A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation

Abstract

A co-ordinated emergency management response to disaster management in nursing homes is desperately needed globally. During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents. The responsibility for the management of nursing homes during the pandemic was multifaceted and responsibilities lay at the national, jurisdictional and regional levels. Success in managing COVID-19 in nursing homes required all these levels to be aligned and supportive, ideally through management by an emergency response leadership team. However, globally there is a paucity of effective management strategies. This article uses the example of the COVID-19 pandemic to propose a risk stratification system to ensure timely and appropriate allocation of resources to nursing homes during disaster preparation and management. Nursing homes should be risk-stratified according to four domains; risk of intrusion, capability for outbreak containment, failure in organisational capability and, failure in the availability of community and health care supports. Risk stratification should also consider factors such as current levels of community transmission, if applicable, and geographic location of nursing homes and services. Early identification of nursing homes at risk for infectious disease, or disasters, and targeted allocation of resources might provide benefits to the reduce number of outbreaks, lower mortality and preserve community supports, such as acute hospital services. The next step is to debate this concept then to validate the selected variables, develop and pilot test a risk stratification tool for use.

Care‐home Nurses' responses to the COVID‐19 pandemic: Managing ethical conundrums at personal cost: A qualitative study

“…Our results provide detailed experiences of RNs working in older people's care-homes during the COVID-19 pandemic. Drawing on Tronto's ethics of care framework enabled us to characterize in novel ways what it meant to be a qualified RN with statutory professional responsibility and accountability, when working in a care-home during a time of international crisis or disaster, described as "a destructive event that overwhelms resources" (Ibrahim & Aitken, 2021). RNs experiencing professional and personal ethical challenges drew on their essential professional ethical stance to negotiate work practices during a complex public health humanitarian emergency, resulting in personal cost for their mental health and wellbeing (Gray et al, 2021).…”

“…Across the world, older people needing support with personal and social care frequently move into long‐term care facilities, such as care‐homes, where care is provided 24/7 by a care assistant workforce, many of whom have minimal clinical qualifications (Backhaus et al, 2021; Ibrahim & Aitken, 2021). Where additional, specialist nursing care is required, these facilities are often designated as nursing homes, staffed by RNs.…”

“…It has also been suggested that the perceived unattractiveness of care‐home nursing is related to ageism and the way in which societies view older generations (McGilton et al, 2020). These issues are global, so it is not surprising that the arrival of the COVID‐19 pandemic in 2020, which brought with it a new set of pressures, compounding the existing ones, had such a devastating effect in care‐homes and on its workforce (Langins et al, 2020), creating an international public health emergency (Fernandez et al, 2020; Ibrahim & Aitken, 2021). Apart from a few exemplars (such as Hong Kong and New Zealand), most countries failed to adequately protect their nursing home populations, exemplified in severe cases in countries such as Italy (Bilal et al, 2020; Brady et al, 2021; Calcaterra et al, 2022; Ibrahim & Aitken, 2021; Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021; Sarabia‐Cobo et al, 2021).…”

“…These issues are global, so it is not surprising that the arrival of the COVID‐19 pandemic in 2020, which brought with it a new set of pressures, compounding the existing ones, had such a devastating effect in care‐homes and on its workforce (Langins et al, 2020), creating an international public health emergency (Fernandez et al, 2020; Ibrahim & Aitken, 2021). Apart from a few exemplars (such as Hong Kong and New Zealand), most countries failed to adequately protect their nursing home populations, exemplified in severe cases in countries such as Italy (Bilal et al, 2020; Brady et al, 2021; Calcaterra et al, 2022; Ibrahim & Aitken, 2021; Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021; Sarabia‐Cobo et al, 2021). Care‐homes for older adults were disproportionately affected by the pandemic with increased resident mortality and staff distress (Langins et al, 2020; Palese et al, 2022; Rocard et al, 2021).…”

“…Ibrahim and Aitkin suggested that the pandemic led to a breakdown in the political and social frameworks at macro (national), meso (regional), and micro (care‐home) levels which led to the well‐documented crisis in care‐homes globally, impacting on nurses' abilities to adapt and provide safe and effective care, compromising their ethical and professional beliefs (Ibrahim & Aitken, 2021). Similar findings were reported by Scrymgeour et al in their qualitative enquiry into care‐home nurses' responses to natural disasters (pre‐COVID‐19, mainly earthquakes and bush fires) in Australia and New Zealand (Scrymgeour et al, 2020).…”