Project summary:

The goal of our project is to develop and apply a comprehensive analytical framework for analyzing COVID-19 mortality locally within neighborhoods and long-term care facilities in a major metropolitan center. During the current public health crisis, information on COVID-19 mortality has typically been reported for the overall population, at single time points, and without regard to locations such as long-term care facilities or other congregate settings. In our study of COVID-19 mortality in Cook County IL (Chicago and suburbs) we examined patterns in COVID-19 mortality over time at the neighborhood level (postal Zip codes) in households and in nursing homes and other long-term care facilities (LTCFs). This framework provides:

• reliable estimates of commonly quoted COVID-19 mortality indicators;
• a better understanding of spatial and temporal distribution of COVID-19 deaths;
• accurate depictions of the role of race, ethnicity, and socioeconomic status in COVID-19 mortality; and
• population and organizational parameters that can inform strategies for public health interventions.

Cook County, the primary setting for this study is a large urban area, located in the US Midwest, with 5.15 million people and covering 1,635 square miles. It has rich racial and socio-economic diversity, and it has a multiplicity of neighborhoods and LTCFs spread across the county.

The major source of mortality data for this study is the Medical Examiner (ME) Case Archive of COVID-19-related Deaths. This archive is organized in a searchable online database format and contains residential address and other information about decedents (age, gender, race, and cause of death) for all deaths that occurred in Cook County from January 2020 to present.

Another source of data is the COVID-19 Nursing Home Data, maintained by the Centers for Medicare and Medicaid Services (CMS), which contains a count of COVID-19 cases and deaths, updated weekly, among residents and staff in each of the 15,000+ nursing facilities in the United States. Information about nursing facility characteristics comes from Medicare’s Nursing Home Compare and from Brown University’s LTC Focus data system. Data on overall mortality come from the Johns Hopkins Coronavirus Resource Center.

Data on population size, age, race/ethnicity, and socio-economic status are obtained from the US Census at the block group level, and then aggregated to the postal zip code level for much of the analysis.

Data preparation and statistical analysis are performed with the IBM® SPSS® Modeller 18.2.1. Geocoding, data projections, geospatial data integration, mapping, and initial spatial analysis are performed using ESRI’s ArcGIS Pro.

Project summary:

This project is a three-phase rapid qualitative appraisal of the perspectives of workers providing LTC to older adults in central North Carolina during the pandemic. We conducted semi-structured interviews with 75 participants using a purposive sample from May to November, 2020. We included participants from both the range of congregate LTC communities and also in-home and community based services. This is a mirror study conducted as part of the global efforts to study healthcare workers experiences during the pandemic spearheaded by the Rapid Research, Evaluation and Appraisal Lab (RREAL) at University College London. Due to the on-going nature of the pandemic, we are preparing to follow up through focus groups with our participants which will include plans for reopening and vaccination.

Project summary:

Effective pandemic preparedness in LTC homes requires rapid and comprehensive implementation of promising practices and policies. The study will investigate a virtual quality improvement (QI) collaborative of six LTC homes in British Columbia, Canada to facilitate shared learning across multiple QI projects to address gaps in pandemic preparedness by teams involving family and friend caregivers, care aides, nurses, healthcare professional, managers and directors. An implementation science team will investigate: 1) How can QI teams use virtual collaboration to facilitate a systematic QI approach to pandemic preparedness? 2) How can the virtual collaboration tool be used to scale-up and spread promising practices and policies for pandemic preparedness across multiple homes through a QI collaborative? Using a concurrent mixed-methods study design, the virtual collaboration tool use and QI activities will be assessed and interviews will be conducted with QI team members about their experiences with the virtual QI collaborative approach.

Project summary:

Introduction

The COVID-19 pandemic has made increasing demands on the adult social care sector whose remit, scope and forms of service delivery are complex. This complexity and the populations served, render statutory authorities’ adult services and the broader adult social care landscape of providers uniquely vulnerable to the impacts of COVID-19 long-term.

Rapid change has taken place; as the initial crisis begins to subside, it is important to build an evidence base that can inform ongoing planning for the COVID-present and post-COVID landscape in which social care services seek to be effective.

This study is focusing on the impact and the responses at the levels of strategic and organisational planning, operational delivery and individual workforce resilience in response to the pandemic in the Greater Manchester region.

The SECURE study has been designed through a partnership which includes: NIHR School for Social Care Research (Manchester), the Greater Manchester (GM) Health and Social Care Partnership, the Greater Manchester Social Work Academy (GMSWA), NIHR ARC Greater Manchester, the Thomas Ashton Institute, Social Work in the University of Manchester and regional service user and carer partners.

Objectives

The main aim of this study is to explore and understand the medium- and long-term effects of the COVID-19 pandemic on practitioners and organisations providing social work and social care to adults in Greater Manchester at the levels of:

• Strategic and organisational planning
• Operational delivery
• Individual workforce resilience

This encompasses:

• Within organisation strategy and processes (e.g. recruitment, retention, training, support systems, finance)
• Operational practice and service delivery concerns (e.g. assessment, risk, prioritisation, allocation of resources and models of service provision and delivery)
• Staff personal and professional impacts (e.g. mental health, well-being, safety, resilience, sickness absence, support needs)

The objectives of this study are to:

• Establish a working example of a regional adult social care COVID-19 response evidence hub that can be replicated nationally and be an open, shared resource in the sector
• Share the anonymised data collected and meta data as rapidly as possible to the benefit of the adult social care sector and other researchers
• Test the feasibility of scaling up the data collection processes and analysis to a national level study.

Methods

This is a mixed methods study. The project will involve an online survey of social care and social work staff in many different locations including voluntary organisations, care homes and local authorities. This survey includes measures of wellbeing.

The research team will look at routine data that is collected by local authorities e.g. service user numbers, different kinds of assessment and costs. This data will be anonymised and be used to build up a picture during and after COVID-19. Some people will also be invited for interview so that they can discuss in depth their experiences at two points in time.

The data from this project about social care will be compared with other COVID-19 studies underway in the NHS to provide evidence across sectors and workforces.

Project summary:

This is a representative survey of the Austrian population aged 20-64 (N=2000) with detailed information on socio-demographics and impact of the pandemic on informal care (e.g. changes to intensity, prevalence and wellbeing and economic situation of carers), unmet needs and health, employment and income and education. A second wave is planned to be fielded in early 2021, making this a longitudinal survey allowing for more detailed analysis of data on heath and informal care, among other outputs.

Project summary:

Objective: To assess the effect of the Blended Gaming COVID-19 Training System (BGCTS) on infection control practices, compliance rates and knowledge of standard precautions among all staff in residential care homes (RCHs). Design: A 2-arm single-blinded cluster randomized controlled trial. Setting: Twenty RCHs (out of the 70 RCHs in the established network). Participants: 188 staff (from 20 RCHs) will be randomized to the intervention group (IG) or the control group (CG) according to their RCHs. Intervention: The intervention is a blended mode of training (e-health mode blended with face-to-face sessions) and the contents are derived from ‘The COVID-19 Risk Communication Package For Healthcare Facilities developed by the World Health Organization. E-health mode refers to a 120-minute web-based training system covering 8 topics in 2 weeks. Short-clip videos and games are used. Two face-to-face 30-minute interactive sessions will be arranged for clarifying concepts. Main outcome measures: Primary outcome: compliance rate of hand hygiene and infection control practices (by non-participatory observations with a checklist on infection control practices). Observation will be made of the staff in the IG and CG when they are working in the facilities. Secondary outcomes: Knowledge and attitudes towards infection control (KAIC) and Self-reported Infection Control Practice (SICP) Expected outcomes: BGCTS will improve staff’s performance at infection control practices. The BGCTS is the first of this kind training, addressing the diverse health literacy levels of staff and helping RCH staff to comply with WHO infection control guidelines. RCHs can adopt BGCTS in staff development training in the future.

Project summary:

BrainLive, funded the Simon K.Y. Lee Foundation, is a 2-year project that mainly aims to develop a best practice model of barrier-free online dementia community support service using information and communications technology (ICT) and productive ageing to deliver intervention and care. In 2 years, we will develop a tested model that is effective and equitable, with good economic value for society, and ready to be widely implemented in various community service settings. The project targets to test the feasibility, acceptability and sustainability of an online community-based dementia service model consisting of a package of evidence-based social care and intervention services for families living with dementia delivered via ICT tools with trained young-old volunteers support, with the following objectives: 1) ensure access to evidence-based intervention and care under infection control situations; 2) prepare families living with dementia and service providers for future remote service development by enhancing their ICT literacy in the post-pandemic era; 3) build capacity of the community to care for families living with dementia by developing young-old volunteers for remote dementia service; 4) promote innovations by NGOs to explore full potentials of ICT-enriched service for continued service, including involvement of carers in the long-term; and 5) identify using service data the best combination of the standard service package and other infrastructure and support for an optimised model to recommend in Hong Kong.

Project summary:

The aim of this research was to understand the impact of the COVID-19 pandemic on people working in care homes in England. We explored how the pandemic has impacted on the emotional wellbeing of staff, including what is being done and could be done to try and protect and support wellbeing. The research involved remote interviews with care home owners, managers, and staff. Findings will be shared to enable learning about how best to support the emotional wellbeing of care home staff in the future. The project ran from November 2020 – July 2021 and findings are expected to be reported late 2021/early 2022. Please contact Kath if you would like to be involved or find out more.

The project sits under a broader project involving working with care homes: Exeter University, Care Homes and Knowledge (ExCHANGE) Collaboration https://www.arc-swp.nihr.ac.uk/research/the-exchange-collaboration, University of Exeter, College of Medicine and Health. Supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South West Peninsula (PenARC).

Project summary:

Government-led mandates have sought to contain spread of coronavirus and reduce burdens on healthcare systems. This had unplanned impact on older people and their loved ones living in care homes in Scotland through social distancing and reduced personal contact. This research investigates the impact of this on the health and wellbeing of family carers. It also aims to learn from and share positive creative practices. Findings will inform longer term learning beyond COVID-19 about range and methods to support positive interactions between care home residents and their loved ones.

It has applied a mixed methods approach and has included: 35 in-depth interviews with family carers; 19 interviews with key stakeholders, most at senior level; 5 ‘creative cafes’ (or informal group sessions with care home staff); an online survey completed by 444 family carers between 31 Aug -21 Sept 2020.

Project summary:

View Care: The primary goal of the project is to gain insights into the current situation, the experience, the organisation of needs and coping strategies of people in need of care during the Corona pandemic. The focus is put on the individual experience and the subsequent sense definitions of the individuals. The theoretical explanations of the current situation of people in need of care are extended by making the new reality’s processing of the subjects themselves a topic. This perspective has been virtually unexamined up to now. Sociological perspectives within the framework of reconstructive social research have only been marginally represented in care research so far. This study aims to expand the methodological and content-related repertoire of previous health services research.

Project summary:

How can the care needs of older people be met in sustainable, fair and culturally acceptable ways? This project aims to answer this question in relation to Indonesia, the world’s fourth largest population. It seeks to understand what care needs older Indonesians have; who provides care; what acceptable care looks like; and how care-dependent people are perceived. The project involves ethnographic research in five diverse communities, combined with collection of household survey data and analysis of existing national-level surveys. The research sites are located in West Sumatra, Jakarta, Yogyakarta, East Java, and Alor.

Three ideas are central to this study. First, we consider care a cultural practice: culture shapes preferences for care providers, what counts as acceptable care, and what being dependent does to a person’s social value and identity. This is why we use ethnography to situate care in its cultural context and compare ethnic groups across Indonesia. Second, care is provided by a mix of family, neighbours, health-care providers and volunteers. This is why we collect data on people’s complete care networks over time. Third, we understand that older people differ in terms of gender, wealth, and family networks. This is why we collect information on people’s economic, demographic and social status and compare care among sub-groups.

Project summary:

The employment of mainly female live-in care workers has become an important pillar of elderly care regimes within Europe. Especially in familialistic welfare states, circularly migrating live-in carers typically from Central and Eastern Europe fill, at least partially, the so-called care gaps emerging from demographic changes as well as the increasing labour market participation of women. Closed borders and other pandemic-related measures put a (temporary) halt to the transnational migration of care workers. Austria, Romania, and Slovakia represent a particular case for studying the effects of COVID-19 responses: Austria is a country with a legalised and highly institutionalised live-in care model. Roughly 80% of care workers come from Romania and Slovakia and commute to Austria in short-term cyclical rotas. As these rotas typically range from two to four weeks, the transnational care arrangements were affected earlier by travel restrictions than in countries where migrant carers stay for longer periods.
By looking at the three mentioned countries, the project examines how live-in care and its workers were affected by the pandemic. We analyse relevant policies and measures in Austria, Romania, and Slovakia and draw on media reports about live-in care and interviews with representatives of live-in care workers’ organisations. What role do the existing regulation of live-in care as well as sending and receiving countries’ pandemic responses play for the situation of care workers? How do care workers, brokering agencies, and their respective organisations react to the pandemic-related difficulties, how do they try to assert their interests, and to what extent does this influence the precarious working and living conditions of care workers? The paper written within the project shows that the pandemic highlighted the fragility of live-in care arrangements and underlined that care workers’ wants, needs, and interests were not only subordinated to the wants and needs of care recipients and their families, but were also at the mercy of several countries and their policies. While both issues have always been true, the national focus of pandemic-related measures drew renewed attention to them as well as to the deep social, gender, and regional inequalities across Europe manifested in care mobility.

