Covid-19: why we need a national health and social care service

Pollock, Allyson M; Clements, Luke; Harding‐Edgar, Louisa

doi:10.1136/bmj.m1465

Cited by 34 publications

(27 citation statements)

References 2 publications

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“…35 An earlier study of COVID-19 outbreaks in Ontario LTC homes reported that lagged staff infection was a significant predictor of future resident deaths. 34 Screening protocols may be missing infected staff who are asymptomatic or minimally symptomatic, and low wages and scarce sick benefits mean that others may be working while ill. 6,8,36 Many staff are also employed part time and work at multi-ple health care facilities, something that has been linked to SARS-CoV-2 transmission among LTC facilities. 5,37 Our additional observation associating the number of active residents in an LTC home and the risk of an outbreak may be related to the fact that larger homes require more staff, thereby increasing the number of potential vectors for infection.…”

Section: Discussionmentioning

confidence: 99%

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Stall

Jones

Brown

et al. 2020

CMAJ

200

216

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ong-term care (LTC) homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada, with residents of these care homes accounting for more than 80% of the country's deaths. 1-3 Residents of LTC homes are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to their congregate living arrangements and exposure to staff with asymptomatic or presymptomatic SARS-CoV-2 infection. 4-6 These residents are also at high risk of morbidity and mortality from COVID-19, as most are older adults with frailty and multimorbidity. 7 There is widespread concern that despite these predisposing risks, LTC homes were both underprepared and underequipped to protect their residents, and questions have arisen as to whether forprofit LTC homes have had worse COVID-19 outcomes. 8,9 In Ontario, Canada's most populous province, all residents of LTC homes receive personal and nursing care as well as subsidized accommodation under a publicly funded LTC program. Regardless of this governmental funding, individual LTC homes can be owned and operated by for-profit, nonprofit or municipal (public) entities. 10 Several observational studies suggest that for-profit LTC homes tend to deliver inferior care across a variety of outcome and process measures. 11,12 These include lower levels and quality of RESEARCH VULNERABLE POPULATIONS

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Section: Discussionmentioning

confidence: 99%

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Stall

Jones

Brown

et al. 2020

CMAJ

200

216

View full text Add to dashboard Cite

show abstract

“…The current global public health crisis caused by the COVID-19 pandemic has highlighted, among many other things, the critical importance of protecting vulnerable populations from infectious disease. Initial data from the COVID-19 outbreaks in the UK, China, and Italy have shown a significantly increased mortality rate for individuals 60 years of age and above regardless of the presence of comorbid conditions, highlighting the vulnerability of this segment of the population [1][2][3][4]. Older adults living in long-term care facilities are especially vulnerable as nosocomial transmission of COVID-19 has been observed in numerous facilities and has contributed to severe outbreaks in healthcare facilities [5,6].…”

Section: Introductionmentioning

confidence: 99%

Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

et al. 2020

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Background The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors. Systematic review registration PROSPERO CRD42020181993

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“…The COVID-19 pandemic has intensified these issues and paradoxically, reduced the face-to-face support they would normally receive from external healthcare providers (British Geriatrics Society, 2020a). The global pandemic has raised awareness of the important, skilled work carried out by care home staff and care homes' role within health and social care systems (Oliver, 2020a;Pollock et al, 2020). Our work has identified how few opportunities there are for the sector to identify priorities for research and comment on the relevance of guidance for the longterm care setting.…”

Section: Discussionmentioning

confidence: 99%

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

Towers¹,

Handley²,

Almack³

et al. 2020

JLTC

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Background In many countries, care homes are being disproportionately affected by the COVID-19 global pandemic, with high rates of mortality (Oliver, 2020a; Comas-Herrera & Zalakin, 2020; British Geriatrics Society, 2020a). In the UK, central government guidance on how care homes should respond to COVID-19 has been inconsistent and criticised for being overly health-focused, disregarding the health and safety of the social care workforce and the conditions within which they are working (The National Care Forum, 2020). There are approximately 1.49 million people working in adult social (long-term) care in England, most of whom are employed by the independent sector (Skills for Care, 2019). Whilst demand for care has led to significant increases in the number of jobs in the social care sector, most of these (76%) are direct care roles, fulfilled by a workforce historically referred to as 'unskilled' (Skills for Care, 2019). Regulated professionals (e.g. social workers, occupational therapists and nurses) account for only 5% of the workforce, compared with 54% of the workforce in health (NHS Digital, 2018). Within adult social care in England, care homes account for approximately 42% of jobs (Skills for Care, 2019), caring for approximately 400,000 people (LaingBuisson, 2018), many of whom have multiple and complex needs, including need for nursing care (Gordon et al., 2014). Despite increases in the number of care jobs in nursing homes between 2009 and 2018, the number of registered nursing jobs has seen a significant decrease (down 20% since 2012). Due to population ageing and funding restrictions, older people living in care homes typically depend on staff to meet basic needs in the last year(s) of life (

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Covid-19: why we need a national health and social care service

Cited by 34 publications

References 2 publications

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

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