INTERNATIONAL REPORTS

Responses to 2.05. Impacts of the pandemic and measures adopted on the health and wellbeing of people who use and provide Long-Term Care


Australia

Levels of depression, anxiety, confusion, loneliness, and suicide risk among aged care home residents have increased since March 2020. Some of this can be attributed to missing family, changed routines, concern about catching the virus, or fear of being isolated in their rooms. In some cases, people living in aged care homes are no longer doing the incidental exercise they were previously doing (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf). Dementia Australia reported that people living with dementia and the people that care for them, especially family carers, have reported adverse effects of COVID-19 on their physical, cognitive, social, and mental wellbeing.

Last updated: August 4th, 2021


Canada (British Columbia)

A recent survey by Safe Care BC found that many LTC staff had increased psychological fears and anxiety and intention to leave as a result of COVID-19. They felt a psychosocial burden responding to pandemic and had concerns about their personal safety and ability to care for residents (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Last updated: August 2nd, 2021


Canada (British Columbia)

A recent survey by Safe Care BC found that many LTC staff had increased psychological fears and anxiety and intention to leave as a result of COVID-19. They felt a psychosocial burden responding to pandemic and had concerns about their personal safety and ability to care for residents (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

A report by the office of the Seniors Advocate British Columbia highlights that the use of antipsychotics among LTC residents has increased by 7% during the COVID-19 pandemic and points towards interRAI assessments suggesting ‘unintended weight loss and worsening mood’ among residents.

Last updated: August 4th, 2021


Canada (Ontario)

A survey of prescriptions for all nursing home residents in Ontario found evidence of increased prescriptions of psychotropic drugs to nursing homes residents between March and September 2020, compared to prescription pre-pandemic. The authors interpret this as likely to be associated with the social isolation experienced by residents due to infection prevention and control measures or decreased capacity for staff to respond to responsive behaviours.

Last updated: August 4th, 2021


Denmark

The latest report on mental health from the nursing home sector indicates that the quality of life is increasing for the majority of residents. Nursing home managers report that residents sleep better, medication is reduced, there are fewer conflicts with residents suffering from dementia, more time for the individual resident, and the sickness rates among staff is now lower. The factors which have contributed to this seem to be that there are no longer any common activities for all residents, instead members of staff make activities in smaller groups of residents or engage with them one by one. Staff report a more relaxed atmosphere, one reason being that they do not have to engage with family members who at times are considered overly critical.

Last updated: August 4th, 2021


Denmark

The latest report on mental health from the nursing home sector indicates that the quality of life is increasing for the majority of residents. Nursing home managers’ report that residents sleep better, medication is reduced, there are fewer conflicts with residents suffering from dementia, more time for the individual resident and the sickness rates among staff is now lower. The factors which have contributed to this seems to be that there are no longer any common activities for all residents, instead members of staff make activities in smaller groups of residents or engage with them one by one. Staff report a more relaxed atmosphere, one reason being that they do not have to engage with family members who at times are considered overly critical.

However, concerns were expressed that the Danish government’s response to the pandemic (e.g. care home visiting ban) was inflexible and not tailored to individuals circumstances (rather, it was based on ‘one size fits all’ rules). Combined with the late ease of restrictions, it had a negative long-term impact on older people’s mental and physical health and concerns were raised that the government should have done more to respect basic individuals’ freedoms (Source: https://www.djoef.dk/presse/pressemeddelelser/2020/s-ae-rligt-de–ae-ldre-og-s-aa-rbare-har-lidt-under-begr-ae-nsninger-i-friheden-i-starten-af-coronakrisen.aspx).

Last updated: August 4th, 2021


England (UK)

During the early part of the pandemic there were reports of substantial increases in the prescription of anti-psychotics to people with dementia during the COVID-19 pandemic, some of this may have been due to increased need linked to delirium management or palliative care, but it is also likely to be attributable to worsened agitation and distress linked to COVID-19 restrictions (such as people in care homes being confined to their bedrooms, or not able to receive family visits).

