and provide technical support for managing new major public health situations.
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16
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Schwartz LB, Lieblich C, Laxton CE, Kaes L, Barnett DP, Port C, Pace DD. COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource. J Am Med Dir Assoc 2023; 24:134-139. [PMID: 36592942 PMCID: PMC9801232 DOI: 10.1016/j.jamda.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic had a big impact on assisted living (AL), a vital setting in long-term care (LTC). Understanding the strengths and opportunities for improvement through practice, policy, and research are essential for AL to be prepared for the next pandemic and other challenges. AL communities experienced the pandemic in unique ways, because of varying regulatory environments, differences in familiarity with using and procuring personal protective equipment not typically used in AL (such as N95 masks), loss of family involvement, the homelike environment, and lower levels of licensed clinical staff. Being state rather than federally regulated, much less national data are available about the COVID-19 experience in AL. This article reviews what is known about cases and deaths, infection control, and the impact on residents and staff. For each, we suggest actions that could be taken and link them to the Assisted Living Workgroup Report (ALW) recommendations. Using the Center for Excellence in Assisted Living (CEAL) 15-year ALW report, we also review which of these recommendations have and have not been implemented by states in the preceding decade and half, and how their presence or absence may have affected AL pandemic preparedness. Finally, we provide suggestions for policy, practice, and research moving forward, including improving state-level reporting, staff vaccine requirements, staff training and work-life, levels of research-provider partnerships, dissemination of research, and uptake of a holistic model of care for AL.
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Affiliation(s)
- Lindsay B Schwartz
- Center for Excellence in Assisted Living (CEAL), Workforce & Quality Innovations, LLC, Bear Creek, NC, USA.
| | - Cathy Lieblich
- Center for Excellence in Assisted Living (CEAL), Pioneer Network, Orlando, FL, USA
| | - Christopher E Laxton
- Center for Excellence in Assisted Living (CEAL), AMDA, The Society for Post-Acute and Long-Term Care Medicine, Columbia, MD, USA
| | - Loretta Kaes
- Center for Excellence in Assisted Living (CEAL), American Assisted Living Nurses Association (AALNA), NAPA, CA, USA
| | - D Pearl Barnett
- Center for Excellence in Assisted Living (CEAL), ADvancing States, Arlington, VA, USA
| | | | - Douglas D Pace
- Center for Excellence in Assisted Living (CEAL), Alzheimer's Association, Washington, DC, USA
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17
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Muacevic A, Adler JR, Edel K, Prabhakaran M, Steffl ML, Shelton J, Pace J, Poolman AE, Anderson SE. Between a Rock and a Hard Place: COVID-19 Lessons Learned From Providers Rounding at Skilled Nursing Facilities in the Rural Midwest. Cureus 2022; 14:e32157. [PMID: 36601216 PMCID: PMC9807139 DOI: 10.7759/cureus.32157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/07/2022] Open
Abstract
On March 11, 2020, coronavirus disease 2019 (COVID-19) was classified as a pandemic, setting in motion unprecedented practice changes across the healthcare industry. Never was this more evident than in Skilled Nursing Facilities (SNFs). SNFs were tested on multiple fronts, requiring innovation and perseverance at levels never before seen. Lessons learned from this setting to better prepare for the next pandemic include: updating and standardizing infection control and prevention policies, ensuring the supply chain keeps up with demand, updating infrastructure, creating a work environment that promotes well-being, and having clear communication plans.
