INTERNATIONAL REPORTS

Responses to 3.05. Long-Term Care oversight and regulation functions during the pandemic


Australia

The Australian Government’s Aged Care Quality and Safety Commission is responsible for providing COVID-19 information and recommendations to aged care providers and facilities. However, state and territory health agencies also have the ability to implement policies in the aged care sector. With both the federal, state, and territorial governments having some oversight over aged care providers, there is a fragmentation of power leading to ineffective and often confusing protocols (Source https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf).

Last updated: September 10th, 2021


Canada (British Columbia)

Health authority owned LTC facilities were found to have had better oversight, management, and support during the pandemic. Provincial health officer orders could be interpreted differently in each health authority, for example leading to different visitor guidelines/policies. The ministry established a clinical reference group as part of the Health Emergency Management British Columbia (HEMBC) to develop clinical policy responses to COVID-19. However, it is unclear how the HEMBC differs from the Provincial Health Services Authority (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf).

Last updated: September 10th, 2021


Denmark

On May 12, 2020, an extensive publication providing new guidelines on how to organize visits in nursing homes was published by the Board of Health. From the introduction, it was made clear that the Board of Health did not have the authority over who could visit, as this was the responsibility of the Board for Patient Safety, and thus underlining the general confusion over which authority was in charge (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Last updated: September 10th, 2021


England (UK)

The Coronavirus Act (March 25 and renewed on September 30, 2020) included provision to relax the responsibilities of local authorities under the Care Act 2014 to streamline their services in case of workforce shortages or increased demand. The Act also enabled rapid discharge of patients from hospital by allowing assessments to be delayed (Sources: https://www.legislation.gov.uk/ukpga/2020/7/contents/enacted; https://www.health.org.uk/publications/reports/adult-social-care-and-covid-19-assessing-the-policy-response-in-england). There was concern that the Care Act Easements included in the Coronavirus Act would be widely used to reduce care packages but only a small number of councils utilised them (Source: https://www.communitycare.co.uk/2020/04/30/eight-councils-triggered-care-act-duty-moratorium-month-since-emergency-law-came-force/). As of November 2020, the CQC reported that no local authorities were currently using Care Act Easements (Source: https://www.cqc.org.uk/guidance-providers/adult-social-care/care-act-easements-it).

The Care Quality Commission interrupted routine inspections on March 16, 2020 (Source: https://www.cqc.org.uk/news/stories/routine-inspections-suspended-response-coronavirus-outbreak). In May 2020, the CQC began to implement an Emergency Support Framework setting out its approach to regulation during COVID-19 (Source: https://www.cqc.org.uk/news/stories/joint-statement-our-regulatory-approach-during-coronavirus-pandemic). This involved suspending routine inspections of services and instead using and sharing information to target support where it’s needed and taking action to keep people safe and protect their human rights. CQC are now starting to resume some inspections in 300 random homes in relation to management of the pandemic, examining four key areas; safe care and treatment; staffing arrangements; protection from abuse; assurance processes monitoring and risk management (Source: https://whiteleyvillage.org.uk/whiteleys-covid-19-response-effective-in-all-key-areas-says-cqc/). Much will be conducted remotely and in person inspections will take place under exceptional circumstances only.

Last updated: September 10th, 2021


Germany

LTC quality checks and necessary patient to staff ratios were temporarily suspended. Regular quality checks will not be undertaken until at least until February 28, 2021. Quality checks were only undertaken if there was reason to suspect that quality of care was not maintained (Source: https://www.pflegeberatung.de/corona).

In March 2020, the German Government allowed care providers to divert from contractual obligations around staffing to avoid gaps. LTC insurance was also given some freedom to avoid gaps in domiciliary care (Source: https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-quartal/corona-gesetzespaket-im-bundesrat.html).

Last updated: September 10th, 2021


Israel

Regulation guidelines in LTCFs during COVID-19 that overrode regular protocols were issued by the national taskforce, The Shield of the Fathers and Mothers. Three of the major policy measures that had particularly important impacts were: the increased testing in LTCFs; the re-evaluation of family visitation policies; and the opening of specialized COVID-19 wards within LTCFs (to reduce the burden on general hospitals and stop the spread of infection from LTCFs to local communities). A study has been published outlining the adaptation and level of success.

Last updated: September 10th, 2021


Israel

Oversight of the COVID-19 response has been given to the Ministry of Health, which set up the National Coronavirus Information and Knowledge Centre alongside the armed force’s (IDF) Intelligence Directorate (Source: https://www.gov.il/en/departments/topics/corona-main-sub).

Oversight of the extension of welfare benefits is in the hands of the National Insurance Institute (Source: https://www.btl.gov.il/English%20Homepage/Benefits/LongTerm%20Care/Pages/default.aspx).

Last updated: September 10th, 2021


Japan

New legislation has been brought in nationally to manage the pandemic, but when it was released, LTCFs had already responded using well-established infection control protocols (Source: https://programs.wcfia.harvard.edu/files/us-japan/files/margarita_estevez-abe_covid19_and_japanese_ltcfs.pdf).

Last updated: September 10th, 2021


Republic of Korea

Nationwide monitoring and inspection of LTC hospitals was conducted to ensure the ‘exclusion’ of workers with a recent travel history to affected regions or countries, or those with symptoms.

Last updated: September 10th, 2021


Spain

There has been little oversight, at most reviews of written documents, which care home managers have found to be very onerous (Source: https://digital.csic.es/bitstream/10261/220460/5/Informe_residencias_COVID-19_IPP-CSIC.pdf).

Last updated: September 10th, 2021


Sweden

The responsibility to restrict the spread of any disease in care homes and other forms of social care services rests with the municipalities together with the regional infection control units (Smittskydd). During the entire pandemic, this local/regional responsibility has been stressed by the Public Health Agency and the National Board of Health and Welfare. The latter has mainly acted by providing recommendations and check-lists, and by presenting good examples. In April 2020 the Government appointed the Health and Social Care Inspectorate (IVO) to conduct a large-scale inspection in care homes and other care units for older and disabled people to investigate the consequences of COVID-19 for quality and safety in the care services (Source: https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Sweden-22-July-2020-1.pdf). The regions are responsible for COVID-19 testing conducted under the Health and Medical Services Act and the Communicable Diseases Act. Under the Work Environment Act the regions also have responsibility for the health and safety of their own staff (Source: https://coronakommissionen.com/wp-content/uploads/2020/12/summary.pdf).

Last updated: September 10th, 2021