Project summary:

Background

Scottish care homes are vulnerable to the widespread transmission of COVID-19 and poor outcomes. The COVID-19 pandemic has disproportionately high fatality rates among older adults, particularly those with comorbidities.

Care homes provide health and care services for approximately 40,000 residents, of which the majority are elders with complex medical and care needs.

COVID-19 has had a significant impact on the care homes within Lanarkshire, similar to other local authorities. While there is a plethora of research focusing on the spread of COVID-19 in the general population, research on the unique transmission dynamics and interventions for COVID-19 in care homes is negligible.

Infection control interventions in care homes need to be both effective in containing the spread of COVID-19 and also feasible to implement in this setting which has a dual nature: a healthcare institution and a home.

Research Aims

This research aim to:

• evaluate the effectiveness of a range of interventions strategies in controlling COVID-19 in care homes
• investigate the impact of staff sharing between care homes in Lanarkshire on the inter-facility transmission of COVID-19
• answer emerging questions for care home stakeholders from Lanarkshire

Project summary:

The aim of this comparative project is to understand how the Covid-19 crisis, by revealing and exacerbating a tension around the work of home care, has transformed the legal and social frameworks of this work and the employment relationships it implies. It will compare five European countries (France, Germany, Italy, Belgium and the UK) to analyse how all the issues that have emerged during the crisis were solved and sometimes reveal deeper tensions. The project focuses on policies concerning home care for older people. In France, it will bring together a study on decision making in the social dialogue and public polices at the level of the national social partners, national administration. This analysis of elite’s actions will dialogue with an ethnographic study at the level of the employers, care beneficiaries and the public. The project will analyse how the conflicts and uncertainties around care work employment relations were solved.

Project summary:

The Covid and Care Research Group are a collective of anthropologists, primarily from the London School of Economics. We draw on a range of methods such as ethnography, network analysis, citizen science and participatory research to understand the impact of the Covid-19 pandemic on the networks of care that animate social life for people across the UK. We explore issues related to gender, ethnicity, race, class and regional inequality. Our research group is collaborative in approach, and works with other disciplines, policy makers, community leaders and community groups across different locations to gain insights into these issues and to generate policy solutions and support local community initiatives.

Project summary:

RATIONALE
COVID-19 has had a devastating impact on the quality of care and lives of vulnerable older adults across Canada. Persons of advanced age with complex chronic conditions and frailty have high rates of infection (and atypical presentation), and if infected, increased risks for severe illness and serious health outcomes. In Canada, up to 85% of COVID-19 deaths have occurred among frail older adults in congregate care settings. While most media and research attention has focused on residents of long-term care (LTC) homes, far less attention has been paid to other common continuing care settings such as assisted living (AL). This is a significant omission given the rapid growth in AL across Canada (particularly within British Columbia [BC] and Alberta [AB]) and the fact that AL residents exhibit similar vulnerabilities to those in LTC and reside in care settings similarly affected by insufficient staffing, oversight and resources for infection prevention and control. Importantly, relative to LTC, AL facilities offer fewer services and have lower staffing levels (including fewer skilled staff members per resident). Consequently, there is an expectation for significant family involvement in AL resident care.

Family caregivers are essential to ensuring older AL residents receive timely and appropriate care. Variation in the type and amount of health and social care they engage in is closely linked with the health and social status of residents and with their own health and well-being. Though the immediate and longer-term effects of COVID-19 (and related workforce shortages, physical distancing and social isolation) on AL residents and their families are expected to be extensive and long-lasting, they remain to be investigated in Canada.

AIM & OBJECTIVES
Our overall aim is to illuminate and understand the impact of COVID-19 (and associated social distancing restrictions and policies) on the care and oversight provided by family caregivers within a diverse array of AL facilities, and the resulting consequences for the health and psychosocial well-being of these essential (though often invisible) care providers. Our prospective observational study will include 1,000 family caregivers randomly sampled from (publicly subsidized) AL facilities across AB and BC. Extensive primary data collection strategies (family caregiver & facility telephone surveys) will be complemented with linkages to health administrative data. We will employ descriptive statistics and hierarchical mixed models to examine:

1. The effects of COVID-19 and related facility restrictions on the types/amount of health and social care provided to residents by key family caregivers. [Impact on essential care]
2. The impact of COVID-19 overall, and of associated changes in care activities and engagement by family caregivers, on the general health, health behaviours and psychosocial well-being of these caregivers. [Impact on caregiver]
3. The nature and timing of COVID-19 related facility infection prevention and control policies, practices, and communication strategies (with family caregivers) as reported by key facility informants vs. family caregivers. [COVID-19 Preparedness]

We will further explore variation in the above estimates and associations by select family caregiver (e.g., age, gender, socioeconomic status), resident (e.g., age, sex, functional status) and facility characteristics (e.g., size, region, for-profit status, COVID-19 testing/outbreak status, visiting policies).

IMPACT
Our research addresses a significant knowledge gap regarding a growing (albeit neglected) care setting expected to be significantly affected by COVID-19. Our findings will directly inform the development and conditions for scale-up of policy and practice interventions to (i) ensure timely communication with, and engagement of, family caregivers in AL during emergencies; and, (ii) permit rapid and enhanced emergency preparedness, staffing and services in AL. Interventions targeting both are essential for mitigating the adverse consequences of future outbreaks and restrictions on residents’ and family caregivers’ health and psychosocial well-being.

Project summary:

The Coronavirus outbreak shed light on major weaknesses that have been characterizing the Italian Long Term Care (LTC) for years. The research focuses on identifying which one were exacerbated in this time of crisis and so to support the understanding of the discontent that the sector has been experiencing over the past decade and future routes of innovation. The analysis is made of four parts: first, analyzing the main features of the Italian LTC sector before the Covid-19 outbreak to investigate the origins of the sector’s weaknesses; second, to deep dive on what happened in nursing homes at the peak of the emergence to investigate the role that the above-mentioned weaknesses played; third, analyzing regional policies for the LTC sector enacted in the hardest months for the country so to assess the institutional attitude towards the sector from the perspective of the public authorities in charge of regulating LTC, namely Regions; last, investigating care providers perspectives so to collect their original point of view concerning the impact of Covid-19 on the sector future. Consistently, the research approach is based on data concerning: LTC services distribution in the country; the spread of the Coronavirus among elderly in Italy and in nursing homes; a mapping of norms enacted in 9 regions on LTC during phase 1 and phase 2 of the emergency; a survey with care providers concerning the impact of Covid-19 on the sector. The research wants to contribute by discussing the main managerial issues stakeholders and policy makers should work on to solve the sector’s major weaknesses and support the sector in the future. Some example of topics that are discussed are: providers’ economic and financial sustainability; the management of human resources; measures to ensure proper coordination among LTC and healthcare services, and among the public and private world; the mission the LTC sector should pursue, along with its services.

Project summary:

Social isolation due to COVID-19 restrictive measures appear to have a major influence on the well-being of people with dementia, informal caregivers, and professional caregivers. While loneliness and challenging behavior may increase in people with dementia, social support for informal caregivers is reduced and their burden increases. In addition, rules regarding physical distance and the use of personal protective equipment complicates the work of healthcare professionals.

This study investigates the impact of social isolation during the COVID-pandemic on home- and long-term care for people with dementia, informal caregivers, and professional caregivers. Interviews with 20 informal caregivers and 20 professional caregivers about their concerns, problems, and needs regarding dementia care and social well-being in times of social isolation will be conducted.

Project summary:

In a multi-phase study, cross-sectional as well as longitudinal observational data on challenges and ressources of long-term care facilities in Germany during the COVID-19 pandemic are collected through an online-survey of directors of nursing and nurse managers. Since april 2020, two phases of data collection have been conducted. Responses for t1 (april to may 2020) include 824 nursing homes, 701 home care services and 96 daycare facilities. Responses for t2 (january to february 2021) inculde 385 nursing homes, 442 home care services and 80 daycare facilities. Next to descriptive statistics on prevalence of COVID-19 among residents and nursing staff, results include numbers on changes in the utilization of nursing care services during the pandemic, on availability of protective gear, on implementation of infection control guidelines and on the use of information and communication technologies (ICT) to support social participation of residents and orgnaization of care processes.

Project summary:

Dutch long term care organizations (LTC’s) installed outbreak management teams (OT’s) to coordinate covid-19 infection prevention and control. These LTC’s and relevant national policy organizations such as the ministry of health expressed the need to share experiences from these OT’s in order to learn and be inspired from each other. OT meeting minutes are next a valuable data source to monitor the impact of Covid-19 in nursing homes and source for creative ideas to tackle the challenges that arise.

The aim of the “Covid-19 Management In NUrsing homes by crisis TEamS” (MINUTES) study is to describe the challenges, impact and the response of the Covid-19 pandemic in Dutch nursing homes.
Participating LTC’s representing over 500 nursing home locations shared their OT’s’ minutes for thematic analysis. Minutes described crisis management, isolation and beds, personal protective equipment and hygiene, personnel, testing, vaccination, visiting, and wellbeing of residents and informal caregivers.

Project summary:

Introduction

Research suggests that older people are more likely to be affected by COVID-19 than other age groups. Because of this, the places in which older people receive care – residential care homes for older people and private homes – have been identified as settings where extra measures are needed to prevent the virus from spreading between people. These measures have included wearing personal protective equipment (PPE), such as masks, visors and gloves, and physical distancing, which involves keeping a distance of two metres between people where possible.

Initial research suggests that during the pandemic, care workers have felt stressed, vulnerable, and overworked, anxious about infection, and faced challenges in keeping older people safe. Some care workers have also said that they have not had access to the right protective equipment and that using masks can have negative outcomes, such as damaging their relationships with older people.

Objectives

This project is exploring:

1. How the COVID-19 pandemic altered care workers’ provision of direct care for older people living in residential homes and in private homes
2. How care workers perceive and navigate COVID-related policy measures and guidelines in their everyday practices and interactions with older people
3. How care workers negotiate the close and intimate aspects of their work within a context where distancing and infection control are central to ‘good care’
4. How the spatial and material resources (e.g., PPE) used by care workers in a pandemic impact upon caregiving relationships and upon care workers’ ability to find meaning and value in their labour
5. How to improve the provision of care for both care workers and older people and, in particular, what lessons can be learnt for future infection outbreaks.

Methods

The project involves interviews with 25 care workers working in care homes for older people in England, and 25 care workers working for home care agencies in England, to find out how the pandemic has changed their work.

Project summary:

This will be a cross-sectional, on-line, anonymous survey of nursing home staff (nurses, health care assistants and activity coordinators) within nursing homes affiliated with Nursing Homes Ireland in Ireland (Survey 1). The same survey will be repeated after 4-6 months to assess longer-term outcomes (Survey 2). To strengthen the overall study design, we are hoping to be able to link data from the two surveys by asking participants to generate their own unique anonymous identification number.

Distinguishing strengths of our study are inclusion of various HCWs, from a range of healthcare environments, with varying degrees of risk exposure, follow-up and an “opt-in” ability to link the two surveys. Additionally, we will be able to compare results with a similar survey targeted at hospital staff. The survey comprises of demographic information and validated questionnaires which assess healthcare workers psychological distress and coping strategies.

We will use mixed-methods to collect and analyse quantitative and qualitative data.

OBJECTIVES

1. To measure the prevalence and extent of symptoms of stress, anxiety and depression among nursing home staff in Ireland in different professions during the Covid-19 pandemic.
2. To identify nursing home staff perceptions about the COVID-19 pandemic, moral injury, coping strategies and help-seeking behaviours.
3. To examine the longer-term risk of persisting mental health issues in nursing home staff during the Covid-19 pandemic.

Project summary:

Infection prevention and control protocols (IPAC) focused on mitigating the risks of staff-to-staff pathogen transmission may be difficult to achieve in Long Term Care (LTC) homes due to the nature of shared work areas. Common design characteristics include centralized, compact and potentially crowded work/break areas; residential design details which may be challenging to clean and disinfect, coupled with the dynamic traffic flow of health professionals, other workers, residents and family. Using a human centred design process, we aim to support the resiliency of LTC homes by studying: how the design of staff work areas and associated patterns of use may be undermining IPAC; short and long term design interventions that may help reduce transmission risks; and the cost-effectiveness of our proposed design interventions. Through evidence-based design we hope to contribute to current pandemic efforts and inform the future design of LTC homes to support safer work conditions.

