Helping Nursing Homes to Manage the <scp>COVID</scp>‐19 Crisis: An Illustrative Example from France

Aïdoud, Amal; Poupin, Pierre; Gana, Wassim; Nkodo, Jacques Alexis; Debacq, Camille; Dubnitskiy-Robin, Sophie; Fougère, Bertrand

doi:10.1111/jgs.16780

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…Link As the pandemic progressed, the French government issued several ministerial directives that included a specialist telephone hotline, out-of-hospital mobile geriatric teams, and support for multidisciplinary decision-making. [22] A study of two hospital-dependent French nursing homes compared with a home with no hospital connection suggested high mortality rates might be associated with a lack of medical care management. [23].…”

Section: Resultsmentioning

confidence: 99%

Effects of COVID-19 in Care Homes - A Mixed Methods Review

Heneghan

Dietrich²,

Brassey

et al. 2022

Preprint

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IntroductionThe report provides an up-to-date review of the global effects of the COVID-19 pandemic in care homes. We used a mixed methods approach to assess care home mortality by country, how the deaths compared with previous periods, and how excess deaths may be explained. We retrieved national datasets for 25 countries on mortality, 17 cohort studies assessing deaths compared to a previous period, and 16 cohort studies reporting interventions or factors associated with excess mortality.The COVID-19 pandemic disproportionately impacted those living in care homes at the highest risk for severe outcomes. However, the pandemic only highlighted and exacerbated a long-running problem: underfunding, poor structural layout, undertraining, under-skilling, under-equipping, and finally, lack of humanity in dealing with the most vulnerable members of society.The 17 cohort studies point to excess mortality worsening during the pandemic. Despite involving vast numbers of care homes around the globe, the quality of the evidence is not good. For example, the majority of the studies infer the cause of extra deaths from the observation window (mainly the spring of 2020) rather than through detailed investigations. This is why we do not draw any clear conclusions about the specific causes of death, apart from noting their significantly high numbers. In addition, we did not review all policy actions since 2020 but note there has been a scarcity of studies since then - an indicator that interest in this problem has waned and likely not been addressed.Analysis of national datasets for 25 countries shows that care home deaths were, on average, 30% of the total COVID-19 deaths (range: 9-64%). The quality of the current evidence base is limited, short term, and lacks standardised methods to prevent robust countrywide comparisons. Residual excess deaths were also observed, with excess mortality being reported for both COVID-19 positive and negative patients.Several reported interventions or factors suggest the potential to mitigate the risk in care homes substantially. Interventions that could reduce mortality include improving the care home quality, increasing staffing levels, reducing the number of beds in the facility, employing staff confinement strategies with residents, and improving clinical care such as implementing daily examinations. Some care home solutions like US ‘Green House’ homes, which usually have fewer than 12 beds, may provide crucial insights into the care home problem compared with larger homes. Furthermore, care home residents faced barriers accessing emergency treatments during the pandemic waves. Finally, interventions targeting care homes should be subject to smaller trials given large effect sizes in some studies.Approximately one per cent of the global population resides in care homes, while care home residents account for nearly one-third of deaths attributed to COVID-19 in the 25 countries studied. Reducing this ratio requires analysing current care home infrastructures, funding models, and incentives for providing high-quality care. The scale of the problem in care homes requires robust evaluation and coordinated strategies to improve outcomes for those most vulnerable to COVID-19. Failure to address these systemic problems could mean global care home populations will be similarly affected by future crises and pandemics.

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Section: Resultsmentioning

confidence: 99%

Effects of COVID-19 in Care Homes - A Mixed Methods Review

Heneghan

Dietrich²,

Brassey

et al. 2022

Preprint

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“…Nathalie Barth PhD 1,2,3 Pauline Gouttefarde MsD 1 Ludovic Lafaie DESC 3 Vignon MsD 1 Luc Goethals MD 2,3 Bienvenu Bongué PhD, HDR 2,3,4 Celarier PH 1,5 Gérontopôle AURA, Saint Etienne, France…”

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Follow‐up of resident's in nursing home after intervention of a geriatric mobile team: Longitudinal study at 1 year after the start of the COVID‐19 pandemic

Barth

Gouttefarde

Lafaie

et al. 2022

J American Geriatrics Society

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“…As with the GERI-PaL program 3 and in order to comply with the French government's guidelines, 4 we rapidly set up a local support platform (LSP) to help NHs to manage their cases of COVID-19. The LSP (described in detail elsewhere 5 ) comprised multidisciplinary decision support (MDS, consisting of a geriatrician, an infectious disease specialist, and a palliative care physician), a specialist phone hotline, mobile geriatric medicine teams (with a nurse and a geriatrician) working with the 63 local NHs (in the county where our hospital is located), and "COVID-19 videoconferences" with all 346 NHs in the region (in 6 counties) to share information on COVID-19 (Figure 1).…”

Section: Innovationmentioning

confidence: 99%

A Local COVID-19 Support Platform for Nursing Homes: Feedback and Perspectives

Coulongeat

Aïdoud

Poupin

et al. 2021

Journal of the American Medical Directors Association

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The COVID-19 pandemic has had a major impact on nursing homes (NHs), which were not prepared to manage infections among their at-risk patient populations. In order to comply with the French government’s guidelines, we rapidly set up a local support platform (LSP) to help NHs to manage their cases of COVID-19. The LSP comprised multidisciplinary decision support, a specialist phone hotline, mobile geriatric medicine teams, and videoconferences on COVID-19. We first quantified the LSP’s interventions in 63 local NHs since the start of the first wave of COVID-19 (March 2020): 9 instances of multidisciplinary decision support, 275 calls to the specialist phone hotline, 84 interventions by mobile geriatric medicine teams and 16 videoconferences. The LSP had been used during and between the first and second waves of the epidemic, and all had evolved to meet the NHs’ needs. In an anonymous online survey, we gathered feedback on the LSP from the NHs to which support had been provided. This initial feedback was important because the platform’s emergency implementation had prevented us from consulting the NHs about its design. The majority of the LSP’s actions were popular with nursing home staff, and all respondents wanted the LSP to continue after the COVID-19 crisis. The COVID-19 pandemic revealed a number of pre-existing problems related to nursing home-hospital collaboration but the LSP made it possible to address some of these issues satisfactorily. Subject to further cost/benefit evaluation, our model of NH-hospital collaboration might help to improve the care provided to NH residents.

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Helping Nursing Homes to Manage the COVID‐19 Crisis: An Illustrative Example from France

Cited by 9 publications

References 9 publications

Effects of COVID-19 in Care Homes - A Mixed Methods Review

Effects of COVID-19 in Care Homes - A Mixed Methods Review

Follow‐up of resident's in nursing home after intervention of a geriatric mobile team: Longitudinal study at 1 year after the start of the COVID‐19 pandemic

A Local COVID-19 Support Platform for Nursing Homes: Feedback and Perspectives

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