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18
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Létourneau J, Bélanger E, Sia D, Beogo I, Robins S, Kruglova K, Jubinville M, Tchouaket EN. Identifying performance factors of long-term care facilities in the context of the COVID-19 pandemic: a scoping review protocol. Syst Rev 2022; 11:203. [PMID: 36151556 PMCID: PMC9502645 DOI: 10.1186/s13643-022-02069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) have been severely affected by the COVID-19 pandemic with serious consequences for the residents. Some LTCFs performed better than others, experiencing lower case and death rates due to COVID-19. A comprehensive understanding of the factors that have affected the transmission of COVID-19 in LTCFs is lacking, as no published studies have applied a multidimensional conceptual framework to evaluate the performance of LTCFs during the pandemic. Much research has focused on infection prevention and control strategies or specific disease outcomes (e.g., death rates). To address these gaps, our scoping review will identify and analyze the performance factors that have influenced the management of COVID-19 in LTCFs by adopting a multidimensional conceptual framework. METHODS We will query the CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, and Web of Science databases for peer-reviewed articles written in English or French and published between January 1, 2020 and December 31, 2021. We will include articles that focus on the specified context (COVID-19), population (LTCFs), interest (facilitators and barriers to performance of LTCFs), and outcomes (dimensions of performance according to a modified version of the Ministère de la santé et des services sociaux du Québec conceptual framework). Each article will be screened by at least two co-authors independently followed by data extraction of the included articles by one co-author and a review by the principal investigator. RESULTS We will present the results both narratively and with visual aids (e.g., flowcharts, tables, conceptual maps). DISCUSSION Our scoping review will provide a comprehensive understanding of the factors that have affected the performance of LTCFs during the COVID-19 pandemic. This knowledge can help inform the development of more effective infection prevention and control measures for future pandemics and outbreaks. The results of our review may lead to improvements in the care and safety of LTCF residents and staff. SCOPING REVIEW REGISTRATION: Research Registry researchregistry7026.
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Affiliation(s)
- Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada
| | - Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, Canada.
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19
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Ford JH, Jolles SA, Heller D, Langenstroer M, Crnich C. There and back again: the shape of telemedicine in U.S. nursing homes following COVID-19. BMC Geriatr 2022; 22:337. [PMID: 35436869 PMCID: PMC9015887 DOI: 10.1186/s12877-022-03046-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03046-y.
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Affiliation(s)
- James H Ford
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Sally A Jolles
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Dee Heller
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Christopher Crnich
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton VA Hospital, Madison, WI, USA
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20
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Davitt JK, Brown J. Using Voice and Touchscreen Controlled Smart Speakers to Protect Vulnerable Clients in Long Term Care Facilities. Innov Aging 2022; 6:igac024. [PMID: 35712325 PMCID: PMC9196695 DOI: 10.1093/geroni/igac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
The Centers for Medicare and Medicaid Services (CMS) restricted long term care (LTC) facility visitation to only essential personnel during the COVID-19 pandemic. The Maryland Department of Human Services distributed Amazon Echoshow 8 voice and touchscreen controlled smart speakers (VTCSS) to a sample of their institutionalized guardianship clients to enhance caseworker access during the pandemic.
Research Design and Methods
This pilot study focused on understanding VTCSS use challenges and the effects on clients’ safety and well-being. Two focus groups were conducted with caseworkers (N=16) who piloted the devices. The interviews were recorded, transcribed, and analyzed using open and axial coding.
Results
Four themes were identified, including challenges to providing casework during the pandemic (e.g. facility technology gaps), challenges to device installation and use (e.g. privacy concerns), strategies for overcoming challenges (e.g. alert features), and benefits (e.g. stimulation, care monitoring) and uses (e.g. enhanced access, entertainment).
Discussion and Implications
VTCSS show great promise to engage the client, maintain visual access, and monitor quality of care. However, facilitating access to such technology requires planning and training before installation.
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Affiliation(s)
- Joan K Davitt
- School of Social Work, University of Maryland, Baltimore, Maryland, USA
| | - Jocelyn Brown
- School of Social Work & School of Medicine, University of Maryland, Baltimore, Maryland, USA
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21
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Sims S, Harris R, Hussein S, Rafferty AM, Desai A, Palmer S, Brearley S, Adams R, Rees L, Fitzpatrick JM. Social Distancing and Isolation Strategies to Prevent and Control the Transmission of COVID-19 and Other Infectious Diseases in Care Homes for Older People: An International Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063450. [PMID: 35329137 PMCID: PMC8955170 DOI: 10.3390/ijerph19063450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/18/2022]
Abstract
Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care homes to prevent and control the transmission of COVID-19 and other infectious diseases. Seven electronic databases were searched: Medline, CINAHL, Embase, PsycINFO, HMIC, Social Care Online, and Web of Science Core Collection. Grey literature was searched using MedRxiv, PDQ-Evidence, NICE Evidence Search, LTCCovid19.org and TRIP. Extracted data were synthesised using narrative synthesis and tabulation. 103 papers were included (10 empirical studies, seven literature reviews, and 86 policy documents). Strategies used to prevent and control the transmission of COVID-19 and other infectious diseases included social distancing and isolation of residents and staff, zoning and cohorting of residents, restriction of resident movement/activities, restriction of visitors and restriction of staff working patterns. This review demonstrates a lack of empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. Evaluative research on these interventions is needed urgently, focusing on the well-being of all residents, particularly those with hearing, vision or cognitive impairments.