Last updated: September 6th, 2021


England (UK)

During the early part of the pandemic it was reported that there was evidence of substantial increases in the prescription of anti-psychotics to people with dementia during the COVID-19 pandemic, some of this may have been due to increased need linked to delirium management or palliative care, but it is also likely to be attributable to worsened agitation and distress linked to COVID-19 restrictions (such as people in care homes being confined to their bedrooms, or not able to receive family visits).

People living in care homes

Guidance issued by the government on April 2, 2020, said that care homes should advise family and friends not to visit except in exceptional circumstances. There is concern and, increasingly, reported international evidence that some of the measures taken to reduce the risk of COVID-19 infections in care homes, such as closing care homes to visitors (including family members), reduction in social interactions and activities, and needing to isolate have had negative impacts on the wellbeing and mental health of people living in care homes. There are multiple reports warning about the alarming rate of deterioration that people with dementia are experiencing under these isolating conditions and being detached from their families. For instance, a survey conducted by the charity Alzheimer’s Society found that 79% of care homes surveyed reported that the lack of social contact is causing a deterioration in the health and wellbeing of their residents with dementia. A survey of care homes from across England found that by late May and early June, 2020, 85% of managers had detected low mood among residents.

People living in the community who use long-term care

There is emerging evidence that reduced use of social support services has had detrimental effects on the quality of life of people affected by dementia and older adults (Sources: https://www.tandfonline.com/doi/full/10.1080/13607863.2020.1822292; https://pubmed.ncbi.nlm.nih.gov/32946619/).

People who are employed to work in social care

A survey of 296 frontline care workers that took place during July and August 2020, found that nearly half of the respondents (47%) indicated that their general-health had worsened since the onset of COVID-19 and 60% indicated that the amount of time their jobs made them feel depressed, gloomy, or miserable had increased since the start of the pandemic. Additionally, 81% reported an increase in the amount of time that their jobs made them feel tense, uneasy, or worried. A significant minority of 23% indicated their job satisfaction had increased, whereas 42% said that they had become a little or a lot less satisfied with their job since COVID-19. In another survey of 43 care home managers in England, 75% of managers reported that they were concerned for the morale, mental health, and wellbeing of their staff. In addition, data reported by Skills for Care indicates that the percentage of days lost to staff sickness have increased by 180% (from 2.7% before the pandemic, to 7.5% between March and August 2020).

Unpaid or informal carers

Many carers have expressed the experience of stress and a negative impact on their physical and mental health (Sources: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/morepeoplehavebeenhelpingothersoutsidetheirhouseholdthroughthecoronaviruscovid19lockdown/2020-07-09; https://www.carersuk.org/images/CarersWeek2020/CW_2020_Research_Report_WEB.pdf; https://www.alzheimers.org.uk/sites/default/files/2020-09/Worst-hit-Dementia-during-coronavirus-report.pdf; https://www.carersuk.org/images/News_and_campaigns/Behind_Closed_Doors_2020/Caring_behind_closed_doors_Oct20.pdf; https://onlinelibrary.wiley.com/doi/10.1111/jar.12811). Carers UK reported that the negative impact on the mental health of carers was greater among carers experiencing financial difficulties. Research found that variations in hours of support were associated with higher levels of anxiety and lower levels of well-being.

Last updated: August 4th, 2021


France

Both Senate and National Assembly commissions report the impact on wellbeing of the breakdown of care arrangements in the LTC population. There has been significant coverage in the reports, and in media, of the “syndrome de glissement” (slipping away syndrome), due to the depressive effects of isolation on older people. The Assembly report presents evidence of the impact on physical health due to the breakdown of OT/PT support, with considerably higher numbers of older people losing autonomy, and requiring support with walking and other activities of daily living.

