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.
After a bumpy start (chronicled in the story of my first family meeting), the nursing home had adjusted my aunt's care to meet her needs, and it was responsive to my concerns and questions throughout her stay. As for me, I never became that caregiver who was present at meals or did my aunt's laundry. Instead, I visited; I talked with her, and I talked with the staff on duty. I assessed her myself, asked questions about her health, and then I advocated on her behalf. That was 2001. I am writing this on a random June Monday in 2020, with my office closed during the era of COVID-19. And I am wondering what my aunt's trajectory would have looked like if I had not been able to check in on her, talk to her, touch her, and then talk to her care team. From the stories circulating about the deaths of older adults, I can say with some degree of certitude that I would have felt helpless and broken if my experience took place in the era of COVID-19. 2,3 Whither the caregiver? As I write, most nursing homes, assisted living facilities, and other congregate living settings still have strict "no-visitor" policies that have been in place since March 2020. 4,5 Despite these rules, somewhere between 30% and 40% of all Americans who have died of COVID-19 lived in nursing homes. 4,6,7 Since March, we have learned that the virus is agnostic as to nursing home quality, and we now know that federal and state governments did not prioritize long-term care settings for COVID-19 testing supplies and personal protective equipment (PPE). 4,5,8 We've always known that infection control protocols are hard to follow when there are too few workers caring for too many residents. 8 And we know that, despite being underpaid and having no PPE, our hands-on direct care workforce showed up to care for our frailest older Americans. 4,5,8,9 They are among the unsung heroes of the COVID-19 pandemic and deserve our thanks. At best, keeping families, other caregivers, and surrogates away from older loved ones with "no-visitor" rules had a modest impact on preventing the spread of COVID-19 in nursing homes, given all the other factors in play. 8 At the same time, these rules have had a significant negative psychological impact on older adults and their families. As we grapple with how to let caregivers visit safely, we should view the situation through the lens of what matters to older adults and their loved ones. 10,11 If we do not, we will be doing our older loved ones a great disservice by continuing to leave their caregivers on the outside looking in to the longterm care facility.
Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable.
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