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Affiliation(s)
- Sarah Sims
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Ruth Harris
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Shereen Hussein
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Anne Marie Rafferty
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Amit Desai
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
| | - Sinead Palmer
- Personal Social Services Research Unit, University of Kent, Canterbury CT2 7NZ, UK;
| | - Sally Brearley
- School of Nursing, Kingston University and St George’s University London, London SW17 0RE, UK;
| | | | - Lindsay Rees
- Encore Care Homes Management Ltd., Bournemouth BH8 9RL, UK;
| | - Joanne M. Fitzpatrick
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK; (S.S.); (R.H.); (A.M.R.); (A.D.)
- Correspondence:
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22
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Gonella S, Mitchell G, Bavelaar L, Conti A, Vanalli M, Basso I, Cornally N. Interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes: A mixed-methods systematic review. Palliat Med 2022; 36:268-291. [PMID: 34965759 DOI: 10.1177/02692163211066733] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most people with dementia transition into nursing homes as their disease progresses. Their family caregivers often continue to be involved in their relative's care and experience high level of strain at the end of life. AIM To gather and synthesize information on interventions to support family caregivers of people with advanced dementia at the end of life in nursing homes and provide a set of recommendations for practice. DESIGN Mixed-Methods Systematic Review (PROSPERO no. CRD42020217854) with convergent integrated approach. DATA SOURCES Five electronic databases were searched from inception in November 2020. Published qualitative, quantitative, and mixed-method studies of interventions to support family caregivers of people with advanced dementia at the end of life in nursing home were included. No language or temporal limits were applied. RESULTS In all, 11 studies met the inclusion criteria. Data synthesis resulted in three integrated findings: (i) healthcare professionals should engage family caregivers in ongoing dialog and provide adequate time and space for sensitive discussions; (ii) end-of-life discussions should be face-to-face and supported by written information whose timing of supply may vary according to family caregivers' preferences and the organizational policies and cultural context; and (iii) family caregivers should be provided structured psychoeducational programs tailored to their specific needs and/or regular family meetings about dementia care at the end of life. CONCLUSION The findings provide useful information on which interventions may benefit family caregivers of people with advanced dementia at the end of life and where, when, and how they should be provided.
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Affiliation(s)
- Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy.,Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gary Mitchell
- School of Nursing & Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland
| | - Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Mariangela Vanalli
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, Roma, Italy
| | - Ines Basso
- School of Nursing, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo," Alessandria, Italy
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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23
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Straker JK, Choi MS. Facility and Family Communication during the COVID-19 Visit Restriction: Early Perspectives of Family Members. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:902-913. [PMID: 34420475 DOI: 10.1080/01634372.2021.1969714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
During the COVID-19 pandemic, family concerns regarding residents in long-term care facilities (LTCFs) increased due to a high proportion of COVID cases and deaths among residents and restrictions that made it impossible to visit. These changes created numerous challenges for facilities communicating with families, and between families and residents. However, little is known about how these facilities addressed these communication challenges and how those communication strategies were related to family perceptions about the facility. We implemented an online survey of family members or friends of residents in LTCFs from April 28 to June 19, 2020, using convenience sampling. A total of 174 responses nationwide reported the types of communications used, frequency of communication and alternative visits, and whether respondents had peace of mind, would recommend the facility, or were considering removing the resident from the facility. The results of our hierarchical logistic regression showed that respondents felt greater peace of mind when there were multiple communication channels to contact the resident. Also, respondents had more negative perceptions of a facility when they were not informed about confirmed COVID cases. Our findings suggest multiple communication channels and transparency about COVID status were effective in keeping positive family perceptions about the facility.
