LTCcovid Country Profiles

Responses to 3.02.03. Measures to support, facilitate and compensate for disruptions to access to care

Australia

The Australian government announced $440 million Australian Dollars to train aged care staff in infection control, increase the number of staff, and for telehealth services. Additionally, $234.9 million Australian Dollars was included as a COVID-19 retention bonus to ensure adequate staffing in the workforce (source: Charlesworth and Low, 2020).

References:

Charlesworth, S & 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.

Last updated: December 22nd, 2021

Austria

The closing of borders during the first wave of the COVID-19 pandemic posed challenges for the Austrian ’24-hour care model’ staffed with migrant care workers who tend to work extended shifts (fortnightly or monthly shifts). Migrant care workers in Austria were unable to return to their home countries and replacement staff were unable to travel into the country. In response to the impact of COVID-19 on the LTC sector, the federal government provided an ‘extraordinary crisis budget of €100 million’. Two provinces (Burgenland and Lower Austria) invested in chartered flights to bring several hundred migrant carers from Romania, Bulgaria, and Croatia into the country. Later on, corridor trains between Romania and Austria were established. Regional governments as well as the Federal Ministry provided a ‘premium of €500’ for migrant carers continuing to provide care in Austria. A hotline was established to support the coordination of care workers across the country.

In care homes, external staff (including occupational therapists/physiotherapists) were ‘extremely restricted’. It is reported that ‘18% of care homes and 15% of people living at home discontinued therapies’ (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).

Last updated: September 9th, 2021

France

A platform was developed in November 2020 for domiciliary/community care providers to pool resources (and regional stakeholders including integrated care pathways, regional health organisations, individual care providers etc.) in a given region to ensure continuity of care and to respond to growing demand (Source: https://solidaritedomicile.fr/solidarit%C3%A9_domicile_informations/solidarit%C3%A9_domicile_information). In May 2020, France was encouraging physician visits and offering greater remuneration after having told homes to minimise such visits in the early months of the pandemic (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).

Last updated: September 9th, 2021

Germany

From March 17, 2020, until September 30, 2020, people wishing to take up LTC payments or care did not have to attend bi-annual care advisory meetings. Payments continued without these meetings. Since advisory meetings have started again, people with care needs can request for these meetings to take place digitally or over the phone (until March 31, 2021, and perhaps until June 30, 2021). Home visit are still not taking place (until February 28, 2021, and perhaps until June 30, 2021). Similarly, funds for adjustment of accommodation due to care needs have been provided following virtual meetings. In addition, between April 1, 2020, and March 31, 2021, additional funding for consumables to support care had been increased from 40 to 60 Euros per month.

People with limited care needs (Level 1) have been given more flexibility on what they spend the support payment of 125 Euros per month (until 31 March 2021) on (Source: https://www.pflegeberatung.de/corona). The German dementia strategy has recognised the added complexity of COVID-19 related measures to the lives of people with dementia and their carers. The strategy proposes increased remote (telephone) advice and counselling for people with dementia and their relatives, expansion of local (voluntary) networks, strengthening neighbourhood support, increased support for working family carers, support for distance carers, improving dementia training of care workers in different care settings (Source: https://www.nationale-demenzstrategie.de/fileadmin/nds/pdf/2020-07-03__Corona_und_Demenz_.pdf).

Home care providers are given permission to sub-contract services to other providers if their own workforce is currently unable to provide the required care due to the pandemic situation (Source: https://www.awmf.org/leitlinien/detail/ll/184-002.html) and individual Länder [States] may have further support measures in place. Guidelines on the provision of home care recommend a shared-decision making process with consumers to establish which services may be adjusted if the home care provider is unable to fulfil demand due to workforce restrictions or other reasons (Source: https://www.awmf.org/leitlinien/detail/ll/184-002.html).

Last updated: September 9th, 2021

Israel

Oversight of COVID-19 has been given to the Ministry of Health, which set up the National Coronavirus Information and Knowledge Centre alongside the armed forces (IDF) Intelligence Directorate. Oversight the extension of welfare benefits is in the hands of the National Insurance.

In the COVID-19 Economic Plan first released in April 2020, under immediate civil and health provisions, measures towards the reduction of risk for high-risk populations included: 130,000 hot meals to older people and people in-need, bi-weekly groceries baskets, and food vouchers for at-risk families, people with disabilities living in the community, and people with mental health problems in the community.

Many day centers for older people were closed due to coronavirus. According to the National Insurance website, day centers contacted their service users individually to help them find alternative programs (Source: GOV.IL). However, day centers reopened in July, 2020.

It is important to note that over time, specific guidelines were developed for different types of settings. For instance, continuing care retirement communities (called sheltered housing in Hebrew). These settings that cater to independent and relatively affluent older people) now have their own specific guidelines. Hence, there is now a better understanding of the unique characteristics of different LTCFs.

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  

Italy

During the first and second waves of the pandemic access to long term care was deeply impacted. Initially, new admission have been stopped. Generally speaking, Regions were oriented to order the closure of the services (both in terms of cessation of activities and of physical limitation of access) by regulating the methods of access. The focus was on the “physical” containment of existing situations and on the prevention of new outbreaks, giving indications on the obligations of use of personal protective equipment (PPE) and on the safety procedures to follow. With respect to home care, there were opposite attitudes with Regions that blocked the services and the access to people’s homes, and others that instead incentivized them. This led to negative impact on equal accesso to care (Cipriani and Fiorino, 2020).

