INTERNATIONAL REPORTS

Responses to 3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic


Germany

Local health authorities instruct and advise LTC providers within their jurisdiction on infection prevention measures. These measures as well as the modes of co-operation and collaboration vary between LTC providers and local health authorities. The health system (particularly the hospital system and the medical care in the community) and the long-term care system, operate independently of each other. No formal coordination exists on a local, regional, or Länder [State] level. Some states and regions have sought to establish informal modes of coordination during the pandemic. Where care providers are no longer able to provide the services for which they have been contracted, they have to contact the care insurance and work towards solutions with the relevant health and regulatory authorities (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

Last updated: September 9th, 2021


Austria

A published paper highlights the fragmented nature of the health and social care system, which leads professionals in both sectors to largely ‘work in ‘silos’’. The paper notes that there is very little exchange between LTC staff working in residential and domiciliary care. It further observes that this lack of exchange between health and LTC services, but also between different LTC services, leads to a situation where some health and LTC workers had to reduce their activities, while others experienced excess demand.

Last updated: September 9th, 2021


Canada (British Columbia)

While the same five health authorities in British Columbia oversee both health and social care, the creation of emergency committees and new medical health officer roles within these authorities created confusion regarding decision making power and authority (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

 

Last updated: September 9th, 2021


Denmark

The Board for Patient Safety enforced that the municipalities introduced restrictions preventing visitors in nursing homes. This included visits inside the institutions, and in common areas, as well as apartments or rooms. It could also include outdoor areas if necessary but this was a decision to be taken by the Municipal Board (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

On April 8, 2020, an extensive guideline was issued by the Board of Health, outlined how nursing homes and other institutions could prevent the spread of COVID-19, in the wake of the so-called controlled re-opening of the country which was planned to take place after Easter (April 14). It was intended to supplement the procedures that the municipalities had already put in place, and provided guidelines on how to organise this. It specifically addressed the handling of the disease as a responsibility of the management. The managers were encouraged to plan the daily activities so that residents gathered in smaller groups than normally, preferably no more than two (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Last updated: September 9th, 2021


England (UK)

In the absence of rapid and adequate support to the domiciliary care sectors, many providers have turned to local initiatives to continue to deliver care in a safe way, for instance through the use of remote monitoring technologies (Source: https://www.carecity.london/your-blog/221-expert-care-in-covid-19). Providers have furthermore reported improved relationships with the healthcare sector, with a more collaborative approach to supporting vulnerable individuals over the course of the pandemic.

Last updated: September 9th, 2021


Finland

Hospital districts became the central organising forces for the pandemic response. Concern over shortages and adequacy of healthcare personnel led to the termination of non-urgent care, most elective surgeries, medical rehabilitations, therapies, and counselling services, and annual health checks (included those of at-home care users) were suspended nationwide. However, the use of hospitals has generally been kept under control (Source: https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view (p. 20)). Early on, avoiding transfer from care homes to hospitals (and vice versa) was put on the mandated guidelines list (Source: https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620-1.pdf (p. 9)).

Last updated: September 9th, 2021


France

At the onset of the pandemic, significant issues were reported among care homes (and other LTC users) relating to access to healthcare facilities. Many care homes did not have named GPs or equivalent contacts which the Senate/National Assembly attributed to higher deaths. As a result, ‘geriatric territorial support pathways’ and mobile geriatric and palliative care teams for care homes were established on March 31, 2020. The geriatric hotline connected care workers to a geriatric consultant and care coordinator from 8am-7pm 7 days/week. A protocol for pharmacy delivery of indispensable products (e.g. paracetamol) and to connect care homes to pharmacies was also developed in some regions (Source: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16687).

Last updated: September 9th, 2021


Germany

Where care providers are no longer able to provide the services for which they have been contracted, they have to contact the care insurance and work towards solutions with the relevant health and regulatory authorities (Source: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf).

Last updated: September 9th, 2021


Netherlands

People interviewed for the McCovid project reported that nursing homes and hospitals collaborated well and there was some exchange of staff (nurses, gerontologists) when needed. Nursing homes were deemed to be well equipped to provide medical care themselves and by accessing health care in the community (GPs, geriatric doctors, other specialists). It is customary to treat illness in nursing homes and only to transfer to hospitals in exceptional circumstances (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view). There was improved regional cooperation between nursing homes and hospitals through regional networks (RONAZ). Nursing homes also assisted hospitals in making available additional beds to increase hospital capacity (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf).

Last updated: September 9th, 2021


Singapore

The Regional Health System model, and the collaborative relationships that were formed through this model prior to the COVID-19 pandemic, was reported to have contributed to the ‘allocation and sharing of infection control resources and training, and the safe transfer and management of patients between acute and community care settings’ (Source: https://ltccovid.org/wp-content/uploads/2020/08/The-COVID-19-Long-Term-Care-situation-in-Singapore-27July-2020.pdf).

Last updated: September 9th, 2021


Spain

In the earlier parts of the pandemic, there was lack of clarity in governance, which resulted, in some instances, in care homes being given contradictory guidance from the regional Departments of Health and by Social Services. This improved in later phases of the pandemic. To improve coordination, in some regions joint working groups were established, whereas in others the Department of Health took control. (Source: https://digital.csic.es/bitstream/10261/220460/5/Informe_residencias_COVID-19_IPP-CSIC.pdf).

Last updated: September 9th, 2021


Sweden

The Corona Commission highlighted shortcomings in coordination, with fragmented organisation of the care system across regions (health), municipalities (social care) and central government agencies. There was no overview of preparedness to tackle a pandemic and there were no established communication channels to facilitate operational coordination and collaboration. In several regions, recommendations were issued that people in care homes who fell ill with suspected or confirmed COVID-19 should primarily be cared for in the care home and not referred to hospital (Source: https://coronakommissionen.com/wp-content/uploads/2020/12/summary.pdf).

Last updated: September 9th, 2021