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Affiliation(s)
- Jane K Straker
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Mi Sun Choi
- Department of Social Welfare, Silla University, Busan, South Korea
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24
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Vogazianos P, Argyropoulos CD, Haralambous C, Mikellidou CV, Boustras G, Andreou M, Silvestros V, Theofanous F, Soteriou S, Gregoriou I, Apostolidou AJ, Demetriou A, Athanasiadou M, Stylianou C, Michael M, Herodotou H, Alexandrou D, Kalakouta O, Pana ZD. Impact assessment of COVID-19 non-pharmaceutical interventions in long term care facilities in Cyprus: Safety improvement strategy. SAFETY SCIENCE 2021; 143:105415. [PMID: 34305320 PMCID: PMC8285258 DOI: 10.1016/j.ssci.2021.105415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/12/2021] [Indexed: 05/11/2023]
Abstract
The current COVID-19 crisis has changed our everyday lives almost in every aspect. Many people worldwide have died or hospitalised due to the severe impact of COVID-19 on the vulnerable population, and in particular to the elderly residents of long term care facilities (LTCF). The problem is amplified due to the fact that many of those occupants also suffer from comorbidities (e.g. respiratory and cardiovascular diseases, hypertension, etc.) and are therefore regarded as a susceptible host to severe COVID-19 disease. Impacts can be felt in the wider societal safety level. The aim of the present study is, therefore, to present the first National multimodal quality and safety improvement strategy plan for the LTCF in the Republic of Cyprus. The current program focused on the intensification of COVID-19 epidemiological surveillance, the promotion of educational training on best practises in infection control and prevention, and the implementation of additional non-pharmaceutical interventions (NPIs), according to the recommendations of ECDC (European Centre for Disease Prevention and Control) and WHO (World Health Organization). This innovative program fostered the interconnectivity and collaboration among the local authorities, academia and the local leaders of the LTCF. In addition, this program reinforced the importance of volunteerism and active participation of medical students in the National initiatives against the COVID-19 pandemic. The effectiveness of the adopted multimodal advanced care-safety planning program is appraised based on the reported new confirmed COVID-19 cases among LTCF healthcare workers and occupants, after the introducing and implementation of the selected NPIs. This multimodal strategy plan seems to be capable of reducing significantly the number of new cases of COVID-19 infections in LTCF and as a result, to also affect the residents' death number.
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Affiliation(s)
- Paris Vogazianos
- Department of Behavioural and Social Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Christos D Argyropoulos
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Christos Haralambous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Cleo Varianou Mikellidou
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - George Boustras
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Michalis Andreou
- Unit for Health Inspections, Ministry of Health, Nicosia, Cyprus
| | - Valentinos Silvestros
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Fani Theofanous
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Soteroulla Soteriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | - Ioanna Gregoriou
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
| | | | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | | | - Maria Michael
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | | | - Denise Alexandrou
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | - Olga Kalakouta
- Unit for Surveillance and Control of Communicable Diseases, Ministry of Health, Nicosia, Cyprus
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
- Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus
| | - Zoi Dorothea Pana
- Center of Excellence in Risk & Decision Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Department of Medicine, European University Cyprus, Nicosia 2404, Cyprus
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25
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Poh L, Tan SY, Lim J. Governance of Assisted Living in Long-Term Care: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11352. [PMID: 34769868 PMCID: PMC8583175 DOI: 10.3390/ijerph182111352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.
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Affiliation(s)
- Luting Poh
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr., Singapore 119260, Singapore;
| | - Si-Ying Tan
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
| | - Jeremy Lim
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
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Vijh R, Prairie J, Otterstatter MC, Hu Y, Hayden AS, Yau B, Daly P, Lysyshyn M, McKee G, Harding J, Forsting S, Schwandt M. Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities. Infect Control Hosp Epidemiol 2021; 42:1181-1188. [PMID: 33397533 PMCID: PMC7853754 DOI: 10.1017/ice.2020.1407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. DESIGN Quasi-experimental, segmented regression analysis. INTERVENTION A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. METHODS A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. RESULTS The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05). CONCLUSIONS Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.
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Affiliation(s)
- Rohit Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Prairie
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Canadian Field Epidemiology Training Program, Public Health Agency of Canada, Ottawa, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Yumian Hu
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Althea S. Hayden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Brandon Yau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Daly
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Geoff McKee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - John Harding
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sara Forsting
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Michael Schwandt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Resciniti NV, Fuller M, Sellner J, Lohman MC. COVID-19 Incidence and Mortality Among Long-Term Care Facility Residents and Staff in South Carolina. J Am Med Dir Assoc 2021; 22:2026-2031.e1. [PMID: 34481792 PMCID: PMC8364806 DOI: 10.1016/j.jamda.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Objectives This study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). Design Longitudinal secondary data analysis. Setting and Participants Adults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). Methods COVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. Results LTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. Conclusions and Implications Narrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.
