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The impact of COVID-19 pandemic on long-term care facilities worldwide: an overview on international issues
- Authors:
- THOMPSON Dana-Claudia, et al
- Journal article citation:
- BioMed Research International, 2020, Online only
- Publisher:
- Hindawi Publishing Corporation
The COVID-19 pandemic had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world, affecting not only the residents but also the care workers and visitors. Due to their advanced age and numerous underlying diseases, the inhabitants of long-term care facilities represent a vulnerable population that should benefit from additional protective measures against contamination. Recently, multiple countries such as France, Spain, Belgium, Canada, and the United States of America reported that an important fraction from the total number of deaths due to the SARS-CoV-2 infection emerged from nursing homes. The scope of this paper was to present the latest data regarding the COVID-19 spread in care homes worldwide, identifying causes and possible solutions that would limit the outbreaks in this overlooked category of population. It is the authors’ hope that raising awareness on this matter would encourage more studies to be conducted, considering the fact that there is little information available on the impact of the SARS-CoV-2 pandemic on nursing homes. Establishing national databases that would register all nursing home residents and their health status would be of great help in the future not only for managing the ongoing pandemic but also for assessing the level of care that is needed in this particularly fragile setting. (Edited publisher abstract)
Of myths and markets: how marketisation of the care home sector contributes to circumstances where abuse is more likely to occur and continue
- Author:
- MOORE Steve
- Journal article citation:
- Journal of Adult Protection, 22(5), 2020, pp.315-331.
- Publisher:
- Emerald
Purpose: Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to catalyse higher order consideration and discussion of one socio-political characteristic that has relevance to the issue of abuse, that is, the market-like environment in which care and nursing homes in England operate. In doing so, the paper argues that the now firmly established but imbalanced “quasi-market” of care that has developed over many years fosters conditions under which both poor care and abuse are more likely to occur. The evidence presented in the paper focusses primarily on the rise to dominance of for-profit care home provision and the contraction of public sector provision. The paper does not examine in detail the characteristics and market presence of the not-for-profit sector because it has not held a numerically significant market share either historically or contemporarily. Design/methodology/approach: Outcomes of the marketisation of the care home sector that has its origins in the political landscape prevailing in 1979 and thereafter, along with the concurrent development of its regulation and oversight, are narrated and analysed. From this, a mythos of the motives behind the transition to a market-like economy that has taken place over four decades is developed and used to explain how prevailing market conditions contribute to the perpetuation of poor care and abuse. Findings: In the opinion of the author, there are identifiable consequences arising from the evolution of the current care economy that dispel the beliefs that providing care by means of current market-like arrangements is advantageous, that the independent regulation and monitoring of such a market is unproblematic and effective, and that the “consumers” in this market are exercising personal choice, in accord with classical economic theory. Practical implications: The paper offers the opportunity for the reader to consider how the development of a “quasi” market of care and nursing home services that has come to be dominated by for-profit private providers, and that is subject to ineffective oversight, may have contributed to conditions where abuse is more likely to occur and endure. Originality/value: This is a conceptual paper that explores the consequences of the creation of the market-like economy of care in which care and nursing homes now operate and suggests that it is time for prevailing market conditions to be re-visited and subjected to remedial strategic intervention. (Edited publisher abstract)
Elder mistreatment in the nursing home: a systematic review
- Authors:
- LINDBLOOM Erik J., et al
- Journal article citation:
- Journal of the American Medical Directors Association, 3(4), 2007, pp.610-616.
- Publisher:
- Elsevier (for the American Medical Directors Association)
This systematically conducted scoping review of the literature (mainly, but not exclusively, North American) looks at types of abuse in the nursing home environment (physical, sexual, psychological, neglect, financial abuse), at possible forensic markers of abuse, and at promising preventive interventions. The limited nature of the evidence base, and the need for more research, is emphasised.