Project summary:

The need for rehabilitation for COVID-19 patients is escalating. The team will develop and evaluate a training package for NHS/social care staff to support them during remote assessment and management of COVID-19 patients requiring rehabilitation. This is challenging to do remotely, as balance and mobility cannot be easily assessed. The staff will be provided with practical guidance and training to increase their skills.

Project summary:

This is a retrospective cohort study on the factors associated with COVID-19 infection and mortality in care homes for the elderly in the Basque Country (Spain). Data for the study was provided by the Basque Health Service, covering 298 of the 300 facilities in the region and 20,186 elderly people living in those care homes from 1 March 2020 to 31 October 2020. For each individual in the cohort, the following information was obtained:

• Care home where the person was living
• Date of birth and sex
• COVID-19 test (Yes/no)
• Date of first positive test for COVID-19
• Date of death

Additionally, the following information was gathered from public social services registers for each LTC facility:

• Ubication: Province, Integrated Health Organisation Area (IHOA) and Health Care Division Area (HCDA) where the facility is located.
• Ownership (public, private non-profit, private for-profit)
• Size (<25 beds, 26-70 beds, >70 beds)

A Multilevel Analysis of individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was carried out following a three-step approach where three consecutive logistic regression models are built, for two separate dependent variables: positive COVID-19 test and all-cause mortality.

• Step 1: a conventional single-level logistic regression was estimated for each dependent variables, including only the individual-level covariates age and sex. Post-estimation predicted probabilities are calculated for each individual and are used to calculate the AUC (Area Under the ROC Curve) for the model. The AUC is constructed by plotting the true positive fraction (TPF) (i.e., sensitivity) against the false positive fraction (FPF) (i.e., 1 ? specificity) for different binary classification thresholds of the predicted probabilities. The AUC measures the ability of the model to correctly classify individuals with or without the outcome (e.g., having a COVID-19 test positive or negative) as a function of individuals’ predicted probabilities. The AUC takes a value between 1 and 0.5 where 1 is perfect discrimination and 0.5 would be as equally as informative as flipping a coin (i.e., the covariates have no predictive power). The AUC of the Step 1 model quantifies the accuracy of using individual-level information alone for identifying individuals with the outcome.
• Step 2: a general contextual effects model is built, expanding the Step 1 model from a conventional single-level logistic regression model to a multilevel logistic regression model with 4 levels: individual (level 1), LTC-facility (level 2), HCDA (level 3), IHOA (level 4). The general contextual effect is appraised using the estimated between-units variance (e.g., care homes variance) as this quantifies the variability in unobserved influences on the outcome (positive COVID-19 test and overall mortality) common to all individuals living in in the same care homes. We then refer the between-unit variance to the total variance in the model using two different measures of general contextual effects: (i) The Intraclass Correlation Coefficient (ICC); and (ii) The increment in the AUC in step 2 compared with the Step 1 (?AUC).
• Step 3: we add the care home covariates to the model for estimating the specific OR for those contextual variables. We focused on measuring the association (ORs) between positive COVID-19 test and three variables, the province where the care home was placed, the type of ownership of the care home and the size of the facility. Step 3 also provides a way of understanding the mechanism behind the observed general contextual effects of the care homes. For this purpose, we calculated the proportional change in variance (PCV) defined as the proportion of the care home variance (which correspond with the total contextual variance) in Model 2 explained by adding specific contextual information (i.e., province and ownership variables) in Model 3.

In the models for overall mortality, positive COVID-19 test was included as a fixed effect in the Step 1 model. Additionally, in step 2, we include a random effect for the slope of the association between COVID-19 test and mortality, that is, we drop the assumption that the slope of this association is the same in all care homes. Therefore, the variance between the care homes becomes a function of the COVID-19 test variable and, consequently, this variance can be different for individuals with a positive COVID-19 test and individuals with a negative test. Accordingly, there also are two VPCs and two AUCs one for COVID-19 positive individuals and other for COVID-19 negative individuals.

Project summary:

The project will develop and validate a conceptual framework which aims to enhance the capacity of state agencies in LMICs to address the potential effects of COVID-19 in care homes for older people. This will include (i) obtaining baseline information about vulnerability to COVID-19 for all care homes in three different sites, including unregistered care homes); (ii) reviewing current practice of relevant state agencies including intersectoral collaboration and specific responses to the pandemic; (iii) continual engagement with stakeholders to support enhanced practice; (iv) monitoring and review of changes to practice and related outcomes in care homes over an 18 month period.

We will apply a range of methods, including a mixed-methods survey of care homes, process evaluation and rapid review, and will conduct comparative analysis and dissemination to support the application of insights beyond the three study sites.

Project summary:

In this 17-month study we will provide evidence of the experiences of people employing their own care workers (Personal Assistants – PAs) during and after the Covid-19 pandemic to inform and improve care practice. Our previous work has asked PAs about their work during the Coronavirus pandemic. This new study will ask people who employ PAs about their experiences during the time of lockdown and beyond. We want to talk with people from different background and circumstances (e.g. those who may have ‘shielded’ or have a particular risk factor) and with both people who pay for a PA by Direct Payments from the council and those who pay their PA independently.

We will interview 70 individual employers (care users) and family members (if they are the employer because their relative cannot manage these arrangements), to learn from their experiences. We will also interview people from 5-6 brokerage or support agencies that help people find possible PAs, or support PA employers. The interviews will be done by phone or by video. We will examine and compare people’s experiences so that we can learn from them about the main pandemic period and beyond (if the virus declines) and to produce reports and outputs that are useful.

Project summary:

In Newfoundland and Labrador (NL), Eastern Health Region serves 65% of the NL population; the 16 Long Term Care facilities (LTCs), in its jurisdiction, identified and addressed many initial challenges through development of policies and practices. However, evaluation of the effectiveness of these measures to improve the care for seniors is essential. Our research focuses on?LTC residents and family-centered care interventions. To support the intervention, with the potential to change the way older adult care is provided in the province. Our aims include accelerating the availability of high-quality evidence to inform Canada’s rapid response to the COVID-19 pandemic; iterative testing to enhance local collaborative efforts and help reorient the existing research infrastructure; and providing evidence on older adults’ care for decision-making and planning throughout Canada. The interventions will include: e-visits and electronic messaging; virtual mental health support; residents’ integrated COVID and non-COVID care plans including virtual care; and infection control and prevention training among LTC leadership. Our findings will be relevant to all Canadian provinces with a population living in rural communities and small towns, and other settings that have similarities to those LTC homes in this province.

Project summary:

Domiciliary Care Workers (DCWs) are employed in both public and private sectors to support adults at home. The support they provide varies but often includes personal care, which demands close contact between care worker and the person being supported. Since the start of the COVID-19 pandemic, people working across the care sectors in England and Wales have experienced higher rates of death involving COVID-19 infection. Social care workers, in both residential and domiciliary care settings, have been particularly badly affected, with rates of death involving COVID-19 approximately double that for health care workers. We aim to generate rapid high-quality evidence based on the views of care workers and by data formed from linking care workers’ registration data to routine electronic heath record (EHR) data. We can use this information to inform public health interventions for safer working practice and additional support for care workers.

Project summary:

This study aims to measure the impact of COVID-19 on Basque nursing homes in terms of resident mortality, and to identify nursing home factors associated with risk of death from COVID-19, as well as nursing-home profiles that have been most impacted by COVID-19.

The study will cover the period from March 2020 to June 2021 and will involve three different types of analysis:

• Estimation of excess mortality in the nursing home population and the general older population in the Basque Country. The aim of this part of the study will be to measure the “net” impact of COVID-19 on older people’s mortality, by measuring excess mortality and the fraction of that excess mortality that is directly attributable to COVID-19, and by comparing the nursing home population with community dwelling older adults. The analysis will also look into the temporal distribution of excess mortality in the nursing home population, to estimate de differential impact of the pandemic on the first and second waves, and the post-vaccination period.
• Analysis of nursing home level variance on overall and COVID-19 resident mortality, and identification of nursing home factors associated with resident deaths. Individual level data will be obtained from the Basque Health Service’s information system (Osakidetza) on SARS-CoV-2 infection and registered deaths, covering the whole nursing home population from March 2020 to June 2021. Multilevel logistic regression models will be applied to this data to estimate the proportion of individual variance on risk of mortality that lies at the nursing home level (as opposed to the individual level) and, therefore, determine how relevant nursing home characteristics or prevention measures can be in explaining risk of death for infected and non-infected service users. Depending on the significance of these general contextual effects, the association between specific nursing home characteristics such as size, ownership, staff-to-resident ratio or unitary cost and risk of mortality will be estimated.
• Typology of nursing homes in terms of mortality impact. Cluster analysis will be employed to identify characteristics of nursing home facilities that make them more vulnerable in terms of COVID-19 mortality. Factors significantly associated with mortality in the previous multilevel logistic regression models will be used to identify relevant nursing home clusters.

Project summary:

The COGER study is collecting data to gain insight into the course of functional and medical recovery in older people affected by COVID-19 participating in rehabilitation across Europe.
The COGER study, designed by members of the Special Interest Group for Geriatric Rehabilitation of the European Geriatric Medical Society (EuGMS), study aims to:
1. Explore the course of activities of daily living (ADL) recovery and influencing factors
2. Describe other outcomes after geriatric rehabilitation in post-COVID-19 patients
3. Describe geriatric rehabilitation services provided to post COVID-19 patients across Europe.

The study has recruited over 700 patients between September 1, 2020 and November 1, 2021.

Project summary:

Developing countries already contain large numbers of older people with social care needs, leading to a rapid growth in private provision, including residential services. Many operate on an informal, entirely unregulated basis. We have developed an online platform for sharing information about the quality of services in care homes for the city of La Plata, Argentina. This responded to concerns about poor service quality, an absence of public information and the limited capacity of official local regulators. The site, launched in 2019, consists of a simple interactive information-sharing platform. The site provides updated information about care homes and a set of service quality principles, developed in partnership with care home directors. It enables service users to provide feedback about providers. This feedback is not directly published on the site: instead, complaints are investigated and providers removed from the site if they are confirmed. The site also provides general information for service users to support the selection and assessment of social care services, and (more recently) the status of the COVID-19 pandemic in local care homes. Our project will evaluate the La Plata intervention, along with new related projects by other organisations in Argentina. We will assess the feasibility and potential benefits of scaling up over the next three years.

Project summary:

The WHELD well-being training intervention for care homes has shown benefits in two clinical trials by improving quality of life, mental health and reduced use of sedatives, and has been developed for virtual supervision. It has now been adapted to the COVID-19 context and evaluated in a RTC; an “implementation ready” programme will then be rolled out for care homes nation-wide.

Project summary:

UCAIRE (Exploring and Understanding the lived experience in CAre homes for older people of Infection risk and transmission during the COVID-19 pandemic: a mixed-methods study to inform what we can learn for future infectious disease outbREaks) is a one-year, mixed-methods study, funded by NIHR SSCR, running until May 2022.

Aim: to explore how older care-home residents, care-home staff and families or friends of residents experienced coping with preventing spread and transmission of the SARS-CoV-2 virus in order to inform development of guidelines and support in managing future outbreaks of infectious diseases in care homes and in providing support to those living and working in care homes.

Objectives:

1. Undertake an online survey of care-home staff to identify broad concepts and specific issues or concerns associated with transmission and spread to and within older people’s care homes.
2. Undertake semi-structured interviews with care-home residents, families/friends and care-home staff to understand their experiences of coping with preventing infection-transmission and risk during the pandemic.
3. Using a mixed methods approach, integrate findings from the quantitative and qualitative arms of the study in order to gain comprehensive understandings from which results and overall guidelines can be developed. Draft guidelines will be further developed at a stakeholder workshop near the study end, in which stakeholder perspectives and input will help to tailor the guidelines appropriately for specific audiences: care-home staff, residents and family/friends of residents.

Project summary:

The Family Involvement and Unpaid Caregiving in Long-Term Care (LTC) project provides insight pertaining to the various personal care tasks performed by caregivers during their visits to residents in LTC homes and how much time it typically takes unpaid caregivers to perform these tasks. The aim of this study is to develop a better understanding on family members’ involvement in direct care in order to inform and facilitate a strong working relationship between care providers and family members who wish to be involved in the care of their loved one.

Why is this work important?

One of the first challenges identified during the COVID-19 pandemic is the lack of a proper definition for what constitutes an essential visitor in LTC homes. This challenge has led to the realization that unpaid caregivers, their care contributions as well as the time they dedicate to the care of their loved one in a LTC home is not well understood.

An appreciation for the true extent and nature of the family’s involvement within LTC could promote efforts on the part of LTC homes to ensure families feel supported and not overwhelmed by their care contributions. Results from this study can aid the design of programs of support for caregivers in LTC while simultaneously forging better relationships between LTC staff and these care providers.

