Is time a healer? Course of demands during the COVID-19 pandemic in long-term care: a repeated cross-sectional survey in Germany

Burnout in residential aged care managers: a scoping review

Residential aged care managers play an important role which can influence outcomes for their staff, their residents, and the organisations they work for. Burnout in residential aged care employees has been researched however burnout in residential aged care managers has received little attention. This scoping review sought to identify literature examining burnout in residential aged care managers.

To investigate the literature currently available on what stressors were experienced by residential aged care managers that led to burnout.

This scoping review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist.

Five databases were searched, including CINAHL, MEDLINE, EMCARE, SCOPUS, and INFORMIT using primo search. The first review of title and abstracts was conducted by three authors to determine eligibility, using the program JBI SUMARI. Two authors were involved in the final screening of each full-text article. Where disagreement occurred, a collaborative discussion took place until consensus was reached. The review included peer-reviewed journal articles focusing on burnout, stress, fatigue, moral distress, exhaustion, or resilience in residential aged care managers or leaders published after 2012 in English.

An initial search of the databases found 275 articles, of which 5 articles met the inclusion criteria for final review. Articles were categorised into the following groups Responsibilities, Reaction, and Regulation. These groups encapsulated risk factors for burnout in residential aged care managers.

As a result of the scoping review, it is suggested that burnout in residential aged care managers can be attributed to environmental stressors, those being situational and organisational (Maslach, 2003), which are outside the control of the individual. Strategies that support residential aged care managers to manage and lessen the phenomenon of burnout require further exploration.

Evolutionary game and stability analysis of elderly care service quality supervision from the perspective of government governance

Objective

The performance of government functions is an important guarantee for the standardized operation of the elderly service market. The objective of this study is to explore the optimal path for the government to govern the elderly care service market.

Methods

The tripartite evolutionary game model is proposed in the paper, which composed of local governments, private elderly care institutions and the public. Furthermore, three mechanisms, i.e. dynamic penalty and static subsidy, static penalty and dynamic subsidy, dynamic penalty and dynamic subsidy, are designed. Under these different mechanisms, the stability of each subject's strategy choice is analyzed by using system dynamics simulation.

Results

The introduction of dynamic mechanisms can compensate for the inability of static mechanisms to bring the system to a steady state. The dynamic penalty and dynamic subsidy mechanism allows the system to evolve to the desired point of stability. The self-discipline behavior of private elderly care institutions is positively correlated with penalties and reputation gains-losses, negatively correlated with subsidies, and not correlated with supervision rewards. Excessive subsidies will promote the collusion of private elderly institutions.

Conclusion

Only when the local government adopts the dynamic penalty and dynamic subsidy mechanism will private elderly care institutions choose to operate in a fully self-disciplined manner. Reasonable adjustments of penalties, reputation gains-losses and subsidies can not only further optimize the dynamic penalty and dynamic subsidy mechanism, but also help to achieve diversified regulatory objectives of the government. This study would provide a reference for local governments seeking to develop effective regulatory policies for the elderly service market.

Influencing factors on the health of nurses-a regression analysis considering individual and organizational determinants in Germany

BACKGROUND

The care sector is characterized by high absenteeism of nursing care employees due to illness. Organizational determinants that can affect the mental health of nurses are known. Although nurses are confronted with different framework conditions in different care settings, there is a lack of comparative data in Germany.

METHODS

The purpose of this study was to examined the relationship between work demands and employee health in different care settings. This cross-sectional survey was conducted between June and October 2021 in four acute care hospitals, seven inpatient care facilities, and five outpatient care services in Germany. 528 nursing care employees (acute care hospitals n = 234; inpatient care facilities n = 152; outpatient care services n = 142) participated in the survey (participation rate: 22.6%-27.9%). For each care setting, data was collected via questionnaire on individual determinants (gender, age, profession, working time), organizational work demands (quantitative workload, qualitative workload, organization of work, social work climate, after work situation, verbal violence, threats, physical violence) and employee health (subjective health status and work ability). Descriptive statistics and binary logistic regressions were performed.

RESULTS

Increasing age (OR = 0.650, 95% CI = 0.424-0.996) as an individual determinant and organization of work (OR = 0.595, CI = 0.362-0.978) as an organizational determinant were negatively associated with subjective health. Furthermore, age (OR = 0.555, 95% CI = 0.353-0.875), a demanding organization of work (OR = 0.520, CI = 0.315-0.858), increasing quantitative workloads (OR = 0.565, CI = 0.343-0.930) and a poorer perceived social work climate (OR = 0.610, CI = 0.376-0.991) were associated with lower work ability.

CONCLUSIONS

Based on the study results, health programs should target both individual and organizational factors. The findings seem to support the importance to include nursing care employees in the planning process, as it can have an impact on their health.

