INTERNATIONAL REPORTS

Responses to 3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes


Sweden

Cohort care i.e. separating infected from non-infected care home residents within a care setting, was introduced; while some municipalities have used separate places for the care of people who have previously been hospitalized and infected with COVID-19. In many care homes new cleaning routines   organized, i.e. staff dedicated solely to care for people with suspected or established infection who live at home. In some care homes, COVID-19 teams have been combined with cohort care (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: September 9th, 2021


United States

The Centers for Disease Control guidelines encourage suspected and confirmed cases amongst new and returning residents of LTCFs to be placed in a designated, in-house COVID-care unit. Details can be found here (https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html).

Last updated: September 9th, 2021


Australia

If the COVID-19 positive person is a staff member, they must apply a surgical mask and leave the aged care facility by isolating at home. If the COVID-19 positive person is a resident, they must be moved to a single room, preferably with an en-suite, to isolate. The residential home may also be placed under lockdown for further testing. The local public health unit is responsible for contact tracing and the monitoring of residents (https://www.health.gov.au/sites/default/files/documents/2021/01/first-24-hours-managing-covid-19-in-a-residential-aged-care-facility-first-24-hours-managing-covid-19-in-a-residential-aged-care-facility.pdf).

Dementia Support Australia provided guidance to support people with dementia during COVID-19. They suggested 1:1 residential support as the ideal way to help a resident isolate (https://dementia.com.au/downloads/dementia/Resources-Library/Helpsheets/Managing-behaviours-during-a-pandemic.pdf).

Last updated: September 9th, 2021


Austria

In care homes, isolation was used frequently, however, this was problematic in situation where more people shared rooms. (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/)

Last updated: September 9th, 2021


Canada (British Columbia)

If a positive case is found in a LTC facility, the operator must close the affected floor/unit/ward or facility/residence to new admissions, re-admissions, or transfers, unless medically necessary and/or approved by a Medical Health Officer. COVID positive residents are not transferred to an external quarantine facility and are only transferred to acute medical care for COVID if necessary (http://www.bccdc.ca/Health-Info-Site/Documents/COVID19_LongTermCareAssistedLiving.pdf).

Last updated: September 9th, 2021


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 spreading 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 14th 2020). It was intended to supplement the procedures that the municipalities had already put in place, and provided guidelines on how to organize 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 (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)

There have been two major difficulties in identifying and isolating infected individuals effectively in care homes in England. First, guidance issued to care homes focused only on people who were displaying symptoms (initial guidance only mentioned a persistent cough and fever as symptoms). It took a long time for official guidance to consistently recognize the potential for pre-symptomatic or asymptomatic transmission (https://ltccovid.org/2020/06/12/asymptomatic-and-pre-symptomatic-transmission-in-uk-care-homes-and-infection-prevention-and-control-ipc-guidance-an-update/). Guidance on identifying residents and staff who may have been in contact with persons who had the virus and preventive isolation became available on April 2, 2020 (https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes/coronavirus-covid-19-admission-and-care-of-people-in-care-homes).

The ability of care homes to implement existing IPC guidance was hampered by a lack of access to testing (tests for asymptomatic residents and staff only started to be available after the April 28, 2020) and PPE, staff shortages and facilities that were not suitable for effective isolation or cohorting (https://journal.ilpnetwork.org/articles/10.31389/jltc.53/). Where care homes are not able to implement adequate isolation or cohort policies, it is the responsibility of the local authority to secure alternative accommodation for the isolation period, drawing on the £1.3 billion discharge funding (https://www.gov.uk/government/news/2-9-billion-funding-to-strengthen-care-for-the-vulnerable).

Ahead of the second wave, the government set up a scheme to prepare “designated settings” that could provide safe isolation for people who were discharged from hospital while positive for Covid and who needed to move to a care home. The settings had a to meet set of standards to deliver safe care for Covid-19 positive residents.

 

Last updated: September 9th, 2021


Finland

National government guidelines to isolation have included LTC unit visiting bans, the provision of single rooms within LTC homes for symptomatic or exposed residents, restricted use of common areas in LTC units, and limited visitation of at-home care users. Some municipalities were quick to adhere to these policies, while others delayed implementation until the end of April (https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620.pdf).

