By Adelina Comas-Herrera (CPEC)
As disturbing news emerge about the collapse of nursing homes in Spain due to COVID-19, where the army entered to find the corpses of people who had been abandoned, there is increasing evidence from Spain, Italy and the United States (see below), about the enormous challenge of trying to prevent and contain COVID-19 in care homes.
The key emerging problems appear to be:
- Enormous difficulties in preventing and containing infections
- Staff shortages, as staff become ill themselves or fear becoming infected (which may be due to trying to protect at-risk household members)
- Lack of Personal Protection Equipment (PPE), perhaps due nursing home staff being considered less essential than hospital staff
- Ambulances/phone triage systems refusing to collect nursing home residents with severe infections, leaving them to die without treatment
So what can be done?
Based on the reports below:
- Improve infection prevention and control in care homes (see new WHO guidance for infection prevention and control in care homes).
- Monitor staffing levels so that replacement emergency staff can be deployed in a timely manner. Spain brought it the army, for example.
- Prioritise PPE suplies for residential and nursing home staff, ensuring that they have at least equal priority as health care service staff.
- If people in nursing homes are not transported to hospital, ensure they receive adequate treatment for the infection in the homes, and palliative care support where needed. While the population in these homes may have very low probabilities of survival, they should not be discriminated against just because of where they live.
- Ensure that homes in the private sector are supported and monitored.
Suggested citation: Comas-Herrera A (2020) COVID-19 outbreaks and deaths in residential and nursing homes: lessons learnt from Spain, Italy and the US. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/03/23/covid-19-outbreaks-in-residential-and-nursing-homes-lessons-learnt-from-spain-italy-and-the-uk-and-some-resources/
I have increasingly come to the view (and published this) that we need care homes to be distinct from the NHS not just in their commissioning / regulation but their whole nexus of health and care provision.
The NHS is too big already and local authorities really need to focus on community placed folk. The present Coronovirus outbreak has reinforced my view (which was already fairly well informed!).
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