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Fyffe I, Sorensen J, Carroll S, MacPhee M, Andrews-Paul A, Crooks VA, Freeman S, Davison K, Walls J, Berndt A, Shams B, Sivan M, Mithani A. Long COVID in long-term care: a rapid realist review. BMJ Open 2023; 13:e076186. [PMID: 38128935 DOI: 10.1136/bmjopen-2023-076186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES The goals of this rapid realist review were to ask: (a) what are the key mechanisms that drive successful interventions for long COVID in long-term care (LTC) and (b) what are the critical contexts that determine whether the mechanisms produce the intended outcomes? DESIGN Rapid realist review. DATA SOURCES Medline, CINAHL, Embase, PsycINFO and Web of Science for peer-reviewed literature and Google for grey literature were searched up to 23 February 2023. ELIGIBILITY CRITERIA We included sources focused on interventions, persons in LTC, long COVID or post-acute phase at least 4 weeks following initial COVID-19 infection and ones that had a connection with source materials. DATA EXTRACTION AND SYNTHESIS Three independent reviewers searched, screened and coded studies. Two independent moderators resolved conflicts. A data extraction tool organised relevant data into context-mechanism-outcome configurations using realist methodology. Twenty-one sources provided 51 intervention data excerpts used to develop our programme theory. Synthesised findings were presented to a reference group and expert panel for confirmatory purposes. RESULTS Fifteen peer-reviewed articles and six grey literature sources were eligible for inclusion. Eleven context-mechanism-outcome configurations identify those contextual factors and underlying mechanisms associated with desired outcomes, such as clinical care processes and policies that ensure timely access to requisite resources for quality care delivery, and resident-centred assessments and care planning to address resident preferences and needs. The underlying mechanisms associated with enhanced outcomes for LTC long COVID survivors were: awareness, accountability, vigilance and empathetic listening. CONCLUSIONS Although the LTC sector struggles with organisational capacity issues, they should be aware that comprehensively assessing and monitoring COVID-19 survivors and providing timely interventions to those with long COVID is imperative. This is due to the greater care needs of residents with long COVID, and coordinated efficient care is required to optimise their quality of life.
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Affiliation(s)
- Ian Fyffe
- Long Term Care & Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Janice Sorensen
- Long Term Care & Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Simon Carroll
- Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Maura MacPhee
- Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Andrews-Paul
- Long Term Care & Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Valorie A Crooks
- Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shannon Freeman
- Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Karen Davison
- Institute of Life Course & Aging, University of Toronto, Toronto, Ontario, Canada
- Health Science Program, Faculty of Science and Horticulture, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Jennifer Walls
- Long-Term Care & Assisted Living Research Partners Group, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Annette Berndt
- Long-Term Care & Assisted Living Research Partners Group, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Benajir Shams
- Long Term Care & Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | | | - Akber Mithani
- Long Term Care & Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
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Havaei F, Staempfli S, Ma A, Sims-Gould J, Franke T, Park M. Resident Impact of the Single Site Order Restricting Staff Mobility across Long-Term Care Homes in British Columbia, Canada. Healthcare (Basel) 2023; 11:3190. [PMID: 38132080 PMCID: PMC10742518 DOI: 10.3390/healthcare11243190] [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] [Received: 10/20/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The Single Site Order (SSO)-a policy restricting staff from working at multiple long-term care (LTC) homes-was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in LTC homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This mixed methods study assesses the impact of the SSO on LTC residents in British Columbia. Interviews were conducted (residents (n = 6), family members (n = 9), staff (n = 18), and leadership (n = 10) from long-term care homes (n = 4)) and analyzed using thematic analysis. Administrative data were collected between April 2019 and March 2020 and between April 2020 and March 2021 and analyzed using descriptive statistics and data visualization. Qualitative and quantitative data were triangulated and demonstrated that staffing challenges became worse during the implementation of the SSO, resulting in the mental and physical health deterioration of LTC residents. Qualitative data demonstrated decreased time for personalized and proactive care, increased communication challenges, and increased loneliness and isolation. Quantitative data showed a decline in activities of daily living, increased antipsychotic medication use, pressure ulcers, behavioural symptoms, and an increase in falls. Addressing staff workload and staffing shortages during SSO-related policy implementation is essential to avoid resident health deterioration.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Sabina Staempfli
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Andy Ma
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Thea Franke
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Minjeong Park
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (F.H.); (A.M.); (M.P.)