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Affiliation(s)
- Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Morgan Fuller
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Joshua Sellner
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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Kyler-Yano JZ, Tunalilar O, Hasworth S, Kohon J, Winfree J, Wilton R, Tuttle A, Carder P. "What Keeps Me Awake at Night": Assisted Living Administrator Responses to COVID-19. THE GERONTOLOGIST 2021; 62:190-199. [PMID: 34324663 PMCID: PMC8411379 DOI: 10.1093/geront/gnab106] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Assisted living (AL) constitutes an important sector of residential long-term care, yet there has been limited research about the impact of the coronavirus disease 2019 (COVID-19) pandemic in this setting. This qualitative study sought to understand the impact of the early stages of the pandemic (February-August 2020) from AL administrators’ perspectives. Research Design and Methods Semi-structured phone interviews were conducted with 40 AL administrators in Oregon. A stratified sampling method emphasizing rurality, profit status, Medicaid acceptance, and memory care (MC) designation was used to maximize variation in perspectives. We asked eight questions aimed at understanding the impact of the COVID-19 pandemic on their roles and AL residents and their families, as well as AL operations, such as staffing and resource procurement. Audio-recorded interviews were transcribed and analyzed using an iterative thematic analysis. Results We identified three themes that characterize AL administrators’ response to COVID-19: emotion and burn-out management, information management, and crisis management. Based on their experiences, administrators made suggestions for managing future crises. Discussion and Implications Our findings demonstrate the slow-burning but devastating impact of the COVID-19 pandemic in AL communities similar to recent findings in nursing homes. Coupled with the limited resources, perceived external pressures, and the ongoing pandemic, many administrators were managing but not thriving in these domains. AL as a care setting, and the role of administrators, requires more scholarly and policy attention, especially regarding emergency preparedness and response.
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Affiliation(s)
| | - Ozcan Tunalilar
- Institute on Aging, Portland State University, Portland, OR, USA.,Nohad A. Toulan School of Urban Studies and Planning, Portland State University, Portland, OR, USA
| | - Serena Hasworth
- Institute on Aging, Portland State University, Portland, OR, USA
| | - Jacklyn Kohon
- Institute on Aging, Portland State University, Portland, OR, USA
| | - Jaclyn Winfree
- Institute on Aging, Portland State University, Portland, OR, USA
| | - Riley Wilton
- Institute on Aging, Portland State University, Portland, OR, USA
| | - Aliza Tuttle
- Institute on Aging, Portland State University, Portland, OR, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
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30
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Gadbois EA, Brazier JF, Meehan A, Grabowski DC, Shield RR. "I don't know how many nursing homes will survive 2021": Financial sustainability during COVID-19. J Am Geriatr Soc 2021; 69:2785-2788. [PMID: 34287843 PMCID: PMC8447370 DOI: 10.1111/jgs.17380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Emily A Gadbois
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joan F Brazier
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Amy Meehan
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Renee R Shield
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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31
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Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med 2021; 12:1127-1136. [PMID: 34136990 PMCID: PMC8208072 DOI: 10.1007/s41999-021-00531-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Aim To describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented. Findings COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Message Substantial learning occurred that will lead to better pandemic preparedness and improve quality of care for nursing home residents at all times. Introduction COVID-19 has caused unprecedented challenges in nursing homes. In this scoping review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges. Methods The MeSH terms “Nursing homes” and “COVID-19” were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes. Results The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations. Conclusion COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.
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Affiliation(s)
- Shamik Giri
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lee Minn Chenn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, Dublin, Ireland. .,Discipline of Medical Gerontology, Mercer's Institute for Successful Ageing (MISA), St James's Hospital, 6th Floor, Dublin, 8, Ireland. .,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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Dys S, Winfree J, Carder P, Zimmerman S, Thomas KS. Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned. Front Public Health 2021; 9:661042. [PMID: 34095066 PMCID: PMC8170034 DOI: 10.3389/fpubh.2021.661042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.