Research questions

Our primary research questions are:

• Who provides unpaid personal care to residents in LTC?
• How often do these individuals provide unpaid personal care to residents in LTC?
• What are the tasks that these individuals perform in providing unpaid care to residents in LTC?
• How much time do these individuals spend on these tasks?

Our approach

We developed a cross-sectional survey that was administered to 224 unpaid caregivers of residents in Ontario’s LTC homes to capture the characteristics of unpaid caregivers and the care task(s) these caregivers were involved in prior to the COVID-19 pandemic.

Project summary:

This project addresses the impact of COVID-19’s on the care home sector including the consequences for the workforce and users while assessing its financial viability, as well as requirements for recovery and resilience.
The UK depends on the financial sustainability of the mainly privately-owned care home sector, which cares for over 400,000 older people. Prior to the pandemic, the Competition and Markets Authority 2017 report highlighted the financial fragility of the sector. It is clear that COVID-19 has exacerbated financial pressures on care homes, potentially leading to highly disruptive closures.
Although there is a growing understanding of the additional costs to the care home sector attributable to COVID-19, there is a lack of knowledge about the implications for the financial sustainability of the sector as a whole, as well as for different types of organisation (e.g. large chains, charities, family-run care homes). Yet, it is essential for policy makers to comprehend these financial impacts if they are to design effective interventions to ensure the stability of care home provision, maintain safe standards of care and deliver good quality services. This new research will complement the analysis of care costs being undertaken by other relevant research conducted by the ESRC Sustainable Care programme.

According to the 2019 report produced by the Skills for Care charity, the 600,000-strong care home workforce is characterised by low pay, high staff turnover and vacancy rates, and reliance on migrant labour. Given the difficulties in recruiting and retaining care home workers prior to the pandemic, policy makers also need to understand and address the financial impact of COVID-19 on staff experiences and efforts to retain staff.

Project summary:

The Finding the Right Balance: Implementing Family Presence in Ontario LTC homes is a multiphase project that will target LTC home residents and family caregivers across Ontario. The research settings include project multiple partner LTC homes in Ontario. The findings will be generalizable to LTC homes and congregate care facilities across Canada and internationally. The objectives of the project are threefold:

1. Update provincial data collection tools to capture metrics on caregiver and visitor access to LTC homes and LTC resident absences and their relationship with COVID-19 outbreaks in LTC homes.
2. Analyze provincial quantitative data on caregiver and visitor access and qualitative LTC home data on the barriers and facilitators to implementing family presence.
3. Execute and study an implementation strategy at our partner LTC homes and create a learning collaborative on implementing family presence in LTC homes across the province.

Project summary:

Over the last few decades, live-in care has become an important pillar of long-term care regimes in familialistic countries like Austria. Commuting live-in care workers, typically women from Central and Eastern Europe, help fill the care gaps resulting from a decline in familial care. Closed borders and other pandemic-related restrictions brought the circulation of care workers, whose rotas typically range from two to four weeks, to a halt. The government scrambled and narratives of an endangered live-in care model and of the ‘systematic importance’ of its carers brought upon a variety of policy responses: to foster care workers’ extension of rotas, a federally funded, tax-free bonus was implemented for live-in carers prolonging their stays for at least four weeks. Additionally, the government initiated negotiations with neighbouring countries in hopes of creating ‘care corridors’ for the suddenly essential live-in care workers. Charter flights and special trains were organised to ensure the supply of live-in carers until borders re-opened. These measures along with the government’s announcement to provide 100 million euros to the social care sector – including live-in care, which received considerable media attention – show the pressure policy actors faced.
The project analyses how live-in care was affected by the pandemic and how related policy responses were shaped by powerful narratives. It asks how different actors including local and federal governments, interest groups, and grassroots organisations interpreted the pandemic-related challenges for live-in care, what problems they defined and how they proposed to solve them, and whose demands they addressed. Preliminary results indicate that while live-in carers were deemed key workers and essential for the long-term care system, the responses deepened the inequalities and dependencies already existing in transnational care arrangements. This links to the structural inequalities and power imbalances that mark live-in care in general. Empirically, the project draws on a media analyses of live-in care in Austria from March 2020 to February 2021. This dataset of over 500 reports is supplemented by governmental documents, relevant laws, and official guidelines as well as six interviews with policy actors in the field. The analyses will shed insights into the narrative of the ‘systematic importance’ of live-in care and its workers and how policy choices were argued and / or defended, focusing on the roles various actors took on in their own or other’s narration.

Project summary:

The study aims to explore the impact of providing health and social care during the Covid-19 pandemic on nurses, midwives, allied health professionals, social care workers and social workers in the UK. The study uses a cross-sectional design to collect data from a convenience sample of nurses, midwives, allied health professionals, social care workers and social workers over five time points: May – July 2020, November 2020 – February 2021, May – July 2021, November 2021-February 2022 and May-July 2022. Data is collected using a self-report online survey consisting of demographic questions, measures of wellbeing, work-related quality of life, coping and several open-ended qualitative questions. Survey data will be supplemented with data gathered through focus group discussions with frontline workers, their managers/regulators and HR representatives.

Project summary:

Aim: To understand how COVID-19 has affected the quality of life, wellbeing, and care of people diagnosed with dementia and their family carers?

The COVID-19 nested study will used a mixed methods design within phase 2 of the wider TFD study. Quantitative measures of Quality of Life, Social functioning and illness severity before, during and after the social restrictions arising from the pandemic will be assessed. Additionally, qualitative interviews will be used to understand the experience in more depth, as well as factors which have specifically influenced QoL.

Design: This study will use a mixed methods approach; quantitatively measuring QoL, before, during and after the COVID 19 isolation period, and qualitatively, through semi structured in-depth qualitative telephone interviews to explore the impact in more detail.

Participants: Existing family carer participants (n=350) in the BSMS Time for Dementia (TfD) study will be invited to participate in this COVID 19 sub-study. TfD is a longitudinal undergraduate dementia education programme with a linked study running across Kent, Sussex and Surrey which directly involves people with dementia and their family carers. All of the potential participants have pre-COVID 19 QOL data that can be used as a baseline comparator.

Measures: DEMQOL-Proxy (Smith et al., 2007)

The Clinical Dementia Rating Scale (CDR; Morris, 1993)

SF-DEM: Social Functioning in Dementia scale, (SF-DEM; Sommerlad et al, 2015)

C-DEMQOL (Brown et al, 2018)

Project summary:

Older people living in care homes often have complex needs and are at high risk of poor health outcomes and mortality especially if they contract the coronavirus. To protect older people from the coronavirus, care homes use measures such as social distancing and isolating of residents. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. Currently, we do not have a good understanding of this challenge and how best to address it.

The aim of our research is to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, families/friends, staff working in and with care homes, and to develop a toolkit of resources for health and care delivery now and to support further outbreaks of the coronavirus.

This 12-month study will be conducted in three phases; a rapid evidence review, in-depth case studies, and toolkit development.

Project summary:

Project summary:

As a result of the COVID-19 pandemic, most care homes have stopped face-to-face visiting. In many care homes contact between residents with dementia and their families are limited to telephone, digital methods or through windows. Other homes have created COVID safe spaces where families can visit from behind a Perspex screen or at a social distance in gardens. Government guidance on visiting has changed numerous times over the pandemic, varies according to national and regional lock-down guidelines and is open to wide interpretation in the sector. Most of these approaches can be extremely difficult for people with dementia to engage with (due to not understanding why they cannot touch/hug their relative, why they are behind a screen etc) and gain comfort from. They may cause more distress than well-being for some residents and may be impossible for those with advanced dementia to take part in.

This topic is being discussed and debated widely in the news on a daily basis and evidence-based information and resources to support development of good-practice approaches in this area is required rapidly.

Our research aims to explore current visiting practices for relatives of care home residents with dementia across England, best practice approaches and barriers and facilitators to these.

Our study will involve

• Rapid literature and practice review (via databases, social media, grey literature, on-line sources, media) of the evidence in this area and to develop a taxonomy of visiting practices related to relatives/friends of care home residents with dementia, pros and cons of these and barriers and facilitators to adopting them
• National on-line surveys of relatives/friends of people with dementia living in care homes and care home providers in England – to identify how widely different approaches to visiting are being employed, their impact, reasons for use and barriers and facilitators to offering the least restrictive approaches to visiting.
• In-depth telephone/video interviews with around 10 relatives and 10 care home managers/senior staff in England – to identify good practice (least restrictive approaches to visiting) and how these might be implemented more widely e.g. what needs to be in place

Project summary:

Nursing homes (NHs) are currently facing an unprecedented crisis due to the rapid spread of COVID-19. Not only are NH residents/patients at risk for infection and death, but also are Certified Nursing Assistants (CNAs) who are on the frontlines providing hands-on care. Studies are needed to understand how the COVID-19 pandemic affects CNAs’ work-related well-being, job satisfaction and intention to stay on the job as well as the impact and challenges that COVID-19 has posed to providing quality care during this pandemic. The overall purpose of our proposed 18-month cross-sectional study is to investigate the impact of COVID-19 on CNAs and NH residents/patients when taking into account employers’ efforts to train and prepare CNAs for their work during COVID-19. Using data from a multi-site employee engagement and management system, and NH COVID-19-related data published by CMS, we will answer the following research questions: [1] what are levels of CNAs’ perceived preparedness and quality of employer communication around COVID-19? [2] what stresses and specific challenges do CNAs experience during this crisis? [3] how are perceived preparedness and quality of employer communication around COVID-19, and CNAs’ stresses/challenges experienced during COVID-19 associated with CNAs’ work-related well-being, job satisfaction, and intent to leave the job?, and [4] what facility-level and CNA work-related characteristics are associated with resident/patient COVID-19-related health outcomes? Insights from this study will help NHs to plan their response to the current crisis and future pandemics or other public health-related crises.

Project summary:

This study aims to evaluate the impact of the pandemic on health service provision and outcomes and provide evidence required to inform the future effective, safe management of care home residents. We will analyse linked care home, community, Emergency Department and hospital admissions data from the North East (n=68 homes, >2500 residents) spanning from before to the initial lockdown period to the present. Interviews with care home staff, residents and their families will be conducted, giving deeper insight into decision making processes and the impact those affected, allowing for an in-depth description of the pandemic in the care homes of the North East.

Project summary:

The aims of this study are, from the perspectives of those with the lived experience, to examine the impact of COVID-19
public health measures on the life and wellbeing and access to care and support of people living with dementia and their care partners
(family, friends and other informal carers); and identify key issues and challenges as well as key lessons in terms of what
worked well, what did not, what was helpful and what was not.

METHODS
Design: A repeated cross-sectional survey of people living with dementia and current care partners, complemented by a
follow-up qualitative interview

Participants: People living with dementia and carer partners (families/friends who have primary care responsibility) in Australia

Recruitment: Volunteers from StepUp for Dementia Research and StepUp Champion Organisations (aged care providers and dementia peak bodies).

Data collection: Online and Telephone survey using REDCap (Time 1 in June-July 2020 & Time 2 in mid 2021, and qualitative interview (in August-September 2020).

Project summary:

The Dementia Isolation Toolkit was developed to provide evidence-informed guidance to support infection prevention and control measures that are consistent with person-centered care within long term care homes (LTCHs) during the pandemic. This project is a four-phase mixed-methods, research study evaluating the impact of the DIT intervention on outcomes related to 1) achieving safe, effective, and compassionate isolation of residents and 2) levels of moral distress amongst LTCH staff in three LTCHs situated in rural and city settings. The effectiveness of the DIT and the processes developed for its implementation will also be explored through developmental evaluation. Our approach includes multiple rapid quantitative (e.g., administrative/clinical surveys) and qualitative (e.g., interviews) analyses with up to 130 LTCH staff and family caregiver participants. We will directly engage these same knowledge users in the implementation process as part of the developmental evaluation, to increase the potential impact of the DIT intervention.

Project summary:

Palliative care is commonly misunderstood as only being relevant for people who are actively dying and in the final weeks or days of life. However, the relief of suffering through the provision of holistic and compassionate care is an essential component of care for all patients with a life-threatening illness. Among newly-admitted residents to long-term care (LTC) homes, where median life expectancy is just 18 months, most receiving care in this setting have limited life expectancy and can benefit from palliative care.

In this project, we will adopt an implementation science approach to evaluate the use of the Risk Evaluation for Support: Predictions for Elder-life in the Community Tool in LTC (RESPECT–LTC) to support their ongoing efforts to embed palliative approaches to care in their processes and culture. RESPECT–LTC is a mortality-risk communication tool that accurately predicts an older person’s six-month mortality risk as well as life expectancy to inform decision-making regarding the initiation of palliative and end-of-life care.

