Research Objective COVID‐19 poses unique challenges to family caregivers. This study explores how family caregivers for older adults with cognitive impairments experience and make decisions about caregiving during a global pandemic. Study Design Using purposive sampling, family caregivers participated in open‐ended qualitive interviews (2019–2020), until thematic saturation was reached. Questions broadly examined caregivers' experiences and decisions, focusing on decisions made around type of care setting. Questions about responses to the Pandemic were added as events unfolded. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long‐term services and support expenditures. They include; Arkansas, Florida, Illinois, Minnesota, New York, North Carolina, and Oregon. All participants were actively involved in the care of someone with dementia or another cognitive impairment over the age of 60. Population Studied 63 family caregivers were interviewed across eight states. About 89% of participants were female, 78% white, 10% black, 5% Asian, 3% biracial, 2% Native American. 36% of respondents reported that those they care for receive Medicaid. Principal Findings This analysis focused on several COVID‐related caregiver decisions: changes in care, challenges with care utilization and access, and policies or changes in care that were helpful during the pandemic were of focus. Four key themes emerged. First, family caregivers experienced communication challenges with long term care facilities often due to COVID‐19 restriction policies. They reported an inability to asses care quality, participate in medical appointments, or communicate with their loved ones. Second, some families chose to cease the care supports they were receiving. Participants cited concern about the virus itself, and about indirect pandemic effects such as their loved ones experiencing confusion, loneliness, and poor care. Third, many respondents expressed the desire to avoid future nursing care, and expressed hesitancy towards seeking HCBS until the pandemic is curbed. Finally, many caregivers reported that telemedicine and other remote health care interventions improved their workload and service access. Conclusions We examined how the pandemic has impacted decision‐making among caregivers of older adults with cognitive impairments. Family caregivers experienced significant concern about COVID‐19 itself, and about the indirect consequences of caregiving caused by the pandemic. Caregivers have also shown flexibility and adaptability in ceasing selected services, contingently continuing services, and utilizing telemedicine and other remote healthcare interventions to protect their loved ones. Many family caregivers utilized remote health care interventions such telemedicine, no‐contact prescription and grocery delivery. Such measures improved service access and reduced caregiver workload. Implications for Policy or Practice Given the persistent challenges posed by COVID‐19...

Background: Reported sexual assault is increasing, and the diverse immediate and longer term needs of the victim are usually met by exposure to a number of healthcare professionals often in diVerent locations, involving delays and travel, increasing the trauma for the victim. Objectives: To set up a centre to address the immediate and longer term needs of the sexual assault victim and review issues arising during the development of the service. Methods: Description of setting up the service in the genitourinary medicine department of Kings College Hospital, south London, and the aspects of care oVered. Results: The number of victims referred by police increased from 15 in 1992 to 58 in 1996. In 1996, 55 female and three male victims were seen. 23 diVerent police stations brought victims for examination; mean age of the victim was 27 years (range 14-60), median time between assault and examination was 22 hours (range 3 hours-3 months); 23% had genital injuries, 59% had other physical injury, and 11% needed further hospital care. 71% accepted screening for sexually transmitted infection (STI), 21% had an STI diagnosed, 16% of the women required emergency contraception, 26% received prophylactic antibiotics, and 58% saw a health adviser. 70% had a follow up appointment arranged of which 50% attended. Conclusion:The high uptake of STI screening, emergency contraception, health adviser consultation, and follow up supports the concept of a comprehensive integrated system to meet the disparate needs of the victim while still obtaining the necessary forensic evidence. The wide catchment area of service users indicates gaps in services available for the assault victim. Earlier genitourinary involvement after sexual assault is becoming increasingly pertinent in relation to HIV prophylaxis. (Sex Transm Inf 1999;75:116-119)

Objectives. To identify individuals at risk for behavioral health (BH)–involved encounters with police in Chicago, Illinois. Methods. We linked Chicago Police Department (CPD) arrest and Fire Department (CFD) BH-involved ambulance event data. We identified at-risk individuals who accumulated at least 1 BH-involved ambulance and at least 1 arrest event between May 2016 and April 2017. We identified a high-use subgroup displaying most intensive services use. We identified high-use locations with highest volume of ambulance events with only CFD data. Results. Of 83 392 individuals and 116 105 events in the linked emergency events data, 1842 at-risk individuals accounted for 2.2% of individuals, 5.6% of all events, and 16% of BH-involved CFD events with police involvement. A total of 330 high-use individuals accounted for 0.4% of individuals, 2% of events, and 4.7% of CFD events with police involvement. Top-100 high-use locations accounted for 9% of CFD events, and individuals of high-use location events are largely distinct from high-use individuals. Conclusions. Integrated police and ambulance data hold promise to identify individuals at risk for BH-involved encounters with police and to support proactive interventions to prevent or improve response at these encounters.

This qualitative semi-structured interview study explores how 64 family caregivers for older adults with Alzheimer’s Disease and related dementias across eight states experienced and executed caregiving decisions before and during the COVID-19 pandemic. First, caregivers experienced challenges communicating with loved ones and healthcare workers in all care settings. Second, caregivers displayed resilient coping strategies in adapting to pandemic restrictions, finding novel strategies to balance risks while preserving communication, oversight, and safety. Third, many caregivers modified care arrangements, with some avoiding and others embracing institutional care. Finally, caregivers reflected on the benefits and challenges of pandemic-related innovations. Certain policy changes reduced caregiver burden and could improve care access if made permanent. Telemedicine’s increasing use highlights the need for reliable internet access and accommodations for individuals with cognitive deficits. Public policies must pay greater attention to challenges faced by family caregivers, whose labor is both essential and undervalued.