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Affiliation(s)
- Sarah Dys
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States.,Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, United States
| | - Jaclyn Winfree
- Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, United States
| | - Paula Carder
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States.,Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, United States
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kali S Thomas
- School of Public Health, Brown University, Providence, RI, United States.,Providence VA Medical Center, Providence, RI, United States
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Thomas MJ, Lal V, Baby AK, Rabeeh Vp M, James A, Raj AK. Can technological advancements help to alleviate COVID-19 pandemic? a review. J Biomed Inform 2021; 117:103787. [PMID: 33862231 PMCID: PMC8056973 DOI: 10.1016/j.jbi.2021.103787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic is continuing, and the innovative and efficient contributions of the emerging modern technologies to the pandemic responses are too early and cannot be completely quantified at this moment. Digital technologies are not a final solution but are the tools that facilitate a quick and effective pandemic response. In accordance, mobile applications, robots and drones, social media platforms (such as search engines, Twitter, and Facebook), television, and associated technologies deployed in tackling the COVID-19 (SARS-CoV-2) outbreak are discussed adequately, emphasizing the current-state-of-art. A collective discussion on reported literature, press releases, and organizational claims are reviewed. This review addresses and highlights how these effective modern technological solutions can aid in healthcare (involving contact tracing, real-time isolation monitoring/screening, disinfection, quarantine enforcement, syndromic surveillance, and mental health), communication (involving remote assistance, information sharing, and communication support), logistics, tourism, and hospitality. The study discusses the benefits of these digital technologies in curtailing the pandemic and 'how' the different sectors adapted to these in a shorter period. Social media and television's role in ensuring global connectivity and serving as a common platform to share authentic information among the general public were summarized. The World Health Organization and Governments' role globally in-line with the prevention of propagation of false news, spreading awareness, and diminishing the severity of the COVID-19 was discussed. Furthermore, this collective review is helpful to investigators, health departments, Government organizations, and policymakers alike to facilitate a quick and effective pandemic response.
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Affiliation(s)
- Mervin Joe Thomas
- Dept. of Mechanical Engg., National Institute of Technology Calicut, Kerala 673601, India
| | - Vishnu Lal
- Dept. of Mechanical Engg., National Institute of Technology Calicut, Kerala 673601, India
| | - Ajith Kurian Baby
- Dept. of Mechanical Engg., National Institute of Technology Calicut, Kerala 673601, India
| | - Muhammad Rabeeh Vp
- School of Materials Science and Engg., National Institute of Technology Calicut, Kerala 673601, India
| | - Alosh James
- Solar Energy Center, Dept. of Mechanical Engg., National Institute of Technology Calicut, Kerala 673601, India
| | - Arun K Raj
- Dept. of Mechanical Engg., Indian Institute of Technology Bombay, Maharashtra 400076, India.
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Gracner T, Agarwal M, Murali KP, Stone PW, Larson EL, Furuya EY, Harrison JM, Dick AW. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open 2021; 4:e217528. [PMID: 33890988 PMCID: PMC8065379 DOI: 10.1001/jamanetworkopen.2021.7528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
Importance Hospitalizations for infections among nursing home (NH) residents remain common despite national initiatives to reduce them. Cognitive impairment, which markedly affects quality of life and caregiving needs, has been associated with hospitalizations, but the association between infection-related hospitalizations and long-term cognitive function among NH residents is unknown. Objective To examine whether there are changes in cognitive function before vs after infection-related hospitalizations among NH residents. Design, Setting, and Participants This cohort study used data from the Minimum Data Set 3.0 linked to Medicare hospitalization data from 2011 to 2017 for US nursing home residents aged 65 years or older who had experienced an infection-related hospitalization and had at least 2 quarterly Minimum Data Set assessments before and 4 or more after the infection-related hospitalization. Analyses were performed from September 1, 2019, to December 21, 2020. Exposure Infection-related hospitalization lasting 1 to 14 days. Main Outcomes and Measures Using an event study approach, associations between infection-related hospitalizations and quarterly changes in cognitive function among NH residents were examined overall and by sex, age, Alzheimer disease and related dementias (ADRD) diagnosis, and sepsis vs other infection-related diagnoses. Resident-level cognitive function was measured using the Cognitive Function Scale (CFS), with scores ranging from 1 (intact) to 4 (severe cognitive impairment). Results Of the sample of 20 698 NH residents, 71.0% were women and 82.6% were non-Hispanic White individuals; the mean (SD) age at the time of transfer to the hospital was 82 (8.5) years. The mean CFS score was 2.17, and the prevalence of severe cognitive impairment (CFS score, 4) was 9.0%. During the first quarter after an infection-related hospitalization, residents experienced a mean increase of 0.06 points in CFS score (95% CI, 0.05-0.07 points; P < .001), or 3%. The increase in scores was greatest among residents aged 85 years or older vs younger residents by approximately 0.022 CFS points (95% CI, 0.004-0.040 points; P < .05). The prevalence of severe cognitive impairment increased by 1.6 percentage points (95% CI, 1.2-2.0 percentage points; P < .001), or 18%; the increases were observed among individuals with ADRD but not among those without it. After an infection-related hospitalization, cognition among residents who had experienced sepsis declined more than for residents who had not by about 0.02 CFS points (95% CI, 0.00-0.04 points; P < .05). All observed differences persisted without an accelerated rate of decline for at least 6 quarters after infection-related hospitalization. No differences were observed by sex. Conclusions and Relevance In this cohort study, infection-related hospitalization was associated with immediate and persistent cognitive decline among nursing home residents, with the largest increase in CFS scores among older residents, those with ADRD, and those who had experienced sepsis. Identification of NH residents at risk of worsened cognition after an infection-related hospitalization may help to ensure that their care needs are addressed to prevent further cognitive decline.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, Arlington, Virginia
- Now with RAND Corporation, Santa Monica, California
| | - Mansi Agarwal
- Center for Health Policy, Columbia University School of Nursing, New York, New York
- Now with Washington University School of Medicine, St Louis, Missouri
| | - Komal P. Murali
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Elaine L. Larson
- Columbia University School of Nursing, New York, New York
- Columbia University Mailman School of Public Health, New York, New York
| | - E. Yoko Furuya
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Hashan MR, Smoll N, King C, Ockenden-Muldoon H, Walker J, Wattiaux A, Graham J, Booy R, Khandaker G. Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100771. [PMID: 33681730 PMCID: PMC7917447 DOI: 10.1016/j.eclinm.2021.100771] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 outbreaks in aged care facilities (ACFs) often have devastating consequences. However, epidemiologically these outbreaks are not well defined. We aimed to define such outbreaks in ACFs by systematically reviewing literature published during the current COVID-19 pandemic. METHODS We searched 11 bibliographic databases for literature published on COVID-19 in ACFs between December 2019 and September 2020. Original studies reporting extractable epidemiological data as part of outbreak investigations or non-outbreak surveillance of ACFs were included in this systematic review and meta-analysis. PROSPERO registration: CRD42020211424. FINDINGS We identified 5,148 publications and selected 49 studies from four continents reporting data on 214,380 residents in 8,502 ACFs with 25,567 confirmed cases of COVID-19. Aged care residents form a distinct vulnerable population with single-facility attack rates of 45% [95% CI 32-58%] and case fatality rates of 23% [95% CI 18-28%]. Of the cases, 31% [95% CI 28-34%] were asymptomatic. The rate of hospitalization amongst residents was 37% [95% CI 35-39%]. Data from 21 outbreaks identified a resident as the index case in 58% of outbreaks and a staff member in 42%. Findings from the included studies were heterogeneous and of low to moderate quality in risk of bias assessment. INTERPRETATION The clinical presentation of COVID-19 varies widely in ACFs residents, from asymptomatic to highly serious cases. Preventing the introduction of COVID-19 into ACFs is key, and both residents and staff are a priority group for COVID-19 vaccination. Rapid diagnosis, identification of primary and secondary cases and close contacts plus their isolation and quarantine are of paramount importance. FUNDING Queensland Advancing Clinical Research Fellowship awarded to Prof. Gulam Khandaker by Queensland Health's Health Innovation, Investment and Research Office (HIRO), Office of the Director-General.
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Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Catherine King
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hannah Ockenden-Muldoon
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Julieanne Graham
- Medical Services Team, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gulam Khandaker
- Central Queensland University, Rockhampton, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
- The Children's Hospital at Westmead Clinical School, The faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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He L, Traphagan JW. A preliminary exploration of attitudes about COVID-19 among a group of older people in Iwate Prefecture, Japan. J Cross Cult Gerontol 2021; 36:1-19. [PMID: 33564989 PMCID: PMC7872306 DOI: 10.1007/s10823-021-09423-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 01/07/2023]
Abstract
In this article, our goal is to provide researchers with a non-western perspective concerning the COVID-19 pandemic through a qualitative study of older adults living in Iwate, a prefecture in Japan that has only recently (27 July 2020) reported its first confirmed COVID-19 cases and which has experienced comparatively few cases since. Because they live in an environment with few COVID-19 cases, the individuals in this study provide an interesting perspective of the pandemic as it is unfolding in rural Japan and our focus here is on documenting the circumstances and ideas of elder residents of Iwate Prefecture to understand individual experiences of this population. Our intention here is to provide data and tentative analysis that may be useful in developing more complex cross-cultural studies related to the lived experience of COVID-19 among older people.