COVID-19 in aged care homes: a comparison of effects initial government policies had in UK (primarily focussing on England) and Australia during the first wave
- Authors:
- CHAN Daniel Kam Yin, MCLAWS Mary-Louise, FORSYTH Duncan Ronald
- Journal article citation:
- International Journal for Quality in Health Care, early cite 2 March 2021,
- Publisher:
- Oxford University Press
- Place of publication:
- Oxford
Background: COVID-19 pandemic has had a major impact globally with older people living in aged care homes suffering high death rates. This study aimed to compare the impact of initial government policies on this vulnerable older population between the United Kingdom (UK) and Australia during the first wave of attack. Methods: The researchers searched websites of governments in the UK and Australia and media outlets. This study examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing); and the effects of these initial policies have had on the mortality rates in the aged care homes during the first wave of attack of COVID-19. Results: This study found both countries have prioritised resources to hospital over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than Australia as at 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1,000), as well as the better community viral testing regime in Australia. Conclusion: In conclusion, the public health policy in Australia aimed toward earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector. (Edited publisher abstract)
The road goes ever on: evidence of the continuing abuse of older people in care homes
- Author:
- MOORE Steve
- Journal article citation:
- Working with Older People, 23(3), 2019, pp.152-166.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present findings from a research project designed to enhance knowledge of the current extent and nature of abuse in contemporary care homes for older people. Design/methodology/approach: A self-completion, postal questionnaire was used to elicit both numerical and textual data that were subsequently subjected to both quantitative and qualitative analysis. The questionnaire was distributed to newly appointed care staff in five participating care homes providing care to older people to determine the nature of any abuse they may have witnessed in the homes in which they had previously worked. Findings: A significant proportion of respondents had witnessed numerous occurrences of primarily psychological and physical abuse and neglect, perpetrated against the older people living in the care homes in which they had previously worked. Research limitations/implications: Although the research draws upon the experiences of only 197 anonymous questionnaire respondents, of whom 180 had witnessed abuse, data suggest that abuse continues to occur in some care homes for older people. Originality/value: The research has revealed staffs’ recent experiences of a range of abusive acts and practices. When combined with two previous studies using the same or a similar methodology, the research also confirms the enduring presence of abuse in care homes. Findings again suggest that changes are required to current methods of external scrutiny and investigation of practices in care homes. (Edited publisher abstract)
Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes
- Authors:
- HUANGA Tzu-Ting, et al
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.2-12.
- Publisher:
- Taylor and Francis
Objectives: Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes. Method: A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed. Results: The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group. Conclusions: The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength. (Publisher abstract)
Association between subjective memory complaints and nursing home placement: a four-year follow-up
- Authors:
- BOCH WALDORFF Frans, SIERSMA Volkert, WALDEMAR Gunhild
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.602-609.
- Publisher:
- Wiley
In order to evaluate whether elderly persons with subjective memory complaints may be regarded as a group of potentially vulnerable patients who need close follow-up, the authors investigated the risk of nursing home placement during a 4-year follow-up period. A prospective cohort survey was carried out. Cox proportional hazard models were used to examine the influence of risk factors on nursing home placement. Results showed that a total of 758 non-nursing home residents aged 65 years and older consulted the General Practitioners in October and November 2002, of whom 50 nursing home placements were observed. Subjective memory complaints were associated with an adjusted Hazard Ratio (HR) of 2.59 for nursing home placement. Other statistical significant covariates were MMSE < 24 (HR = 3.95), age and extreme anxiety/depression. The effect of subjective memory complaints is seen to moderate when subjects are older. The authors conclude that the data of this study indicated that in an elderly primary care population the presence of subjective memory complaints was a significant independent predictor for nursing home placement together with other known risk factors.
Nursing home litigation and tort reform: a case for exceptionalism
- Authors:
- STUDDERT David M., STEVENSON David G.
- Journal article citation:
- Gerontologist, 44(5), October 2004, pp.588-595.
- Publisher:
- Oxford University Press
The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of conventional medical malpractice tort reforms to the nursing home sector. In this article, we caution against such an approach. Nursing home litigation has a number of distinctive features that raise serious questions about the wisdom of implementing reforms generically across the care continuum. Drawing on findings from our previous study of nursing home litigation, the authors outline these features and argue for careful attention to them as policymakers evaluate options for reform.
Use of constraints and their correlates in Norwegian nursing homes
- Authors:
- KIRKEVOLD Oyvind, SANDVIK Leiv, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.980-988.
- Publisher:
- Wiley
Primary carers in 222 wards in Norwegian nursing homes were asked about use of constraints towards 1926 patients during seven days. Constraints were grouped as mechanical restraints, non-mechanical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The patients' mental capacity (CDR score), activity in daily living (ADL) and behaviour (BARS score) were rated. Type and size of ward, staffing level and educational level of the staff was recorded. In all 758 of the patients were subjected to any constraint. Degree of dementia, aggressive behaviour and loss of function in ADL had significant impact on all types of constraint except for electronical surveillance. The strongest associations were found between degree of dementia and mechanical restraint, impaired ADL and mechanical restraint and aggression and force or pressure in ADL. Mechanical restraint was less used towards patients in special care units for persons with dementia (SCU) compared to patients in regular units (RU), whereas non-mechanical restraint was more frequent used in SCUs. Type of ward had no significant impact on use of other types of constraints. Staff level and education level of the staff had no significant impact on the use of constraint. Constraint is frequently used in nursing homes, and most frequent toward patients with severe dementia, aggressive behaviour or low ADL function.
Risk of institutionalization among community long-term care clients with dementia
- Authors:
- SCOTT William K., et al
- Journal article citation:
- Gerontologist, 37(1), February 1997, pp.46-51.
- Publisher:
- Oxford University Press
Reports on a study in the USA where Community Long-Term Care (CLTC) data were used to identify factors increasing the risk of institutionalisation in people with dementia. Clients diagnosed with dementia and observed at least twice between June 1993 and December 1994 were studied. Logistic regression determined that clients with a decline in ADL function who were white, had a non-relative or child as a caregiver, and were diagnosed with Alzheimer's disease were at increased risk of institutionalisation. Discusses the results in relation to designing additional interventions to prevent institutionalisation.