Last updated: September 9th, 2021


France

Many care homes had to individually isolate service users, especially at the beginning of the pandemic, due to lack of adequate PPE. The guidance published in April 2020 around testing would test the first symptomatic resident, who would then be taken care of either in strict isolation or in single rooms. If one care worker tested positive, all workers were required to be tested and isolate. This was noted as a struggle by the Assembly Commission as many care homes had shared rooms for residents (https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf). This was linked to severe health impacts (https://ltccovid.org/2020/05/05/summary-sars-cov-2-related-deaths-in-french-long-term-care-facilities-the-confinement-disease-is-probably-more-deleterious-than-the-covid-19-itself/).

A study from France comparing mortality in nursing homes with staff confining with residents compared to national average showed that staff confining with residents was effective in preventing infection and reducing mortality (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769241).

Last updated: September 9th, 2021


Germany

Guidance to support people living in care homes stress the importance of human dignity and focus on the need to ensure social participation and quality of life of residents (https://www.awmf.org/uploads/tx_szleitlinien/184-001l_S1_Soz_Teilhabe_Lebensqualitaet_stat_Altenhilfe_Covid-19_2020-10_1.pdf). Guidance on approaches to isolation of confirmed/suspected cases in care homes are provided (and regularly updated following the latest evidence) by the Robert Koch Institute.

In some federal states (e.g. Bavaria) relevant ministries can also issue guidelines (https://www.stmgp.bayern.de/wp-content/uploads/2020/08/20200818_handlungsanweisungen.pdf).

Last updated: September 9th, 2021


Ireland

Irish authorities have worked with hotels to accommodate people either with symptoms or awaiting transfer. https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf

Last updated: September 9th, 2021


Israel

Several LTC homes set up COVID wards and/or isolation areas within their institutions to limit number of people in need of ambulatory transfer to hospitals (https://ltccovid.org/2020/12/22/video-and-slides-of-the-14th-december-ltccovid-webinar-on-international-experiences-2nd-3rd-covid-19-waves-vaccines-and-beyond-in-the-long-term-care-sector/). Medical geriatric centers were also asked to open at least one ward dedicated to mild or moderates COVID-19 cases; if cases became severe, patients were transferred to a general hospital (https://journal.ilpnetwork.org/articles/10.31389/jltc.75/). Due to lack of post-hospital geriatric support, many older COVID-19 remained in isolated recovery in hospital (https://www.haaretz.com/israel-news/.premium-israeli-icus-fill-up-with-recovered-elderly-covid-19-patients-with-nowhere-to-go-1.9232240).

Last updated: September 9th, 2021


Japan

LTCFs used well-established infection control procedures and swiftly isolated affected residents and suspended visits and social events (as they are used to do in the case of influenza/TB outbreaks). Mask-wearing was also already common practice in the event of these outbreaks. Data suggests most cases were contained with few large outbreaks within facilities (https://programs.wcfia.harvard.edu/files/us-japan/files/margarita_estevez-abe_covid19_and_japanese_ltcfs.pdf).

Last updated: September 9th, 2021


Netherlands

The association of geriatricians has issued guidelines for infection control in care homes (Verenso). The ability to control infection has increased substantially between the first and second wave. The publicly financed programme “Dignity and Pride on Location” has developed a “roadmap” to help providers to prepare for a new pandemic (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


Republic of Korea

All care home residents with confirmed COVID-19 infections were moved to quarantine centres or long-term care hospitals, so there have been no deaths registered in care homes

Last updated: September 9th, 2021


Singapore

In comparison to other countries, there were only very few cases in nursing homes in Singapore. All of the residents with COVID-19 were transferred to acute hospitals.

Nursing homes introduced mandatory split zones to reduce the number of contacts for residents and staff. The zones cannot house more than 100 residents, a fixed set of staff and need to have dedicated entry and exist points. Communication between staff in different zones should take place remotely via text messages, phone or video conference. Shared spaces, such as pantries and lifts should have staggered access that allows for cleaning between the use from different zones. Medical staff needing to move across split zones are recorded for contact tracing and have to adhere to increased infection prevention and control measures (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

One of the most effective measures to contain outbreaks was the transfer of residents with COVID-19 to other temporary care settings, as well as preventing further spread, this practice was identified as positive for physical and mental wellbeing because it enabled the other residents to experience fewer constraints (https://digital.csic.es/bitstream/10261/220460/5/Informe_residencias_COVID-19_IPP-CSIC.pdf).

Last updated: September 9th, 2021