Project summary:

The study involves partnerships with six publicly–funded long-term care homes in Nova Scotia and Prince Edward Island implementing family support visitations, in line with their province’s public health directives, to increase family presence during the COVID-19 pandemic. Guided by the Consolidated Framework for Implementation Research (CFIR), multiple methods will be employed to assess multilevel implementation contexts of support visitations. We will also consult with key informants in select other jurisdictions to draw upon their lessons learned implementing similar family visitation programs. Our objectives are:

1. To explore and identify the contextual attributes of successful implementation processes.
2. To understand facilitators and barriers of successful implementation.
3. To understand how family has been engaged/represented in the implementation process.
4. To assess the outcomes and impacts of support visitations on residents, family and staff.
5. To obtain insights into implementation and sustainability from other jurisdictions.

Project summary:

It is essential that we stop the spread of the COVID-19 virus in long-term care. The Public Health Agency of Canada instituted evidence-based, rapid redesign and resource redeployment practices to protect the health and ensure the safety of staff, residents and their families. Measures included strict visitation and “one high risk site” staffing policies, prohibiting LTC staff from employment in more than one facility. Our mixed methods, exploratory study will focus on implementation and impact of the “one high risk site” staffing policy on staff, family and residents in 4 LTC facilities in 2 British Columbia health authorities. We are guided by the Consolidated Framework for Implementation Research (CFIR).?

Project summary:

In this project, Registered Practical Nurses (RPNs) together with residents and their families, other health professionals, and managers of care will implement the PIECES™ Canada framework using virtual technology. PIECES is a care planning framework to guide person-centred team-based care planning for residents of LTC. A cross-sectional study design employing explanatory mixed methods will gather information from key stakeholders – including RPNs, family care partners and cognitively-able residents – using online surveys, focus groups, and individual interviews. Working together in partnership, an interdisciplinary team of researchers from Western University, University of British Columbia, Copper Terrace and Vision’74 LTC homes in SW Ontario, the Registered Practical Nurses Association of Ontario (WeRPN), PIECES Canada, Canadian Gerontological Nurses Association and SPOR-OSSU aim: to improve family and resident experience as essential care partners; build resilience in RPNs as team leaders to support the workforce in LTC; improve LTC staff and leader preparedness to mitigate impacts of future COVID-19 outbreak; accelerate available high-quality, real-time, actionable research evidence; and develop a plan to adapt, sustain, and scale the proposed intervention across LTC homes.

Project Partners Websites:

Canadian Foundation for Healthcare Improvement

PIECES™ Canada

WeRPN – Registered Practical Nurses Association of Ontario

Project summary:

Residents and families are often faced with making critical and emotional end-of-life decisions without any preparatory discussions. This results in stress and conflict. A long-term care (LTC) palliative toolkit has been developed to address the immediate LTC homes needs in response to COVID-19. The LTC toolkit includes tools and practices that support: (a) the engagement of residents and families across disease trajectories, (b) workforce capacity development and the implementation of supports to reduce stress and improve psychological health, (c) the development of organizational structures and processes embedded in the LTC home to promote a palliative approach to care. Our mixed methods project will include: (1) situational & stakeholder analysis with LTC staff, residents and families; (2) toolkit Implementation at one LTC home in New Brunswick, Ontario and Saskatchewan; (3) staff focus groups and interviews to assess implementation perceptions & suggestions for improvement.

Project summary:

Knowledge users have identified a need to improve palliative care in long-term care (LTC) homes in Ontario and Alberta, and investigators in these provinces have access to data to conduct rapid implementation research. Our 3 main objectives are: 1. Data measurement to detect variations in end-of-life medication prescribing (proxy to palliative care delivery) before and during COVID-19; 2. Mixed methods evaluation to understand the barriers/facilitators of end-of-life prescribing in LTC; and 3. Intervention to support homes in both provinces, focusing on those most challenged to provide end-of-life care during COVID-19. For the quantitative component, we will use data on LTC homes in Ontario and Alberta held at Institute for Clinical and Evaluative Sciences (ICES) and Alberta Health Services (AHS). For the qualitative component, we will reach out to LTC homes identified as being top/bottom prescribers and interview staff, healthcare providers, and resident caregivers at these homes to gain a deeper understanding of the quantitative findings.

Project summary:

This project has 3 objectives:

1. To measure the impact of the pandemic on health and social services use, infection rate and mortality of Persons living with dementia both in the community and in long-term care facilities. This will be done using provincial databases.
2. To understand the Person living with dementia’s and caregivers’ perceived needs, behaviours and experiences of health and social services. This will done through interviews and questionnaires done and filled out by caregivers and Persons living with dementia’s.
3. To generate and disseminate evidence-based and actionable recommendations on effective strategies to tackle the current wave of the pandemic and prepare for subsequent waves. We will hold a deliberative dialogue with all stakeholders involved.

Project summary:

Summary:

Aim: To capture the experiences of frontline care home and NHS staff caring for older people with COVID-19 and to share the lessons learnt about the presentation, trajectories, and management of the infection with care homes that have and have not yet experienced the virus. We addressed this overall aim through the following objectives: To understand the clinical presentation and illness trajectories of COVID-19 for older people (aged over 65 years) being cared for in hospital and care homes; To describe what worked well and what more is needed for care and treatment of older people with COVID-19; To identify key lessons for supporting infected older people to recover well or, if that is not possible, to die well; To share findings and lessons learnt (objectives 1 to 3) with care home senior staff to explore useful strategies for managing the infection at an individual and organisational level within the home for the mutual benefit of residents, relatives and staff; and To explore the resonance and relevance of lessons learnt (objectives 1 to 4) with care home providers and to identify any gaps. Method: We used an appreciative approach, working across disciplinary boundaries and care settings. In phase 1 (June and July 2020) we interviewed 35 frontline staff (18 care home and 17 NHS staff) to address objectives 1 to 3 and gather in-depth understanding. In phase 2 (September 2020) we hosted a consultation event with 11 senior operational and quality managers in care homes to establish the resonance, relevance, and any gaps in relation to Phase 1 findings and strategies for managing COVID-19 at an organisational level within the home for the mutual benefit of residents, relatives and staff. All data collection was conducted remotely by video or telephone call.

Project summary:

This project evaluates emerging litigation in relation to COVID-19 related deaths in Australian residential aged care centres, in terms of its capacity to address longer term structural harms of institutionalisation and activist calls for de-institutionalisation of aged care. In order to facilitate evaluation, the project compares aged care COVID-19 litigation with COVID-19 litigation strategies and outcomes in the context of an analogous confinement setting: immigration detention. The project involves critical analysis of court documents in COVID-19 litigation by reference to an interdisciplinary theoretical framework drawing on socio-legal studies, critical disability and ageing studies, and migration studies.

Project summary:

Long-term care services, in particular care homes, have been badly hit by the COVID-19 pandemic but to varying degree across countries. Between 0 and 80% of all cases of COVID-19 deaths have occurred among care home residents, while it is currently under-researched how home care users and LTC staff are affected. There is also considerable variation in the timing, sequencing and content of measures applied, on a general societal level, as well as in those applied in the LTC sector specifically, such as care home lock-downs and access to PPE and testing.

There is urgent need for policy makers and LTC provider organizations to learn from the emerging evidence, not the least in Sweden with comparably high death rates in society as a whole and in the LTC sector. Therefore, the aim of this scoping review is to identify and learn in a systematic way how older LTC users especially but also care workers and whole provider organizations are affected by the COVID-19 pandemic and the measures introduced. The review will focus on different measures and their effect on disease spreading and mortality among users and staff, as well as the effect on wellbeing and Quality of Life among users. When possible, the review will consider variation related to gender, class, ethnicity, and region in user outcomes.

We will map the emerging body of evidence, identify research gaps, and make recommendations for future research. The review is used also to inform six case studies (D, DK, ES, N, S, UK), presenting a time line of measures introduced and infection and mortality rates in LTC. In comparison to the review, this will have the country as a focus and will provide a more in-depth understanding of the relations between measures and outcomes, which will allow us to report on best practices and knowledge gaps.

Project summary:

We will collect baseline and follow-up qualitative data from older adults, people with dementia, and family carers, and hold focus groups with care professionals, to explore the long-term impact of COVID-19 public health measures on their mental health. We will also hold coproduction workshops in each country to develop strategies to address mental health and well-being in each country and develop an external funding application. We will then compare how public health measures are affecting these vulnerable groups across the three different LMICs, to generate better understanding on how to support their mental health better during this ongoing pandemic.

Project summary:

We conducted a rapid review of the academic and grey literature to map the emerging evidence of the impact the COVID-19 pandemic and related public health measures have on unpaid family carers supporting adults with care needs. Our review spans evidence from Europe, Asia, Australasia, North America and Latin America.

Project summary:

The Mc-COVID 19 project is set to analyse the socio-sanitary co-ordination procedures in the context of institutionalized older-age care (age group that appears particularly vulnerable in this epidemic context), in Spain as well as in the rest of the EU-15. This study focuses on the articulation of resources between health and social policies, and aim to contribute to improve the effectiveness of the decision-making process and crucial aspects in the fight against the pandemic. To better understand what happened in these centres and facilitate policy learning, this study identifies the difficulties faced by institutional actors and nursing homes’ managers between January and August 2020. To this end, the research team conducted 25 in-depth interviews with managers in such centres (directors, administrators, and medical supervisors) in various Spanish regions (Comunidades Autónomas). In addition, the research group interviewed high-ranking officials responsible for both social services and public healthcare at the central and regional levels, and representatives of the trade unions and the employers’ associations of the nursing homes. Furthermore, the team examined documents issued by governmental and independent sources, together with the results of a survey elaborated by the Institute for the Older-age and Social Services (IMSERSO) of the Ministry of Health. Findings aim to be useful to inform other public policy sectors involved in crisis-related situations.

Project summary:

This study is a partnership between MedSafer, Point Click Care (PCC) and two Ontario long term care homes (Hillel Lodge in Ottawa and Kensington Gardens in Toronto). Providing comprehensive medication management is critical during the pandemic to optimize the care received by older adults, who are at high risk of COVID-19 complications. We previously integrated MedSafer, a software for deprescribing, into the PCC electronic medical record. We will be piloting the integration of the software into the workflow of two long term care homes during the ongoing COVID-19 pandemic. We aim to test the feasibility and user experience of providing electronic decision support for medication management, in order to improve care during and beyond COVID-19. This process is expected to decrease harmful or unnecessary medications, improve staff safety and efficiency and lead to better outcomes for residents.

Project summary:

The study aims to assess the long-term psychological consequences (psychopathological symptoms, anxiety and sleep disturbances) associated with the exposure of LTCF employees to the second wave COVID-19 pandemic in Poland. Access to personal protective equipment, mental health support at the workplace will be also examined as potential factors modifying the level of psychological distress. Quantitative data will be gathered by a population-based on-line survey administered between September 15 and November 15 2020 among LTCF personnel in Poland. Additionally, qualitative data will be collected through a focus group with LTCF employees. The project is a continuation of the research on psychological consequences arising from the exposure of LTCF employees in Poland to the SARS-CoV-2 crisis between May and June, 2020.

Project summary:

We use nationally representative administrative data to describe the impact of COVID-19 among residents in the English care homes and the financial viability of the sector.

Using data from all care homes in England we estimated overall excess deaths and by care home characteristics: setting type (nursing or residential home), client types (offering services for people aged 65+ and/or people with dementia or offering services to children and adults), ownership status (whether not-for-profit – charity/NHS/LA-run homes – or for-profit), whether known to be affiliated to a large provider/brand or independent, and classification according to their registered maximum bed capacity (small, medium and large). Using data from the Capacity Tracker and CQC we’re examining how care home ownership and local care market structure are associated with the probability of experiencing and dealing with COVID-19 outbreaks in the English care homes.

Project summary:

This study is a two–phase adaptation and implementation project of evidence-based health workforce interventions developed by our team to support health and wellbeing of staff and residents in two Long-Term Care Homes (LTCHs) in Ontario during the COVID-19 pandemic. The implementation of workforce interventions will be led by Nurse Practitioners (NPs). NPs are ideally placed to successfully implement and sustain the recommendations due to their dual clinical and leadership roles, as revealed by the findings of our previous qualitative study involving 14 NPs throughout Ontario. In phase 1 the interventions will be selected and adapted to the context; staff needs and staff characteristics within the 2 LTCHs. Phase 2 involves an effectiveness-implementation hybrid design which will assess adaptation and preliminary efficacy of the implementation of recommendations selected in Phase 1. The expected outcome is a reduction in staff moral distress following the implementation of the intervention.

Project summary:

This study aimed to evaluate the preparedness and adherence of Brazilian care home managers to the recommendations of the World Health Organization infection prevention and control guidance for long-term care facilities in the context of COVID-19. The authors created a 46-item questionnaire using the ‘Infection prevention and control guidance for long-term care facilities in the context of COVID-19’, published by the World Health Organization on March 21st, 2020. We divided the questionnaire into nine sections: prevention, physical distance within the institution, rules for visitors, prospective surveillance for COVID-19 among residents, prospective surveillance among employees, source control, restrictions on movement and transportation, provision and availability of personal protective and cleaning equipment, technical support to face the pandemic. We created a global score of adherence to the IPC guidance based on the adoption of 20 questions related to IPC original questionnaire. We considered it as ‘excellent’ when at least 14/20 recommendations (70%) were fulfilled, as ‘good’ when 10 to 13 questions (50 – 69%), and ‘low’ when less than 12 items (<49%) were answered positively. We recorded the overall number of deaths and residents (and mortality rates) informed by care home managers in 2019 and 2018, and hope to compare this data with 2020 next year and identify if adherence to IPC recommendations influenced these rates.

