COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From an Online Survey with Long-Term Care Administrators

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022

CONTEXT

Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities.

OBJECTIVE

To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December 2022 and to include US Food and Drug Administration COVID-19 testing and vaccine authorizations.

DESIGN

A narrative chronological review of all New York State Department of Health guidance.

RESULTS

Documents and associated guidance and regulations are divided into 4 sections: (1) lockdown until COVID-19 vaccine emergency use authorization; (2) COVID-19 vaccine authorization until phased reopening; (3) phased reopening, vaccination requirements, and booster vaccination; (4) the period of the bivalent booster.

CONCLUSION

Controlling the spread of SARS-CoV-2 within ALFs required a multifactorial approach that included stringent infection control measures, testing, and vaccination and careful attention to the social structure and support systems within ALFs. The SARS-CoV-2 pandemic highlighted the complexity of controlling spread of an easily transmissible respiratory pathogen in assisted living communities and the need to structure infection control programs within the diverse ALFs that provide care for our aging population.

U.S. nursing home leadership experiences with COVID-19 and its impact on residents and staff: A qualitative analysis

OBJECTIVES

To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff.

DESIGN

Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach.

SETTING AND PARTICIPANTS

A stratified sample frame defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022.

RESULTS

Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions.

CONCLUSIONS AND IMPLICATIONS

New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.

Telehealth: Moving Older People Along the Adoption Trajectory

Although the concept of telehealth has been in development for many years, the global pandemic galvanized its growth and utility. In general, people adopt technological advancements at different velocities that, when plotted in a chart, resemble a bell-shaped curve. People who are quick to adopt new technologies are designated innovators, while those who are the very last to adopt new technologies are dubbed laggards. Often, older people fall into the laggard category for several reasons including physical, mental, and emotional barriers. In some cases, they lack the technology or experience with various programs that would make such programs accessible. Regardless, telehealth has proven its worth as a way to deliver care in areas distant to the health care provider when physical examination is unnecessary. It can reduce the likelihood of exposure to contagious disease. Telehealth also has the potential to reduce unnecessary emergency department visits, and long-term care facilities that have used telehealth have demonstrated cost savings. Little study has been conducted to determine how pharmacists are using telehealth, but after examining available research on telehealth, pharmacists can identify pitfalls and implement steps that reduce barriers for older people.

Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies

BACKGROUND

The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy.

OBJECTIVE

This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic.

METHODS

In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication & Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised.

RESULTS

In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable).

CONCLUSIONS

Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study's findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/36269.

Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic

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.

The effect of COVID-19 on nuclear medicine and radiopharmacy activities: A global survey

Globally, COVID-19 affected radiopharmaceutical laboratories. This study sought to determine the economic, service, and research impacts of COVID-19 on radiopharmacy. This online survey was conducted with the participation of employees from nuclear medicine and radiopharmaceutical companies. The socioeconomic status of the individuals was collected. The study was participated by 145 medical professionals from 25 different countries. From this work, it is evident that 2-deoxy-2-[18F]fluoro-D-glucose (2-[18F]FDG), and 99mTc-labeled macro aggregated albumin 99mTc-MAA were necessary radiopharmaceuticals used by 57% (83/145and 34% (49/145;) respondents, respectively for determining how COVID infections affect a patient's body. The normal scheduling procedure for the radiopharmacy laboratory was reduced by more than half (65%; 94/145). In COVID-19, 70% (102/145) of respondents followed the regulations established by the local departments. Throughout the pandemic, there was a 97% (141/145) decrease in all staffing recruitment efforts. The field of nuclear medicine research, as well as the radiopharmaceutical industry, were both adversely affected by COVID-19.

Residents' experiences of encounters with staff and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study

BACKGROUND

The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes.

AIM

The aim of this study was to explore residents' experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic.

DESIGN

An exploratory study with an inductive approach.

METHODS

Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist.

RESULTS

Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls.

CONCLUSION

This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

Implementing Technology Literacy Programs in Retirement Homes and Residential Care Facilities: Conceptual Framework

Background

The COVID-19 pandemic caused widespread societal disruption, with governmental stay-at-home orders resulting in people connecting more via technology rather than in person. This shift had major impacts on older adult residents staying in retirement homes and residential care facilities, where they may lack the technology literacy needed to stay connected. The enTECH Computer Club from the University of Waterloo in Ontario, Canada created a knowledge translation toolkit to support organizations interested in starting technology literacy programs (TLPs) by providing guidance and practical tips.

Objective

This paper aimed to present a framework for implementing TLPs in retirement homes and residential care facilities through expanding on the knowledge translation toolkit and the framework for person-centered care.

Methods

Major concepts relating to the creation of a TLP in retirement homes and residential care facilities were extracted from the enTECH knowledge translation toolkit. The domains from the framework for person-centered care were modified to fit a TLP context. The concepts identified from the toolkit were sorted into the three framework categories: “structure,” “process,” and “outcome.” Information from the knowledge translation toolkit were extracted into the three categories and synthesized to form foundational principles and potential actions.

Results

All 13 domains from the framework for person-centered care were redefined to shift the focus on TLP implementation, with 7 domains under “structure,” 4 domains under “process,” and 2 domains under “outcome.” Domains in the “structure” category focus on developing an organizational infrastructure to deliver a successful TLP; 10 foundational principles and 25 potential actions were identified for this category. Domains in the “process” category focus on outlining procedures taken by stakeholders involved to ensure a smooth transition from conceptualization into action; 12 foundational principles and 9 potential actions were identified for this category. Domains in the “outcome” category focus on evaluating the TLP to consider making any improvements to better serve the needs of older adults and staff; 6 foundational principles and 6 potential actions were identified for this category.

Conclusions

Several domains and their foundational principles and potential actions from the TLP framework were found to be consistent with existing literatures that encourage taking active steps to increase technology literacy in older adults. Although there may be some limitations to the components of the framework with the current state of the pandemic, starting TLPs in the community can yield positive outcomes that will be beneficial to both older adult participants and the organization in the long term.

Benefits, Satisfaction and Limitations Derived from the Performance of Intergenerational Virtual Activities: Data from a General Population Spanish Survey

The growing social gap between people of different generations has led to a greater interest in the study of intergenerational interactions. Digital technologies have become necessary for people of all ages to perform daily activities, increasingly including older people. The use of information and communication technologies (ICTs) and virtual tools can provide older people with excellent opportunities to connect with other generations, improving their quality of life and well-being. The aim of this study was to examine the benefits, satisfaction, and limitations of intergenerational interactions generated by the use of virtual tools. The participants are subjects of any age and different social groups residing in Spain and have completed an online survey. The analysis of sociodemographic data of the respondents showed that there is a significant correlation between the use of social networks and all the variables analyzed, except for their level of autonomy. Most participants who participated in intergenerational virtual activities reported the benefits of their social participation, relationships, mood, mental health, and academic education. Moreover, most participants were quite or very satisfied with the person with whom they used the virtual tools, especially if the person was a friend, their partner, sibling, another relative, or colleague. Except for grandparents, people who participated in intergenerational virtual activities and who had no limitations or disabilities were more frequently reported by the participants. In conclusion, intergenerational interactions through the use of virtual tools can contribute to improving the social inclusion and relationships of all people involved.