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Benzinger P, Wahl HW, Bauer JM, Keilhauer A, Dutzi I, Maier S, Hölzer N, Achterberg WP, Denninger NE. Consequences of contact restrictions for long-term care residents during the first months of COVID-19 pandemic: a scoping review. Eur J Ageing 2023; 20:39. [PMID: 37847318 PMCID: PMC10581973 DOI: 10.1007/s10433-023-00787-6] [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] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
During the early stages of the COVID-19 pandemic, stringent measures were implemented in most countries to limit social contact between residents of long-term care facilities (LTCF) and visitors. The objective of this scoping review was to identify and map evidence of direct and indirect consequences of contact restrictions, guided by three conceptual perspectives: (1) stress and learned helplessness (i.e., failure to use coping behaviors even when they are available and actionalble); (2) social contact loss; and (3) 'total institution' (i.e., a facility operates following a fixed plan due to spelled-out rules and norms, controlled by institutional representatives). We used the framework for conducting a scoping review by Arksey and O'Malley; included were peer-reviewed manuscripts reporting on the outcomes of contact restrictions from the beginning of the pandemic until the end of 2020. After removing duplicates, 6,656 records were screened and 62 manuscripts included. Results pertaining to the stress and learned helplessness perspective primarily focused on depressive symptoms, showing substantial increases compared to the pre-pandemic period. Studies examining cognitive and functional decline, as well as non-COVID-19 related mortality, were limited in number and presented mixed findings. The majority of study outcomes related to the social contact loss perspective focused on loneliness, but the study designs did not adequately allow for comparisons with the pre-pandemic status. The evidence concerning outcomes related to the 'total Institution' perspective was inconclusive. Although detrimental effects of social isolation in the long-term care context found support particularly in the negative affect domain, other outcome areas did not allow for definitive conclusions due to considerable variations in findings and, in some cases, insufficient statistical power.
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Affiliation(s)
- Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany.
- Institute of Health and Generations, University of Applied Sciences Kempten, Bahnhofstrasse 61, 87435, Kempten, Germany.
| | - Hans-Werner Wahl
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Anne Keilhauer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Ilona Dutzi
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Simone Maier
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Natalie Hölzer
- Center for Geriatric Medicine, Heidelberg University Hospital, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Natascha-Elisabeth Denninger
- Centre for Research, Development and Technology Transfer, Technical University of Applied Sciences Rosenheim, Hochschulstraße 1, 83024, Rosenheim, Germany
- Medical Faculty, Institute for Health and Nursing Science, International Graduate Academy, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
- Medical Faculty Heidelberg, Department of General Practice and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Doyle M, Louw JS, Corry M. Staff Perceptions of the Impact of the COVID-19 Pandemic on Older Adults Living in a Residential Long-Term Care Facility. J Gerontol Nurs 2023; 49:44-50. [PMID: 37768581 DOI: 10.3928/00989134-20230915-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Older adults residing in long-term care facilities (LTCFs) were an at-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Actions to prevent transmission in LTCFs included visitation restrictions, suspension of group activities, and isolating residents in their rooms. Despite these measures, this vulnerable cohort experienced high levels of infection and mortality. The current article reports RNs' and health care assistants' perceptions of the impact of COVID-19 on residents in a LTCF. Using a descriptive qualitative design, semi-structured interviews, which were conducted with seven RNs and four health care assistants, were thematically analyzed. Three themes emerged: Impact on Daily Routine, Disruption to Relationships With Staff, and Vulnerability. Staff perceived residents were negatively impacted physically, emotionally, and socially as a direct consequence of COVID-19 and by strategies introduced to protect them contracting the virus. It is recommended that the long-term impact of the COVID-19 pandemic on this cohort be evaluated from the perspective of all stakeholders (i.e., residents, staff, and families) using a longitudinal research design. [Journal of Gerontological Nursing, 49(10), 44-50.].
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Kortes-Miller K, Natale M, Wilson K, Stinchcombe A. The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic. Geriatrics (Basel) 2023; 8:90. [PMID: 37736890 PMCID: PMC10514792 DOI: 10.3390/geriatrics8050090] [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] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners' roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.
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Affiliation(s)
| | - Maïa Natale
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Lapane KL, Lim E, Mack DS, Hargraves JL, Cosenza C, Dubé CE. Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:1127-1132.e6. [PMID: 37355245 PMCID: PMC10227205 DOI: 10.1016/j.jamda.2023.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES COVID-19-related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents' loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness. DESIGN National survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5). SETTINGS AND PARTICIPANTS US Nursing Home Directors of Nursing/Administrators (n = 1676). METHODS The survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results. RESULTS One-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues. CONCLUSIONS AND IMPLICATIONS Despite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents' social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Emily Lim
- Department of Gerontology, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - J Lee Hargraves
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA; Center for Survey Research, University of Massachusetts Boston, Boston, MA, USA
| | - Carol Cosenza
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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7
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Havaei F, Sims-Gould J, Staempfli S, Franke T, Park M, Ma A, Kaulius M. Impact of the single site order in LTC: exacerbation of an overburdened system. BMC Health Serv Res 2023; 23:666. [PMID: 37340438 DOI: 10.1186/s12913-023-09670-7] [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] [Received: 08/04/2022] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada. METHODS A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 - March 2020) and four quarters during the pandemic (April 2020 - March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis. RESULTS Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO. CONCLUSIONS The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada.
| | - Joanie Sims-Gould
- Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Sabina Staempfli
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Thea Franke
- Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Minjeong Park
- Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Andy Ma
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Megan Kaulius
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
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