Project summary:

The “Presence of Family: (Re)Integrating Essential Care Partners in Ontario’s LTC Homes” project will help to develop and disseminate an intervention to allow family members (who are chosen by the resident and who provide them with physical/psycho-social care) to have safe access to the LTC home. We will work with three Ontario LTC homes to implement an intervention that combines training with a commitment to follow safety protocols and use ID badges, and facilitates greater access for essential care partners to the home. We will use developmental evaluation, a rapid scoping review, an economic analysis of the value of the care provided by family members, and a mixed methods outcome evaluation. To spread the learning from this work, we will convene an Advisory Board that includes members from participating LTC homes, family members, and other stakeholders.

Project summary:

The goal of our project is to evaluate the implementation process, the viability and the acceptability of interventions aimed at favouring the presence of relatives (in person or virtually) in 5 LTC’s in Quebec City and in a rural area. We chose patients with Alzheimer’s disease and other dementias as population. We want to assess the characteristics of the LTC’s, facilitating factors and barriers to the implementation of interventions, and the acceptability of the interventions to care staff, family members and the elderly patients. In addition, we will look at the results in the elderly and their relatives. Finally, a cost effectiveness study will be carried out. An evaluative research design is preferred in order to assess the conditions of implementation and document the preliminary effects of the interventions. A multiple case study will be carried out.

Project summary:

Dutch long term care organizations installed outbreak teams to coordinate covid-19 infection prevention and control. Outbreak teams’ minutes described a large amount of divers measures that were taken.

The aim of this follow-up study on the “Covid-19 Management In NUrsing homes by crisis TEamS” (MINUTES) study is to prioritize measures taken and to reflect upon decision making by OTs.
Panels of 4 to 7 multidisciplinary nursing home professionals (managers, physicians, nurses, support services, client representatives..) selected, discussed and prioritized measures they found important and urgent with Covid-19 outbreaks. We organized separate panels about measures regarding isolation, residents’ wellbeing, and staff.

Project summary:

The project aims at analyzing the situation of the older people living in long-term care centres in the region of Madrid paying attention to the personal conditions, the health situation, the coping and resilient feelings facing the pandemic, the family and social relations, the social isolation and loneliness, the supporting conditions of living environments and their well-being and quality of life. A review of public policy measures regarding care homes will be also carried out. Research strategy consists on a combination of methods, quantitative survey and in-depth interviews. The project wants to give voice to older residents as the main source of information by means of a field work that involves access to residences that meet certain security requirements, respect for people’s dignity and non-invasion of your personal situation. Compliance with these conditions is ensured by the approval of the study in the Bioethics Committee of the Higher Council for Scientific Research.

Project summary:

COVID-19 has had a devastating impact on care homes, their residents and families, and staff. Over 20,000 care home residents in England have died from COVID-19 to date. Many more have experienced symptoms and distress. Palliative care is an essential component of the pandemic response, but there has been limited examination of palliative and end-of-life care provision in English care homes during COVID-19, or strategies to improve this during subsequent pandemic peaks.

The study aims to examine the response of care homes in England to meet the rapidly increasing need for palliative and end-of-life care for residents during the COVID-19 pandemic, and make recommendations for policy. The main objectives of the project are:

1. 1. To describe the response of care homes to palliative and end of life care needs during the COVID-19 pandemic, and the experiences, preparedness and impact on the workforce.
   2. To explore in-depth the challenges and facilitators to providing palliative and end of life care in care homes during the pandemic.
   3. To make recommendations for policy and develop guidance that helps to improve and sustain palliative and end of life care during current and future pandemic peaks.

Project summary:

Palliative care and end of life care responses must be urgently evaluated to understand how they are responding to the COVID19 pandemic and how they can be improved, in terms of services, workforce and symptom management. The findings will provide insights to inform a coordinated and effective response and will be provided to the National Health Service and Public Health England.

Project summary:

1. BACKGROUND, JUSTIFICATION, HYPOTHESIS AND OBJECTIVES

1.1 Background

The sector where the COVID-19 pandemic has probably had the most devastating impact has been in the care homes one, especially care homes for older people. Beyond the death toll, it is likely that there have been many and very significant the effects on the psychological and social well-being of residents, their families and professionals. Furthermore, there have been important ethical, political and economic implications that have guided the actions of service providers and the social and health care system.

1.2 Justification

To our knowledge, there has been no systematic and in-depth evaluation of this reality in Catalonia, which would be crucial for planning better present and future responses:

• This project is centred on what has unfortunately become the face of the COVID-19 pandemic (care homes), a historically neglected and stigmatised setting, where people who are particularly vulnerable to COVID-19 live.

• This project explores particularly sensitive and essential areas (impact on physical, emotional, social and spiritual needs of residents, family members and professionals) from a gender perspective. This project has been validated by organisations of older people in a participatory process.

1.3 Hypothesis

• The COVID pandemic has had a high impact on residents, professionals and organisations in the residential sector in Catalonia.

• The causes of this impact are multifactorial, and related to the characteristics of the pandemic, but also due to previous structural deficits.

• There are specific responses to each of the causes identified, and the impacts caused, which can constitute a systematic plan for the improvement of the residential sector.

1.4 Objectives

The ResiCOVID-19 project has two main objectives:

• To evaluate the impact of the pandemic on people living in old age, dependency and mental health care homes in Catalonia, as well as on their families, workers and organisations.

• On the basis of the lessons learnt, to build proposals for improving care and the care model.

2. METHODOLOGICAL DESIGN

A research strategy has been designed that combines different methodologies:

For the first objective: Description of COVID-19’s impact in the long-term care home sector

1. Literature review for international contextualization: Systematic mapping of the literature published from the beginning of the pandemic to the present time.
2. Analysis of Big data from the Catalan Health Service’s Register of Morbidity and Use of Healthcare Resources: Retrospective population-based study (March 2020) of the population of Catalonia living in long-term care homes.
3. Fieldwork in a multicentric cohort of people and representative residences: A mixed quantitative/qualitative study to describe the basic characteristics of people who live in care homes, based on a randomized representative sample of long-term care homes in Catalonia.

For the second objective: Proposals to improve the care model

1. Consensus on improvement proposals with the stakeholders involved: Construction: focus groups + SWOT by dimensions, with professionals and residents/families
2. International benchmarking of improvement proposals: Structured interviews and review of documentation and national and international literature to identify and describe good practices.

Project summary:

Staff turnover and job vacancy rates are persistently high in UK social care. Understanding the drivers of staff retention and motivators of care staff is important to enable the sector to provide sustainable, high-quality services and meet increasing demand. This project, which runs between April 2019 and March 2022, aims to help social care providers, commissioners, regulators and policy-makers understand the specific organisational and individual drivers of staff retention in the social care sector by exploring:

• What specific characteristics do social care workers have, and how committed are they to their jobs, when compared with workers in other low-wage service industries?
• Why are there differences in retention rates between social care providers, and between social care and other low-wage service industries?
• Why do care workers decide to leave their jobs, and why do some job leavers choose to leave the social care industry altogether?
• What is the impact of COVID-19 on workforce retention and sustainability?

We are answering these questions by:

• Analysing existing data from national surveys and large datasets, primarily: the UK Quarterly Labour Force Survey; the Annual Survey of Hours and Earnings; the Employer Skills Survey; the National Minimum Dataset for Social Care (NMDS-SC); the Skills for Care survey of individual employers and personal assistants; and the Care Quality Commission (CQC) health and social care provider register.
• Collecting primary data on the impact of COVID-19 on the social care workforce by means of: a) a ‘pulse’ workforce web survey; and b) a longitudinal (two wave) telephone survey of care workers.
• As well as carrying out the data analysis, we will consult and work closely with adult social care stakeholders, including providers, care users, care workers, family carers, commissioners, regulators and policy makers. We will organise annual workshops across the country to gather views on emerging findings and generate examples of ‘good working conditions/quality jobs’ in the social care industry, and pathways to achieve these nationally.

Project summary:

The project

The Social Care COVID Resilience & Recovery project will draw together learning from scientific evidence and from international experiences of long-term care systems. The aim is to inform policy and practice as the social care sector in England grapples with, and recovers, from Covid-19, and to put the sector on a more resilient footing for the longer-term.

The project is funded by the National Institute for Health Research (NIHR) and is a collaboration between the Care Policy Evaluation Centre (CPEC) at the London School of Economics & Political Science (LSE) and the Nuffield Trust, with support from the National Care Forum.

Why is this work important?

The ongoing outbreaks of Covid-19 have had an enormous impact on those who use and provide long-term care in England, with substantial excess mortality both for people who use home care and who live in care homes. It has also had far-reaching implications for the mental and physical health of those in contact with the system and has put major financial pressure on care providers.

As England continues to grapple with Covid-19, and begins to look towards the post-covid recovery process, there is an opportunity to learn from international experiences in preventing, mitigating and recovering from waves of infection. There is also an opportunity to identify the underlying factors and pre-existing faultlines within the system that meant the sector was in a fragile state as it went into the pandemic, and to learn from elsewhere about how to put the system on a more sustainable and resilient footing in the long-term.

What are we planning to do?

Our primary research question is: What can we learn from international evidence and experiences in order to support the recovery of the social care sector to inform the development of policies to prevent and manage future outbreaks in social care settings in England?

The project aims to:

• Co-develop a framework to provide strategic direction for how the whole social care sector (not just care homes) in England can recover from, and be better prepared and more resilient to, ongoing and future pandemics;
• Synthesise international evidence on Covid-19 and lessons relevant to the English social care sector;
• Draw together learning to support the sector’s recovery and to inform the development of policies to improve the resilience of the sector in the long-term.

Our approach

The project is split into four work packages, comprising:

1. Workstream 1: Situational analysis and development of analytical framework. This phase will seek to understand the impact of the Covid-19 pandemic on people who use and provide social care in England; of the policy and practice responses to mitigate those impacts; and the factors that supported or hindered the implementation of policies in England. We will use this situational analysis and a Theory of Change workshop to establish a framework from which to assess the relevance of international experiences and evidence to the social care system in England. In parallel, we will start a living report on international experiences in order to identify opportunities for lesson learning;

2. Workstream 2: Scoping reviews of existing evidence. Evidence reviews to map and synthesise empirical evidence of key policy and practice measures to prevent and mitigate the impact of the pandemic, and barriers and facilitators of implementation of those measures;

3. Workstream 3: International case studies. We intend to identify four case study countries whose experiences during covid-19 offer relevant learning for the English social care system. In-depth learning will be drawn together about the resilience of the system as it entered the pandemic; the policies and processes adopted to mitigate the impact of Covid-19; factors that helped and hindered; and what measures are being taken to support recovery.

4. Workstream 4: Synthesis. Lastly, findings across all these workstreams will be synthesised, using the framework developed in workstream 1, and recommendations developed for policy and practice.

The research team is supported by a Public Involvement and Engagement Group and an advisory group of experienced academics and representatives of key stakeholder organisations. These groups act as critical friends, ensuring that the project is relevant and of high quality and will provide links with other groups carrying out relevant research or with other stakeholders with an interest in this area.

Timescale

The project started in January 2021 and will end in October 2023.

Project summary:

Our project aims to identify and implement promising and best practices, create a community of practice to reduce social isolation and loneliness in LTC residents of linguistic and cultural minorities of Manitoba, Quebec and N-B. It is a collaborative research approach that will be used and the Consolidated Framework for Implementation Research (CFIR) will be considered involving LTC homes residents, families, frontline workers and managers, all seen as experts.

Project summary:

Few low- and middle-income countries have data on dementia prevalence obtained directly from their own populations. One element of the STRiDE programme (STrengthening Responses to dementia In DEveloping countries, www.stride-dementia.org/) aims to fill this gap by generating new prevalence evidence in two (South Africa and Indonesia) of the seven STRiDE countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). STRiDE is designed to support and accelerate the development of effective dementia policy and national planning in these seven countries and a toolkit that can be applied in other low- and middle-income countries, with the ultimate goal of improving dementia care, treatment and support systems so that people with dementia are able to live well.

Within the prevalence study, 4,400 older adults (and an informant/carer) will be recruited from sites in Indonesia (n=2,200) and South Africa (n=2,200). Whilst the primary outcome will the estimated prevalence of dementia within each country, participants will be asked questions across the following 11 domains: (i) dementia staging, (ii) cognitive measures, (iii) socio-demographics, (iv) costings, (v) activities of daily living and disability, (vi) neuropsychiatric symptoms and depression, (vii) generic quality of life and wellbeing, (viii) disease specific quality of life, (ix) carer burden, (x) stigma, and (xi) elder abuse.