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Affiliation(s)
- Lauren He
- Westlake High School, Austin, TX USA
| | - John W. Traphagan
- Department of Religious Studies, University of Texas At Austin, A3700, 2505 University Ave, Austin, TX 78712 USA
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Albarracin Z, Silverman M, Mineo J, Al-Abbasi B, Koff S, Martell C, Levene RS. Health Care Workers' Knowledge, Attitudes, and Beliefs Related to COVID-19 in Palliative Medicine and Hospice Care. Palliat Med Rep 2020; 1:331-338. [PMID: 34223494 PMCID: PMC8241391 DOI: 10.1089/pmr.2020.0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Although coronavirus disease 2019 (COVID-19) has impacted on a global scale, the knowledge, attitudes, and beliefs of the health care workers who provide the care at the end of life have not been evaluated. Objectives: To assess and understand palliative medicine and hospice care health care workers' knowledge, attitudes, and beliefs related to COVID-19. Design: A web-based survey was created. Primary outcomes included attitudes, beliefs, and knowledge. Secondary outcomes included comparison in between health care workers who described themselves at high risk versus not at high risk of complications related to COVID-19 infection. Setting/Subjects: In total, 1262 adult hospice workers in the United States were invited. Results: A total of 348 workers completed the survey. Of them, 321 were analyzed, 54.52% were over the age of 50 years, 84.74% were females, 41.75% were nurses, 29.6% were administrative staff, and 6.54% were physicians. Of these workers, 39.56% considered themselves at high risk to develop complications related to COVID-19 infection, 74.46% felt neutral to uncomfortable treating these patients, 77.57% believed that the recommended personal protective equipment (PPE) was adequate, 89.41% supported the risk-reduction strategies, 84.73% obtained information from health authorities, 25.55% from social media, 31.46% believed COVID-19 was likely created in a laboratory or intentionally, and 66.14% of hospice workers who considered themselves at high risk of complications felt available PPE was adequate to protect them compared with 85.05% of responders who did not consider themselves at high risk (p < 0.0001). The majority of respondents were incorrect in seven of the eight clinical scenarios. Conclusion: Improving staff knowledge and information related to COVID-19 would enhance staff safety, improve patient care, and relieve anxiety.
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Affiliation(s)
- Zaida Albarracin
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA
| | - Michael Silverman
- Geriatrics/Palliative Medicine/Hospice, West Palm Beach VA Medical Center, West Palm Beach, Florida, USA
| | - Jocelyn Mineo
- HCA Healthcare: East Florida Division GME, Ft. Lauderdale, Florida, USA.,HCA Physician Services Group, East Florida Division, Ft. Lauderdale, Florida, USA
| | - Baher Al-Abbasi
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA
| | - Susan Koff
- Trustbridge Health, West Palm Beach, Florida, USA
| | | | - Richard S Levene
- University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, Florida, USA.,Trustbridge Health, West Palm Beach, Florida, USA
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Burkett E, Carpenter CR, Hullick C, Arendts G, Ouslander JG. It's time: Delivering optimal emergency care of residents of aged care facilities in the era of COVID-19. Emerg Med Australas 2020; 33:131-137. [PMID: 33131219 DOI: 10.1111/1742-6723.13683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen Burkett
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Healthcare Improvement Unit, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | | | - Carolyn Hullick
- Belmont Hospital, Belmont, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Braun RT, Yun H, Casalino LP, Myslinski Z, Kuwonza FM, Jung HY, Unruh MA. Comparative Performance of Private Equity-Owned US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open 2020; 3:e2026702. [PMID: 33112402 PMCID: PMC7593807 DOI: 10.1001/jamanetworkopen.2020.26702] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. EXPOSURE Nursing home ownership status. MAIN OUTCOMES AND MEASURES Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. RESULTS Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes. CONCLUSIONS AND RELEVANCE In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.
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Affiliation(s)
- Robert Tyler Braun
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Lawrence P. Casalino
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Zachary Myslinski
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Farai M. Kuwonza
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Mark Aaron Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
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