Nursing Homes in COVID-19 time: Why are there so many examples of failure to care and protect?
Data show the nameless failure to protect and save vulnerable persons from the coronavirus in many developed countries’ Care Homes
By Stephane Bilodeau
Nursing Homes (NH) and the Long-term care (LTC) sector in general have been hit hard by the COVID-19 pandemic. This note examines, through observations and data analytics, the similarities and differences between pandemic experience in NH in various countries and regions around the World.
With an average of more than 5,500 LTC resident deaths in OECD countries, many of these countries had a high proportion of deaths occurring in long-term care. Notably, NH residents accounted for 68% of all reported COVID-19 deaths in Canada (81% of all Canadian LTC deaths), 66% in Spain, 64% in Belgium, 40% in the USA and an average of more than 42% in other OECD countries (with some reporting less than 10% in Slovenia and Hungary and less than 20% in Austria and the Netherlands).
Using the most recent data from the Centers for Medicare & Medicaid Services (CMS), the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), released a report in August showing NH in the U.S. have experienced an alarming 15% spike in new COVID cases mainly due to community spread among the general population.
The proportion of infected NH residents who died from the disease also varied considerably across countries, from 4% in Slovenia to 83% in Norway. In Canada, the mortality rate for those infected with COVID-19 in NH was about 36% as of early July. Many countries have reported high rates of infection among health care workers, leading to absenteeism and staffing shortages. The Vivaldi study, based on responses from 5,126 care homes in England, found that residents in care homes that used bank or agency nurses or carers most days or every day were 1.58 times more likely to test positive for Covid-19 than those in homes that did not use such staff.
Nevertheless, a report released by the CIHI (Canadian Institute for Health Information), shows that “Countries that have implemented mandatory prevention measures specifically targeting the LTC sector at the same time as confining and closing public spaces (Australia, Austria, the Netherlands, Hungary and Slovenia) have experienced lower rates of COVID-19 infection and disease-related mortality in LTC. These are the success stories that need to be reproduced.
To maximize chances of success in NH some preventive measures are recommended, such as immediate infection control measures, visitor restrictions, acute care and PPE funding, recruitment, training and generalized screening in LTC facilities, the establishment of isolation units to manage case clusters, broad LTC testing, infection control training and audit, rapid response control, prevention teams and additional support for staff in LTC, such as increased staffing, the creation of specialized teams and the distribution of personal protective equipment (PPE).
You can find more recommendations in the EndCoronaVirus.org guidelines here:
https://www.endcoronavirus.org/papers/covid-19-guidelines-for-high-risk-care-institutions.