Alice Ashwell, Roxanne Jacobs, Sumaiyah Docrat and Marguerite Schneider (STRiDE South Africa)

With the outbreak of Covid-19 in South Africa in March 2020, the National Advisory Group (NAG) of the Strengthening Responses to Dementia in Developing countries (STRiDE) research project in South Africa decided to undertake a survey to ascertain how long-term care facilities (LTCFs) that accommodate people living with dementia were responding to Covid-19 and the resultant lockdown. A Covid-19 Working Group was established to oversee this process. This study focused only on LTCFs, and not on home-based or short-term care situations.

Members of the Working Group were requested to circulate a short questionnaire to their mailing lists. The questionnaire was circulated twice: first in May 2020, during the early stages of the outbreak, and then in July to ascertain how LTCFs were coping as infections peaked.

Initially only an English version of the questionnaire was circulated, but at a meeting of the Working Group in July, it was decided to translate the questionnaire into Afrikaans and to extend the survey period by a few weeks.

Prior to the production of this report, the results of each the surveys were compiled and shared with members of the STRiDE NAG and Working Group, as well as with the respondents. The report on the first round of the survey was also included in a report on the response of South African LTCFs. Online discussions with Working Group members and respondents about the interim reports informed the Discussion and Conclusions sections of this report.

Key findings:

• News from the UK and Europe about the impact on COVID on Long-Term Care Facilities (LTCFs) allowed South African LTCFs to plan in time for the hard lockdown that started in late March 2020. This limited the number of infections and deaths attributed to COVID.
• This report synthesizes findings from a survey of 48 LTCFs. From the time LTCFs went into lockdown until the date of submission of their questionnaires, 16 of the 48 LTCFs (33.0%) surveyed had experienced infections, recoveries and/or deaths amongst residents and/or staff members (last responses dated 2 September 2020).
• Many LTCFs developed their own policies and procedures before receiving these from the government. LTCFs learnt to be flexible and adaptable.
• Training of staff and providing a supportive and accommodating environment facilitated staff commitment and resident well-being, but as the lockdown continued it became difficult to maintain and find replacement staff. 
• LTCFs experienced significant financial strain due to unpaid subsidies, an inability to fill vacant rooms from the waiting list and the large unanticipated costs of providing PPE and adapting facilities.
• The impact on people with dementia was significant as many could not understand the need for masks and did not cope with being in isolation in their rooms. Efforts were made in some facilities to find ways to organise the living areas to avoid having to isolate people with dementia in their rooms. 
• The lockdown experience raised the profile of older people and LTCFs in South Africa, as it did globally. However, there is no consistent monitoring of infections and deaths within LTCFs specifically. However, in November 2020 the National Department of Social Development initiated a surveillance project on the impact of COVID on older people broadly (i.e. not specifically including LTCFs).
• A recommendation proposed by participants is that the entire long-term care system be reviewed, including LTCFs, home-based care and community-based support. Conversations are needed about the future of retirement villages and care homes, alternative perspectives on ageing, ‘age-friendly’ communities, and appropriate models of care.

The full report is available here: