LTCcovid Country Profiles

Responses to 3.06.01. Surge staffing and other measures to support care homes with outbreaks or critical staff shortages

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.

 

Overview

Early in the pandemic there were examples of care homes where, due to a severe COVID-19 outbreak, staffing levels became too low for the care home to operate safely and be able to respond to the increased care needs linked to the outbreak. There is increasing alarm about the impact of the Omicron variant on staff availability in many countries.

Rapid response teams and surge staffing

In response to critical staff shortages, many countries deployed “rapid response” or “strike teams” that were mobilised to support these care homes. These range from medical teams deployed to deal with the health needs arising from an outbreak or technical support with Infection Prevention and Control, to more practical logistical support provided by the army or teams of people without prior care experience.

Increased involvement of family carers and volunteers in care provision in care homes

Another potential approach could involve an increased role for family carers of people living in care homes in the provision of care and support, or at least facilitating the levels of care by family members provided pre-pandemic, see section 3.07.03. on Visiting and unpaid carer policies in care homes.

There is evidence from before the pandemic that family and other unpaid carers and volunteers provided substantial care to people living in care homes. It can be argued that, if that family care is no longer available because visits are restricted (with no or only very brief, distanced visits allowed), this will result in either residents receiving less care, or in care home staff needing to take on additional care tasks.

A Dutch qualitative study found that family carers of people living with dementia in care homes reported that they were able to provide less care and felt felt sidelined when they were no longer able to continue providing care (Smaling et al., 2022).

References:

Smaling HJA, Tilburgs B, Achterberg WP, Visser M. The Impact of Social Distancing Due to the COVID-19 Pandemic on People with Dementia, Family Carers and Healthcare Professionals: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(1):519. https://doi.org/10.3390/ijerph19010519

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Surge staffing arrangements

To supply ‘surge’ staffing to residential aged care during COVID outbreaks, in early April 2020 the Australian government initially employed healthcare delivery provider Aspen Medical and care staff platform Mable to provide rapid response teams to residential and community care. As of 2 October 2020, significant surge workforce assistance had been provided by both state and National Aged Care Emergency Response (NACER) teams, with many workers deployed from interstate.

The Government’s National Aged Care Emergency Response (NACER) was introduced, during Victoria’s second wave, to mobilise experienced aged care workers from areas across Australia without community transmission of coronavirus (COVID-19) to help care for residents in care facilities that face staff shortages because of COVID-19. Staff recruited include registered nurses, enrolled nurses, personal care workers and cleaners. These workers can be deployed to care facilities for a four week period, followed by two weeks of quarantine and are supplied with uniforms and PPE, regular COVID-19 tests during their placement and have access to pastoral and mental health support.

Scale of use of surge staffing

By 14th January 2022 these labour hire firms had supplied staff for around 60,000 shifts in aged care services affected. This included 39,104 shifts through the Recruitment, Consulting and Staffing Association (RCSA). Aspen Medical had provided staff to fill 1,245 staff as clinical first responder deployments and Mable had filled 2,711 shifts.The State and NACER Teams have played a relatively small role (204 personnel were deployed).

How has this worked?

In evidence before the Royal Commission into Aged Care Quality & Safety, concerns were raised about the minimal experience many of the surge staff had in residential aged care.

An Independent Review COVID-19 outbreaks in Australian Residential Aged Care Facilities published in April 2021 found that, during the second wave in Victoria and staffing levels became depleted there was not enough supply of qualified and or experienced staff, the review found that some of the surge workforce did not have appropriate skills and experience, had not had sufficient training in Infection Prevention and Control, or did not speak English well enough, managers struggled to work with surge staff and many care homes preferred to avoid using workers they did not know.

This experience shows that organising and mobilising a surge workforce is a major logistical challenge that requires an extraordinary collaborative effort to deliver staff where they were needed. Some large providers with capacity to engage their own interstate
staff, also organised similar programs and incentives for staff to work in other states.

The Independent Review by Lilly and Gilbert also highlights that, in order to repond to the situation some care homes redesigned roles, so that staff without care skills and experience were deployed to roles such as helping residents communicate with their familes and updating families, and in some cases staff who were isolating at home would support remotely the surge workers, sharing their knowledge about the residents and their needs.

References:

Charlesworth, S and Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International
Long-Term Care Policy Network, CPEC-LSE, 12 October 2020. https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf

Lilly A. and Gilbert L. (2021) Independent Review: COVID-19 outbreaks in Australian Residential Aged Care Facilities – No time for Complacency. https://www.health.gov.au/resources/publications/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities

Last updated: February 18th, 2022   Contributors: Sara Charlesworth  |  Lee-Fay Low  |  

Preparations for possible future staff shortages began quite quickly, and a survey for a reserve of health professionals, including retired workers and students, began in early spring (https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

Last updated: February 18th, 2022

Mobile geriatric and palliative care teams were deployed to care homes from 31st March 2020. The Assembly recommends these be embedded longer-term (https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf). 

To support the Omicron wave over Winter 2021-22, guidance was issued on 3 January 2022 which enabled health and care staff to work conditional to them having a complete vaccination cycle (including booster) and no symptoms. It is unclear to what extent this policy has been used.  

Last updated: October 23rd, 2024   Contributors: Alis Sopadzhiyan  |  Camille Oung  |  

Measures varied between the States. The Ministry of Health in Bavaria introduced a long-term care group to support residential care settings in responding to COVID-19 cases in December 2020. The group includes experts in care, the authority monitoring quality of care for people with long-term care needs and disabilities and is called out as soon as one confirmed case has been established in a care home. The aim of this group is to prevent, advise and control infections and to support the task force infectious disease. Prior to the long-term care group (since March 2020), the Infectiology task force supported care homes in responding to outbreaks (https://www.stmgp.bayern.de/presse/neue-einsatzgruppe-unterstuetzt-pflege-einrichtungen-im-kampf-gegen-die-corona-pandemie/?output=pdf; https://www.n-tv.de/regionales/bayern/Pflege-Einsatzgruppe-beraet-fast-200-Heime-article22297279.html; https://www.stmgp.bayern.de/presse/huml-pflegeheime-brauchen-besonderen-schutz-vor-covid-19-handlungsanweisungen-des/?output=pdf).

In Lower Saxony care homes experiencing COVID-19 outbreaks could get support from qualified hygienists since May 2020. Health authorities can request support from these mobile teams through the Ministry of Social Affairs, Health and Equality in Lower Saxony (Niedersächisches Ministerium für Soziales, Gesundheit and Gleichstellung) (https://www.ms.niedersachsen.de/startseite/service_kontakt/presseinformationen/mobile-teams-zur-unterstutzung-von-pflegeheimen-bei-covid-19-ausbruchen-eingerichtet-kooperation-mit-medizinischem-dienst-der-krankenversicherung-188513.html).

A report from April/May 2020 showed that among residential care settings experiencing COVID-19 cases, 96.1% (n=749) receive support from a crisis team (https://www.uni-bremen.de/fileadmin/user_upload/fachbereiche/fb11/Aktuelles/Corona/Ergebnisbericht_Coronabefragung_Uni-Bremen_24062020.pdf).

Last updated: February 18th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

In April 2020 the army was deployed to provide desinfection tasks in care homes across Hungary.

Last updated: February 18th, 2022

In Ireland, national and regional outbreak teams were set up to oversee, prevent and tackle COVID-19 clusters in residential LTC settings. Care home providers started to report COVID-19 outbreaks to the Health Information and Quality Authority (https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: February 18th, 2022

The Israeli Army Home Front Command was called to assist in LTCF disinfection during three major facility outbreaks in mid-2020 (in a Jerusalem LTCF for older people, in a LTCF for older people in the South, and in a LTCF for disabled adults and children in central Israel) (Sharona Tsadok-Rosenbluth et al, 2020).

As the pandemic carried on, Israel’s army supplied critical response teams to support care homes and users, providing contract tracing, testing, medics, and vaccination support, and 29 quarantine locations nationwide (Nikkei Asia; The Telegraph).

Last updated: February 18th, 2022

There were no no national or regional strategies to provide “squads” or rapid response teams to support care homes with outbreaks or staff shortages. When these teams were deployed, this was through local partnership and supported by private care providers.

Last updated: February 18th, 2022   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

A study analysing the minutes and other meeting documents of Outbreak Teams operating in care homes (including residential and nursing care homes) during weeks 16 to 23 of 2020 (covering the first two waves of COVID infections in the Netherlands) shows that at times of high levels of staff absences due to COVID-19 infections and need to isolate, additional staff was brought in. These additional staff included  temporary workers, non-healthcare staff members and army medical staff. In some situations staff who needed to self-isolate were also provided with equipment to be able to work from home. (van Tol et al, 2021).

References:

van Tol LS, Smaling HJA, Groothuijse JM, et al COVID-19 management in nursing homes by outbreak teams (MINUTES) — study description and data characteristics: a qualitative study BMJ Open 2021;11:e053235. doi: 10.1136/bmjopen-2021-053235

Last updated: February 8th, 2022

If a resident in a nursing home receives a positive COVID-19 test, a COVID-19 Incident Response Team (CIRT) is called in immediately by the AIC. These response teams consist of ‘representatives from the nursing home, the supporting regional hospital, the Ministry of Health, the Agency for Integrated Care, National Public Health Laboratory as well as the National Centre for Infectious Diseases. The response teams work on containing the number of positive cases, stepping up infection control, carrying out swabbing and testing operations, contact tracing, heightening vigilance (health monitoring of staff and residents), communicate with residents’ relatives and media, develop a service continuity plan and maintain adherence to the IPC measures, ensure workforce recovery after quarantine (https://ltccovid.org/wp-content/uploads/2020/08/The-COVID-19-Long-Term-Care-situation-in-Singapore-27July-2020.pdf).

Last updated: February 18th, 2022

Practical support for understaffed care homes:

During December 2021 the National Guard has been deployed to nursing homes across the United States to enable nursing homes with critically low numbers of staff to continue to operate. There is an acute shortage of staff in nursing homes across the country (a pre-pandemic problem).

In Minnesota 400 guard members with no previous experience in care have undergone rapid training before being sent to provide temporary support to nursing homes facing severe staffing shortages homes. The 75 hour training programme has been provided over 8 days, online and in person, by the Minnesota Department of Health and Minnesota National Guard medical staff, through sixteen Minnesota State community and technical colleges, the Guard members quality as emergency certified nursing assistants (CNA) and termporary nursing aides. This is in addition to an initiative to recruit, train and deploy at least 1,000 new certified nursing assistants for Long-Term Care Facilities in Minnesota by the end of January and an expansion of the emergency staffing pool so that short-term emergency temporary staff can be deployed to open up additional long-term care beds for people who are ready to be discharged from hosptial.

In October 2021 a provider survey found that 23,000 nursing home positions were unfilled in Minnesota, 8,000 more than in March of the same year.

Infection Prevention and Control strike teams:

In the United States a federal strike team initiative offered technical assistance and recommendations to facilities experiencing large outbreaks, with a focus on controlling the outbreak. The strike teams were deployed to nursing homes with outbreaks of 30 or more cases and typically included infection prevention specialists, epidemiologists and public health experts.

Analysis of the reports from the strike teams visits to 96 nursing homes in 30 states between July and November 2020,  had support from federal strike teams. These nursing homes faced challenges related to staffing, lack of Personal Protection Equipment (PPE), COVID-19 testing and implementation of COVID-19 Infection Prevention and Control (IPC).

The American Rescue Plan Act of 2021 has made available $500 million through the Centers for Disease Control and Prevention (CDC)’s  Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement, for the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project. The funds can be used on temporary staff and also to procure needed laboratory equipment, PPE, and technology to help reporting.

Virtual support:

In the United States there were also many examples of community health teams supporting nursing home staff, for example via telemedicine.

Last updated: February 18th, 2022

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica Breuer, Jorge Browne Salas, Jenni Burton, William Byrd, Sara Charlesworth, Adelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin Hämel, Nina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’Donovan, Camille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. Schmidt, Agnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.