TRIAL REGISTRATION

The project was registered in the German Clinical Trial Register (DRKS00024961, 09/04/2021).

Home care in Germany during the COVID-19 pandemic: A neglected population?

INTRODUCTION

Older persons and those with pre-existing conditions are at the biggest risk for severe illness and death from COVID-19. In Germany, more than 3.3 million people out of this population receive care in their own homes. User representatives and nurses have criticized health policy during the COVID-19 pandemic as inappropriate for the home care setting. This policy analysis, therefore, aims to answer the question, which policy changes should be made following Bardach's framework.

PRE-PANDEMIC POLICY

Home care in Germany is mainly funded through the statutory long-term care and statutory health insurance funds. It focuses on compensation of physical functioning, selected therapy-related tasks prescribed by a physician and is not well integrated with acute and primary care.

POLICY PROBLEMS

The pandemic highlighted the following challenges: nurses are excluded from policy decisions; epidemiological data from the home care setting is lacking; nurses do not have prescribing authority for vaccines; user and family education is not made available; home care-specific guidance on infection control and prevention is absent and the home care setting is underprepared to care for acutely ill patients.

POLICY ALTERNATIVES

Nurses need to be included in policy decision and authorized to adopt more responsibility in home care than currently possible. Home care-specific policies and guidance are needed and integration with primary care should be sought.

DISCUSSION

Changes to current policy in the identified areas could make the health system more resilient to future crisis.

CLINICAL RELEVANCE

Older persons and those with pre-existing conditions are at the highest risk for severe illness and death from COVID-19 and most of them receive care in their own homes in Germany. Improving health policy governing home care, improving the availability of valid data and evidence, and improving the delivery of home care during the pandemic will contribute to better outcomes.

Is the Systemic Agency Capacity of Long-Term Care Organizations Enabling Person-Centered Care during the COVID-19 Pandemic? A Repeated Cross-Sectional Study of Organizational Resilience

The COVID-19 pandemic has strained long-term care organization staff and placed new demands on them. This study examines the role of the general ability and power of a long-term care organization to act and react collectively as a social system, which is called systemic agency capacity, in safeguarding the provision of person-centered care during a crisis. The question of how the systemic agency capacity of long-term care organizations helps to ensure person-centered care during the pandemic is an open research question. We conducted a pooled cross-sectional study on long-term care organizations in Germany during the first and second waves of the pandemic (April 2020 and December 2020–January 2021). The sample consisted of 503 (first wave) and 294 leaders (second wave) of long-term care organizations. The top managers of these facilities were asked to report their perceptions of their facility’s agency capacity, measured by the AGIL scale, and the extent to which the facility provides person-centered care. We found a significant positive association between the leaders’ perceptions of systemic agency capacity and their perceptions of delivered person-centered care, which did not change over time. The results tentatively support the idea that fostering the systemic agency capacity of long-term care organizations facilitates their ability to provide quality routine care despite environmental shocks such as the COVID-19 pandemic.

Psychosocial burden and associated factors among nurses in care homes during the COVID-19 pandemic: findings from a retrospective survey in Germany

Background

Care homes were hit hard by the COVID-19 pandemic. Although high levels of psychosocial burden (i.e., anxiety, depression and stress) during the pandemic have been described for healthcare workers in hospitals, evidence on the psychosocial burden for nurses in care homes during the pandemic is scarce.

Methods

A total of 811 nurses participated in a retrospective online survey between November 2020 and February 2021. Information about the COVID-19 situation (i.e., working demands, COVID-19 cases in their facility, and COVID-19-related burden) of nurses in German care homes during the first wave of the pandemic (March 2020 to June 2020) was gathered. The Stress Scale of the Depression Anxiety and Stress Scales (SDASS-21), the Generalized Anxiety Disorder Scale-2 (GAD-2), the Patients-Health-Questionnaire-2 (PHQ-2), and the Copenhagen Psychosocial Questionnaire (COPSOQ) were used to screen for psychosocial burden.

Results

Among nurses, 94.2% stated that working demands since the COVID-19 pandemic increased. Further, 59.1% showed clinically relevant levels of either stress, anxiety, and/or depression. Multiple regression analysis showed significant associations between COVID-19-related burden and qualification (p < .01), dissatisfaction with COVID-19 management of care home manager (p < .05), COVID-19-related anxiety (p < .001), and dementia as a focus of care (p < .05). Stress, depression, and anxiety showed associations with COVID-19 related burden at work (p < .01), COVID-19-related anxiety (p < .001), social support (p < .01), and sense of community (p < .05). Stress was also associated with COVID-19 cases among residents (p < .05), and size of care home (p < .05).

Conclusion

Short- and long-term strategies (i.e., psychosocial counseling, mandatory team meetings, more highly qualified nurses, additional training) in the work environment of nursing, in crises, but beyond, should be encouraged to reduce the burden on nursing staff in care homes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00807-3.