Within some of these domains we will also ask a series of questions related to the impact of COVID-19 on participants’ (e.g. person with dementia and carer) lives, including:

• Household debt
• Household income
• Household spending
• COVID symptoms, testing and deaths in the household
• Impact of day-to-day life
• Impact of health and wellbeing
• Impact on caring role

Project summary:

Both dementia and hearing loss are highly prevalent in care home residents and often lead to poor outcomes such as impaired communication and reduced quality of life. Despite this, previous literature suggests that hearing loss is often poorly managed in care homes, particularly for residents living with dementia. It is likely that COVID-19 has exacerbated existing communication difficulties and access to hearing rehabilitation. For example, by the use of face masks and visors, audiology visitation restrictions, social distancing and other measures. This study will address the driving factors for providing hearing loss support and barriers to doing so in the care home setting, taking into account the COVID-19 pandemic within care homes.

The study adopts a mixed-methods approach with both online surveys and follow-up semi-structured interviews. Participants include frontline care home staff such as registered nurses, care workers and other healthcare professionals.

Project summary:

Our study employs a mixed methods approach anchored in CFIR’s 37 constructs, spanning five domains, to shape our data collection and analysis, including iterative rounds of multiple forms of data collection using means from a maximum variation sample of stakeholders. Stakeholders are from three groups: I) LTC+ workers (i.e., nurses, nurses’ aides, physical, occupational and recreation therapists, as well as food service, laundry, maintenance, housekeeping and hair salon workers along with leaders in these program areas) from two Knowledge Users (1 charitable foundation; 1 for-profit organization). Data will be collected from LTC+ workers using surveys, individual interviews, and participating in stakeholder workplace meetings. Surveys will afford workplace level data about risks for moral injury using the “Moral Distress Survey” (short form, Iaboni, 2021). Interviews will be conducted to collect detailed accounts of mental health needs and moral injury risks by asking workers to share stories of their experiences navigating COVID-19 and to obtain worker ideas for, and assessments of, mental health support/moral injury prevention toolkit ideas.

Project summary:

This primary purpose of this activity is to improve the early recognition, prevention, response and control of COVID-19 among older persons living in institutions and the community-at-large. The specific objectives are as follows:
1. To support related government agencies in the comprehensive development of guidelines for the welfare and care management of older persons in long-term care facilities during COVID-19 pandemic period;
2. To evaluate the needs of at-risk and vulnerable older persons and assess the operational challenges of relevant health and social aged care providers in managing the risks and impact of COVID-19 on the elderly; and
3. To strengthen the capacity of aged care service providers, including care workers and family caregivers, in the management of older persons with chronic multimorbidity during COVID-19 pandemic period by coordinating information and resources across different sectors and at all levels.

Project summary:

This research will provide evidence on long-term care homes in Ireland during the COVID-19 pandemic and inform how best to ensure the sustainability of long-term care homes in the longer term. The project is funded by a Research Collaborative in Quality and Patient Safety (RCQPS) COVID-19 Pandemic Award. The project will examine if particular types of long-term care homes were more likely to experience higher COVID-19 infections and deaths. Findings will provide evidence on which homes may require additional support during the pandemic and beyond. The project will also review some of the temporary measures introduced during COVID-19 to support the sector, and assess if, and to what extent, these measures may be necessary in the future to maximise the safety of residents and the sustainability of long-term care homes. A key component of the project is to work closely with knowledge users in the Department of Health and the Health Service Executive to ensure findings from the project can be used to inform policy in practice.

Project summary:

This report (see below) presents the findings of an online survey targeted at the informal carers of older, frail or disabled people across Europe regarding their experience during the COVID-19 crisis.

The study, conducted by Eurocarers in collaboration with the Italian Institute of Health and Science on Ageing (IRCCS-INRCA), and with the support of the European Commission, builds on 2500 questionnaires submitted by informal carers in 16 countries.

It allows to:

1. Document and analyse the impact of the COVID-19 outbreak on various aspects of the informal carers’ daily life (e.g. health, caregiving situation, access to care services, support networks, professional life and finances); and

2. Collect informal carers’ views and recommendations on ways to better support them in times of a pandemic.

For more info: https://eurocarers.org/publications/impact-of-the-covid-19-outbreak-on-informal-carers-across-europe/

Project summary:

This research project focuses on whether ownership is relevant to the severity of COVID-19 outbreaks in the nursing home sector. It carries the title ‘The COVID-19 outbreak in the nursing home sector – does ownership matter?’

This research consists of (at least) two parts. Firstly, it will provide a rapid review of the evidence available on this topic. Secondly, this project will follow a case-study approach to embed the findings in their respective national context. This part of the research project will be our main contribution. We will use input from various countries (e.g. Canada and Australia) to draw conclusions. If there is sufficient data, we will analyse the relationship between the composition of the long-term care sector (i.e. for-profit providers’ share of total beds in nursing homes and/or number of homes) and the share of COVID-19 deaths in the long-term care sector across different countries.

Project summary:

Our qualitative interview study aims to explore the experiences of family carers whose loved ones with dementia reside in a care home, and the experiences of care home staff of providing care during the pandemic. We are aiming to recruit around 20 family carers and 20 care home staff across the UK, and our study will be completing data collection in November 2020.

Project summary:

The aim of this COVID-19 related study is to explore the experiences for family who are unable to visit their relatives who permanently reside in a care home. This relates to ‘usual’ family visits as well as compassion visits that may be made at a time when end of life (EOL) procedures would be followed. We want to understand current interactions between family and their relatives living within a care home during the period of a UK-wide lockdown and continuing after care home visits are allowed by family.

It is proposed through the findings from this COVID-19 care home study to co-develop resources that facilitate good practice with practical messages of how family can be actively engaged in the continuing care of a loved one in a care home when restrictions may be in place. For example, this can occur when there is an outbreak of a more common infection and the care home is restricting visitors.

Methods: Qualitative ongoing virtual interviews with family carers

Project summary:

Schedule 12 of the Coronavirus Act 2020 included the unprecedented power for local authorities to suspend the majority of their adult social care duties under the Care Act 2014. The suspensions are known as “easements”. Eight local authorities triggered easements at the height of the pandemic, and many others withdrew services nevertheless. Under the pandemic, triggering easements remains part of the strategic planning of a number of authorities. Yet we know very little about the consequences for people with high levels of need, such as older carers of partners with dementia at home. This research investigates these consequences. We want to compare experiences in different local authorities for older carers, and investigate this issue also from the point of view of safeguarding and social work leads, who were making difficult decisions in crisis circumstances. Through doing this we seek to understand in a balanced way the wider social impacts and legal implications of this suspension of legal rights.

Project summary:

This project aims to provide a rapid synthesis of published studies of mortality rates and incidence of COVID-19 among people living with dementia.

Research questions:

1. What is the relationship between Covid-19 restrictions (including lockdown) and the cognitive, psychological and functional symptoms among people with dementia living in the community?
2. What is the relationship between Covid-19 restrictions (including lockdown) and the cognitive, psychological and functional symptoms among people with dementia living in care homes?

We will follow PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for conducting the review and preparing the report. We developed search terms for three databases (Pubmed, PsychINFO and CINAHL) to identify all studies reporting primary data on the effect of COVID-19 isolation and confinement measures on people living with dementia. Included studies are in English language only and will be critically appraised using the Joanna Briggs critical appraisal tools. All study designs will be considered for inclusion. We extracted information related to cognitive measures, psychological symptom, activities of daily living and changes in medication (primary outcome measures) along with tools used to measure symptoms, setting where the study is conducted (e.g. community, day clinic, care home), sample size and dementia type (when reported) of participants. Evidence will be synthesized narratively.

Project summary:

This is a collaboration between Liverpool and the ARCAD in Uganda. The ARCAD is led by Dr Isaac Ddumba. In June 2020, researchers in Uganda conducted 30 semi-structured interviews with older adults (aged 60+) about their experiences of how public health measures have impacted on their lives. We have submitted the first paper which is currently undergoing review, and are hoping for the first findings to be published by Christmas. What already emerged early on from the interviews was the severe impact on the basic necessities of life that the pandemic is having.

Project summary:

A three-phase concurrent exploratory mixed methods study to explore the impact of COV ID-19 related isolation and quarantine restrictions on staff, family and residents in one aged care facility. An analysis of interRAI data will be undertaken using assessments completed prior to, and after lock down restrictions were eased in order to identify changes in the interRAI domains related to resident’s health and wellbeing. Subsequent phases will undertake semi-structured interviews with residential care staff, family and residents on their experiences of isolation and quarantine restrictions and its impact on the health and wellbeing of residents.

Project summary:

This project has three research questions:

1. What are the wellbeing, health and social effects of the COVID-19 pandemic, including social restrictions and changes to how people are supported, on the lives of adults with learning disabilities across the UK over time?
2. What actionable factors are associated with better outcomes for: a) people with mild/moderate learning disabilities; b) people with severe/profound learning disabilities?
3. What urgent issues concerning people with learning disabilities are emerging over time?

Longitudinal data will be collected 3 times in the 12-month project (1 Sept 2020 to 31 Aug 2021) from two purposively sampled cohorts across the UK: 1,000 adults with mild/moderate learning disabilities (interviewed directly via telephone etc by research interviewers); and 500 adults with severe/profound learning disabilities (via online survey with carers). Core data will include wellbeing, health (including COVID-19), the impact of COVID-19 on wellbeing, lifestyle and finances, living circumstances, and changes in support received. Additional questions at any wave will be determined by the process outlined below.

These surveys will take place within three repeated cycles:

Step 1: Collaborating organisations and policy-makers across the UK bring forward urgent issues, and select with researchers additional questions for the next survey wave

Step 2: Surveys are conducted

Step 3: Survey results are rapidly analysed, shared with policy-makers, and disseminated in multiple (including accessible) formats.

Project summary:

This is a mixed-methods systematic review, reviewing the evidence of both qualitative and quantitative studies in the field. The aim of this review is to understand the impact of the pandemic and its associated restrictions on the lives of people living with dementia and unpaid carers, specifically focusing on three key areas: (1) Health (including mental health, physical health, cognitive health and dementia symptomatology, and social health); (2) Social care access and utilisation; and (3) Financial implications.

Project summary:

Led by the UK, we are collecting qualitative and quantitative data on the experiences of public health measures on the lives of people living with dementia and unpaid carers in the UK, Australia, Poland, Italy, and India. This involve telephone semi-structured interviews with up to 25 participants in each country, as well as follow-up interviews in the UK and Australia. These findings are complemented by an online and telephone survey. This study will provide the very first international comparative analysis of the impacts of the pandemic on dementia.

Project summary:

Introduction

COVID-19 is having a significant impact on people in need of care and support and on social care services. The Coronavirus Act 2020 became law early in the pandemic. Some of its changes relate to English local authorities’ (councils’) social care duties, particularly ‘easements’ which allow them to radically change what they do under the Care Act 2014 and how they do it (for example, postponing reviews or changing a person’s care arrangements or not supplying care at all). There have been no studies of how this new Act has been affecting: Councils, the people working in them, and people receiving Care Act services.

Objectives

This study is investigating how the changes of the Coronavirus Act were put in place in social care by:

• mapping which local authorities applied for Care Act easements, exploring why and for which activity(ies)
• exploring the impact of the Care Act easements on practice and on service users/ carers affected, and whether the aims of seeking easements were realised.

Methods

This study is taking an exploratory research design drawing on document analysis and qualitative data collection, including through expert interviews and interviews with staff, people who use services and carers.

Resources

Project website: https://www.kcl.ac.uk/research/easements-to-the-care-act

Project summary:

The VIVALDI study, investigates the epidemiology of SARS-CoV2 infection amongst care home residents and staff in England, through collaboration with a range of Care Home Providers.

We will undertake a cohort study collecting serial blood samples from staff and residents in c.200 care-homes in England. Blood results will be linked to results from nasopharyngeal PCR swab testing undertaken through the national testing programme. Results of nasopharyngeal PCR testing will also be collected from a further >100 homes where blood samples were not collected. Data collection began in June 2020 and will end in April 2022.

The data will be used to investigate the proportion of staff and residents who become infected with SARS-CoV-2, the duration of the antibody response and the vaccine-induced immune response.

Data linkage with hospital episode statistics and mortality data will provide insight into outcomes and transmission amongst staff and residents. Linkage of PCR testing data with information on hospital admissions, and analysis of viral sequencing will provide insights into:
• the patterns of disease transmission within care homes,
• the role of high-risk groups,
• how often infection is either imported from or exported to care home settings from the community or hospitals.

This work will provide robust data to inform optimal approaches for SARS-CoV2 control and prevention within care homes. Individual level-data will be made available to individuals involved in provision of direct care to residents. Aggregate data outputs (at regional and national level will be made widely available.