From Autumn 2020 access to care was re-established but this was not sufficient to restore previous levels of take up rates, with a double effect on wellbeing and health outcomes of elderlies and on economic performances of care provider. Concerning the latter, national and regional measures have been enacted to provide extra funding so to mitigate the losses of activities consequences of the first waves of the pandemic. One example is Piedmont region.

Sources:

Cipriani, G., & Di Fiorino, M. (2020). Access to care for dementia patients suffering from COVID-19. The American Journal of Geriatric Psychiatry, 28(7), 796-797.

Last updated: December 4th, 2021   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

Luxembourg

Measures were taken to ensure the continuity of care in residential care facilities during evenings, weekends, and public holidays (e.g. by establishing an on-call system for general practitioners, and establishing stocks of medications in care homes) (Source: https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8396&furtherPubs=yes).

Last updated: September 9th, 2021

Netherlands

GPs have been told they should closely monitor those who are homebound and frail and should act like a case-manager when they develop COVID-19 symptoms (Source: https://ltccovid.org/wp-content/uploads/2020/05/COVID19-Long-Term-Care-situation-in-the-Netherlands-25-May-2020-1.pdf). During the second wave, efforts were increased to ensure continuity of care and services for people receiving domiciliary care and for those requiring daytime services (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

Poland

The government promoted volunteering services in the community and neighbourhood to support older people with care needs in household activities or with groceries, among others (source: Ageing policies – access to services in different EU Member States).

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  Agnieszka Sowa-Kofta  |  

Republic of Korea

Even though 99% of community services were closed from February 28, 2020, onwards, staff members working in community care services are continuing to provide care such as delivering meals, ‘checking on welfare’, and ‘supporting activities’.

Last updated: September 9th, 2021

There are examples of how, from the initial days of the pandemic, some hospitals who had existing arrangements to support local care homes organized teams to liaise and support them in dealing with COVID-19. For example Saez and Arredondo (2021) describe how a team formed by a geriatritian, two nurses, a registrar and a physiotherapist supported four care homes in their area during the first months of the pandemic, with support ranging from phone consultations to provision of training, medications, tests and Personal Protection Equipment.

References:

Sáez-López P, Arredondo-Provecho AB. (2021) Experiencia de colaboración entre hospital y centros sociosanitarios para la atención de pacientes con COVID-19. Rev Esp Salud Pública. 95: 14 de abril e202104053.

Last updated: February 22nd, 2022

England (UK)

During March and April 2020, there was a substantial reduction in hospital admissions among care home residents. Elective admissions reduced to 58% of the 5-year historical average and emergency admissions to 85% of the 5-year historical average. By reducing admissions, care home and NHS teams may have reduced the risk of transmission, but there may have also been an increase in unmet health needs.

To facilitate access to crucial medicines, on April 23, 2020, the Department of Health and Social Care (DHSC) (2020) published new standard operating procedures for the use of medicine in care homes and hospice settings in England. The scheme allowed care homes and hospices to re-use medicine that was issued for one resident for another under specific circumstances and only in crisis situations. The guidance document contains information on the specific circumstances in which medicines labelled for one person (who no longer needs them) can be used for another person. The usually strict regulations around re-using or recycling medication were relaxed as there were ‘increasing concerns about the pressure that could be placed on the medicines supply chain during the peak of the COVID-19 pandemic’.

From May 15, 2020, the NHS was expected to ensure that care homes were able to receive clinical support from primary care and community health services.

References:

DHSC (2020). Novel coronavirus (COVID-19) standard operating procedure: running a medicines re-use scheme in a care home or hospice setting. Accessed on 15/03/2022

Hodgson, H. et al. (2020). Adult social care and COVID-19: Assessing the impact on social care users and staff in England so far. The Health Foundation briefing. Accessed on 15/03/2022

Last updated: March 15th, 2022   Contributors: William Byrd  |  

Scotland (UK)

The Adult social care – winter preparedness plan: 2021-22 sets out the measures that will be applied across the adult social care sector to meet the challenges over the winter 2021 – 2022. This includes provisions to maintain high quality integrated health and social care services across cares settings. There has been £62 million allocated for 2021/22 to help with building capacity in care at home community-based services. This funding is for:

1. Expanding existing services, by recruiting internal staff; providing long-term security to existing staff; enabling additional resources for social work to support complex assessments, reviews and rehabilitation; commissioning additional hours of care; commissioning other necessary supports depending on assessed need; enabling unpaid carers to have breaks.
2. Funding a range of approaches to preventing care needs from escalating, such as intermediate care, rehabilitation or re-enablement and enhanced MDT support to people who have both health and social care needs living in their own homes or in a care home.
3. Technology-Enabled Care (TEC), equipment and adaptations, which can contribute significantly to the streamlining of service responses and pathways, and support wider agendas. (Source: https://www.gov.scot/publications).

Last updated: March 24th, 2022   Contributors: Jenni Burton  |  David Henderson  |  David Bell  |  Elizabeth Lemmon  |