Last updated: August 4th, 2021


Germany

There is no information available that systematically measures the impact of COVID-19 on the health and wellbeing of people with LTC needs. However, concerns for people’s mental health are being raised, especially for people living in residential care settings whose social life has been severely disrupted. Even before COVID-19, research has estimated that among those 65 and older living in care homes, 25-45% had depression. It has further been estimated that only 40% of those received a diagnosis and only about half of those with a diagnosis received adequate treatment and support (Sources: https://www.zeit.de/amp/news/2021-02/26/treffs-gegen-depressionen-in-alters-und-pflegeheimenhttps://www.aerzteblatt.de/nachrichten/98943/Wissenschaftler-Depression-bei-Heimbewohnern-seltener-behandelt).

Last updated: August 2nd, 2021


Israel

Israel’s Ministry of Health collaborated with JDC-ESHEL, a social policy and research incubator NGO, to provide long-term carers and service users with information and resources on pandemic-related physical and mental wellbeing. Of note was their guide for caregivers of dementia patients, and efforts to combat loneliness amongst older people (Source: https://www.haaretz.com/haaretz-labels/1.8816132). The welfare and strengthening of resilience amongst older people during times of lockdown and social isolation have been of primary concern in the national COVID-19 plan for the aging (Magen Avot V’Emahot).

One important finding was a report on the psychosocial effects of the pandemic on migrant carers which highlights a particularly unique feature of Israel’s LTC system. These carers are often vulnerable members of the workforce, working minimum wages on precarious work visas without a pathway to citizenship or permanent residency (unlike other high-income countries). During COVID-19, East Asian caregivers also faced harassment and discrimination. Issues of gender equality amongst unpaid carers were reported.

Last updated: August 4th, 2021


Jamaica

At the beginning of the pandemic, when there were curfews in place, the list of people exempt from the curfew did not include unpaid carers or paid home care workers, it is expected that this forced some caregivers to have made life changes in order to continue providing care (for example moving in together).

The loss of routine activities may have resulted in loss of the social and practical support that many carers rely on, for example through church activities.

The banning of visitors to long-term care facilities may have also affected the ability of carers to provide adequate supplies of medication and toiletries, as well as emotional support to their relatives.

Source: https://ltccovid.org/wp-content/uploads/2020/05/The-COVID-19-Long-Term-Care-situation-in-Jamaica-25-May-2020-1.pdf

Last updated: September 8th, 2021


Japan

Closure of day care and community services risks having significant impact on wellbeing (Source: https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.366 ). There is research into the impact of restrictions on the general population but so far none found on the LTC population.

Last updated: August 2nd, 2021


Sweden

Studies reported negative impact on mental health of care home residents and their families following the visiting restrictions as well as on mental health of older people following government guidance for people over 70 to limit their social contact (Source: https://aldrecentrum.se/wp-content/uploads/2021/02/Johansson-L.-Sch%C3%B6n-P.-2021.-Governmental-response-to-the-COVID-19-pandemic-in-Long-Term-Care-residences.pdf).

Last updated: August 2nd, 2021


United States

Recent studies show that the ability to receive and supply care services in long-term care facilities and at home proved very difficult across the United States during the pandemic. One study based in New York identifies the key struggles for home-care workers during this time: “invisibility, inconsistent levels of support, and difficult trade-offs between personal health and finances from nonunionized home care workers and family caregivers.” It also promotes structural reforms, such as increased provision of PPE and education; coordinated efforts between home health agencies and local public health departments to assess magnitude of infection in certain areas; and increased state support of legislation that protects said workers (regarding pay and health insurance) (Source: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769095).

Much of the coverage of COVID’s impact on wellbeing in United States long-term care facilities focuses on loneliness and isolation, highlighted by images shared online nationwide of families visiting loved ones in long-term care facilities outside of their windows. Of particular concern is the potential impact of solitude on the mental strength of those in long-term care facilities with Alzheimer’s/Dementia (Sources: https://www.nytimes.com/2020/10/30/us/nursing-homes-isolation-virus.html; https://www.nytimes.com/2021/02/26/well/family/nursing-home-covid-dementia.html).

Last updated: August 2nd, 2021