Primary Objectives:
• To estimate the proportion of care home staff and residents who have been infected with SARS-CoV-2 and investigate how this varies by care home characteristics and individual-level characteristics.
• To monitor vaccine effectiveness against laboratory-confirmed SARS-CoV-2 in care home staff and residents, and outbreaks

Project summary:

The UK Pandemic Ethics Accelerator harnesses and mobilises the UK’s internationally renowned expertise in ethics research. Four major UK universities and the Nuffield Council on Bioethics form the collaborative which has received £1.4M funding from the Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation rapid response to covid.

The Accelerator provides rapid evidence, guidance, and critical analysis to inform policy and help improve decision–making. It also supports, informs and promotes public debate around key ethical challenges, and ensures that ethical thinking is embedded at the core of future pandemic preparedness.

The Accelerator covers a variety of policy domains, and has recently authored several outputs relating to social care.

Project summary:

Colombia has suffered political violence since the 1950s notably la violencia, more recently drug cartel and migrant flows linked. These severely impact citizens. Colombians are now being affected by the global COVID-19 pandemic. It remains unclear how these events are affecting residents’ mental health and wellbeing, particularly older adults.

The proportion of Colombian older adults is expected to double from 10% to 20% by 2050. This rise increasingly impacting upon Colombians, particularly in regions like Urabá in the Department of Antioquia, that have suffered throughout their history from inequality and lack of development due to inattention from the state and the constant presence of prolonged political conflict that deepens these structural inequalities. Those over 60 years of age have witnessed the history of violence in the country, as victims or perpetrators (for those who were part of armed groups). These account for a complex understanding of the conflict and turn them into the advocates for peace, as they have witnessed the dire consequences of war -they have suffered and survived them. In this sense, the elderly in Colombia are the ones who weave the life-story memories of the conflict, but suffer consequences.

Our research centres on the municipality of Turbo, typical of such regions and populations. Uraba Antioqueno has been one of the territories most affected by the Colombian armed conflict in the last six decades. It is considered one of the regions of the Department of Antioquia with the highest numbers of expulsion of people for reasons related to the armed conflict or violence, though at the same time it is one of the main receiving areas for victims from Choco in the Pacific region and the Atlantic coast, as well as the migratory transit of foreigners from Africa and Latin America who seek reaching the United States. In 2020 413,397 inhabitants (78.6% of the total regional population of 525,685) were registered as victims of the armed conflict. In Turbo, the proportion is 64.5% (83,993 victims). In the region, 9.7% (n=14,425) are classed as older adults, living in urban, rural, peri-urban and dispersed rural areas.

Our proposal embeds co-production with public and professional advisors throughout. We have already been undertaking consultations with local older residents and professionals in determining the approach and designing the project.

This proposal will collect and combine key existing datasets added to new information collected using mental health surveys and both individual interviews and focus groups to map the mental health condition and pressures on older adults, suffering from decades of conflict and now COVID19. These findings will link with a systematic review of interventions to support the mental health of older adults in lower and middle income countries (LMICs), with a particular focus on conflict survivors, linked to in-depth interviews with international academic experts.

The evidence summary, combined with quantitative and qualitative data from Turbo will be used to co-design and test a community-based psychosocial care strategy and intervention with, and for, Turbo older residents to reduce and manage mental health problems. It will address the situations identified at family and community levels in the Turbo research phases, linking with different regional health and welfare systems and datasets.

This will then be evaluated as a pilot for its cost effectiveness, impact on mental health and other key factors as well as acceptability to professionals and service users. The findings will be used to inform a larger formal trial grant application across wider populations; as well as guides to implementing the approach more widely to support its application across other populations, within Colombia and other LMICs; as well as higher income countries, starting with England, with a focus on addressing the mental health needs of migrants who have experienced conflict.

Project announcement: Supporting older adults’ mental health in conflict-riven regions of Colombia – News – University of Liverpool

Project summary:

This research study investigates the impact of COVID-19 on quality of care in residential long-term care (LTC) in New Brunswick, Canada using a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. The learnings and insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis within rural Atlantic Canada.

Project summary:

Part of the wider Strengthening responses to dementia in developing countries (STRiDE) project, this sub-study aims to explore the financial, social and health costs and consequences of providing unpaid care for people with dementia in India, Jamaica, and Mexico. We use highly inductive qualitative interviewing to understand the complexities in caregiving experienced by people who care, or have cared, in each setting. In March 2020 we suspended in-person fieldwork in light of the global COVID-19 pandemic and sought to adapt our methodology.

The pandemic presents a period of potential crisis for people providing unpaid long term care. It is likely that some people caring for those with dementia, as well as those they care for, will contract the virus. Moreover, it is likely that a period of complete or reduced face-to-face contact within social networks, reduced availability of services and restrictions on economic activities will affect caregivers’ experiences of providing care. Should either the pandemic, or national and local responses to the pandemic, significantly affect participants’ daily lives, this period is likely to highlight and possibly exacerbate inequities in whether and how providing unpaid care to a family member with dementia presents a burden to caregivers. Data about COVID-19 experiences are likely to help us better understand the broader costs and consequences of providing unpaid dementia care, as well as the impact of response measures on caregivers during the pandemic and the legacy of additional care and support needs that these responses may generate and that will need to be addressed when in-person services resume.

To this end, discussion of COVID-19 experiences will be a key part of a full programme of remote in depth interviews with caregivers in India, commencing February 2021. In Mexico, a series of short ‘check in’ calls with existing participants over the second half of 2020 is being complemented by extended discussion of COVID-19 as part of remote in depth interviews with existing and new participants that began in December 2020. In Jamaica, a longer series of repeated short ‘check in’ calls with caregivers interviewed pre-March 2020 are helping us to generate observational data on COVID-19 experiences and shape plans for further generation of remote in depth interview data later in 2021.

Project summary:

THRIVE aims to understand Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in care homes for older people during the COVID-19 pandemic, how this impacted on resilience, mental health and well-being, and to collaboratively develop theory-informed approaches for ongoing and future support in this professional group.

The study is being undertaken in two phases:

• Phase 1: Key-informant interviews with NMC-registered nurses practising in care homes to describe and understand their distinct experiences of working during COVID-19 and its impact on their resilience, mental health and well-being, including the availability and appropriateness of support. This phase is now complete, and preliminary findings were presented at the LTCcovid International living report on COVID-19 and Long-Term Care, 06/12/2021 (https://ltccovid.org/international-living-report-covid-ltc/)

• Phase 2: Undertake a series of deliberative workshops to discuss findings and issues through constructive, co-produced dialogue to consider ideas (old and new) for developing strategies and interventions that support care-home nurses’ resilience, mental health and well-being. This phase is ongoing, but we expect to report early 2022.

Project summary:

Visit-id: a study of care home visiting arrangements during Covid-19 is being conducted by a team from the Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, led by Josie Dixon with Klara Lorenz-Dant, Edmund Stubbs and Manna Mostingham, Karen Harrison-Dening and Daniel Casson.

It is funded by the National Institute for Health Research (NIHR), Policy Research Programme as part of its Recovery, Renewal, Reset: Research to inform policy responses to COVID-19 in the health and social care systems funding call. It runs from 2021 to 2023. It is supported by a steering group involving senior representatives from Dementia UK, Alzheimer’s Society, Healthwatch, Carers UK, HC-One, Care England, Jewish Care, Freemantle Trust, Glasgow Royal Infirmary/University of Glasgow and Sheffield CCG and by a reference group of four experts-by-experience with close relatives living in a care home during the pandemic.

Project summary:

Rapid review to gather evidence for the ways in which care homes have arranged communication between themselves, residents and family carers. This may be at a time of enforced closure, such as due to the SARs virus or C-19 or reporting empirical work which has been undertaken to explore use of different approaches such as use of technology (SMART phones, iPad, Facebook Portal).

It is proposed that the findings of this review will highlight good practice which could be implemented within the current restrictions to care homes across the globe but also for ‘distance’ carers across all age spectrums and different types of care settings, i.e. facilities for older people, learning disability, respite and short-term care provision.

Methods: Rapid review of empirical published studies

Project summary:

Project Summary

This project aimed to synthesise published studies of mortality rates and incidence of COVID-19 among people who use and provide long-term care (LTC). Acknowledging the evolving nature of evidence during the pandemic, this project was set up in April 2020 as a living systematic review with continuously updated database searches and publication of key findings. A protocol was published on the PROSPERO database of systematic reviews (CRD42020183557). Initial findings were reported on medRxiv and fed into a WHO Policy Brief on the prevention and management of COVID-19 in LTC.

We developed search terms for seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We exclude studies not focusing on LTC. Included studies are critically appraised using the Joanna Briggs Institute critical appraisal tool for prevalence studies. We extract information on the number of deaths, COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions. Findings are initially synthesised narratively. Upon assessment of the heterogeneity of populations in included studies, we will quantitatively synthesise rates of mortality and infection.

In the last published report (1 August 2020), a total of 54 study reports for 49 unique primary studies or outbreak reports were included, which documented the severe impact that COVID-19 had on LTC. In badly affected care homes, more than two thirds of residents may be infected with COVID-19, and close to one fifth of all residents at care homes with outbreaks may die as a result.

Project summary:

The objective of this administrative supplement is to examine the impact of COVID-19 in US nursing homes, understand its treatment and outcomes in this setting, and identify organizational characteristics that may mitigate or fuel spread of the infection among staff and residents. This is a collaborative partnership between Genesis HealthCare, the largest long-term care provider in the US, and Brown University. To date, we have examined facility and county predictors of outbreak, individual patient risk factors for mortality and other outcomes, mortality trends, symptom presentation, prevalence of asymptomatic and pre-symptomatic infection, and SARS-CoV-2 antibody development in this population. Other analyses are currently underway focused on post-acute care, functional recovery, sensitivity and specificity of SARS-CoV-2 antigen tests, medication management, and COVID-19 outcomes among individuals with chronic kidney disease.

Project summary:

This research is a qualitative study on the impact of Covid-19 on home care clients in Ireland. Through 9 interviews, HCCI explored the mental, physical and social impact of Covid-19 and the coping mechanisms used during the pandemic. This research is a client centered study that builds on previous HCCI research on home care providers experience during Covid-19.

The study finds that robust infection prevention and control measures provided safety and reassurance to clients, allowing most home care to continue uninterrupted and kept cases low relative to acute hospitals and long term residential care facilities.

The need for clients to cocoon in theirs homes and the closure of recreational and day services resulted in clients expressing social isolation and a strain on their mental well-being.

Clients were unable to exercise to the same extent and felt a loss of motivation. The long term effects of sedentary behavior are well documented and the long term physical effects of Covid-19 needs further research.

To cope, clients pointed to personal relationships with family, friends, neighbours and carers as a source of comfort and companionship.

Clients used technology and the internet to facilitate social connections. The internet was popular for online shopping, video games and digital content.

Participants spoke about the importance of keeping a positive mindset when coping with the pandemic. They demonstrated commendable mental resilience and adaptability, developed through their life experiences, bereavements, illness, and religious faith.

In conclusion, the IPC measures put in place by providers reassured participants that their home was safe and helped make home care the safest method of care during Covid-19 Pandemic. While cocooning and social isolation placed a mental strain on participants, personal relationships, technology and a positive mentality helped them adapt and persevere

Project summary:

The aim of this study was to identify the lived experiences of care home staff in implementing new infection control measures (including PPE) in care homes early on in the COVID-19 pandemic and how these impacted on the residents they cared for. We were also interested in understanding how the perspectives of staff in different occupational roles may differ as well as identifying the sources of support available to staff.

Project summary:

Carers UK’s ‘Caring Behind Closed Doors’ work involved two online surveys in Spring and Autumn 2020, with 5,047 and 5,904 respondents respectively, designed to capture and draw attention to the impact of the COVID-19 pandemic on unpaid carers across the UK. The first survey focused on the initial ways in which the pandemic affected carers’ lives (for example increased costs, difficulties accessing supplies), whereas the six months on report was able to reflect on the ongoing impact on mental and physical health and carers’ needs for support during the approaching winter months.

Project summary:

An interdisciplinary team of aging researchers at the University of Washington released a new report, “Caring for Washington’s older adults in the COVID-19 pandemic: Interviews with organization leaders about the state of social and healthcare services.”

Drawing on interviews with 45 senior leaders of social services and health care organizations serving older adults, this report identifies current challenges confronting service delivery and client care, as well as those that will persist to shape future strategy and planning. Organization senior leaders are most concerned about people living with dementia, those with low-incomes, those who are living alone or unhoused, Latinx immigrant and migrant older adults, people with limited English proficiency, and tribal elders. Several key findings and themes emerge relevant to policy and practice. Themes discussed include:

-intensified social isolation and the digital divide

-creative and promising adaptations

-observed negative health impacts

-staffing reductions and shortages

-urgent fiscal shortfalls and organizational needs

Read the press release