Caregiving at a Physical Distance: Initial Thoughts for COVID‐19 and Beyond

Abstract

mask on the affected resident. Isolation is likely most important and should be done promptly, as the stakes are high. We know that there are atypical presentations to this infection in older people, and a cough even without fever should raise suspicion. 8 Every attempt should be made to accommodate these residents in a different area of your facility. If your facility is unable to physically isolate, it may be appropriate, whenever possible, to request that residents and patients wear masks or facial coverings. 9 If testing is limited, consider coordinating with your laboratory to safely arrange pooling samples by using one assay for multiple people to identify that your facility has COVID-19 circulating. 10 For example, use one assay to test four people. If the test returns negative, you can be reassured. If it returns positive, likely further testing and aggressive isolation would be necessary.If testing is more readily available than PPE, testing of residents and staff should be done as frequently as possible, ideally every week. If you can establish through testing and isolation a COVID-19 free facility, staff testing may be more important that resident testing. Recommendations for isolating should also include, wherever possible, partnering with neighboring LTCFs to cohort confirmed patients. COVID-19-specific units can be set up, which would minimize rotating staff, reduce training time and allow for limited reuse of face shields, gowns, and other equipment.In summary, in these fast-changing circumstances, the authors would like to stress that in the absence of treatment, isolation should be the fundamental guiding principal and that whatever tools are available to a LTCF to achieve that may be variable and should be optimized to that end.

Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations

“…Seven articles focused on extending the scope of, and reducing barriers to, telehealth, such as reducing the restrictions on reimbursement of telehealth services [ 66 ], allowing services to cross US State lines [ 67 ], and lifting restrictions on prescribing controlled substances [ 68 ]. Studies recommended making telehealth services more accessible, including to those without access to adequate technology or internet services [ 69 ], those with low technological literacy [ 70 ], and individuals with disabilities [ 71 ]. Recommendations included making internet access free for the duration of the pandemic [ 72 ], providing computers to low income families [ 67 ], or delivering services by phone [ 73 ].…”

“…Seventeen articles recommended telehealth services for mental health care in order to combat the impacts of the pandemic [ 74 ], as well as to provide continued care for those with existing mental health conditions [ 75 ]. Telehealth may also be used for populations who face barriers accessing care, such as individuals in rural communities [ 76 ], requiring stroke care [ 77 ], with dementia [ 78 ], with chronic health conditions or chronic pain [ 71 ], who are homeless [ 75 ], who are pregnant [ 79 ], with substance use disorders [ 46 ], with HIV [ 46 ], and those seeking contraceptive or abortion services [ 23 ].…”

“…Thirty-four articles recommended improving protective measures for at-risk individuals. Some discussed the need for increased personal protective equipment (PPE) for specific groups, including workers with occupational exposure [ 97 ], in jails [ 34 ], in schools [ 92 ], for caregivers of home-care patients [ 98 ], in group living facilities [ 71 ], in LMIC [ 99 ], and in opioid treatment facilities [ 100 ]. Some recommended PPE be provided to individuals in high-risk populations, such as elderly [ 101 ] and those with disabilities [ 102 ], along with increased training on proper use specifically in the context of LTCs [ 54 ].…”

Changes in social relationships during an initial “stay-at-home” phase of the COVID-19 pandemic: A longitudinal survey study in the U.S.

“…Social distancing directives have limited the ability of family members, caregivers, and friends to continue with typical and daily interactions. Programs such as virtual meet-up groups and virtual check-ins are promising ways to increase social connectivity for those who are homebound; and, COVID-19 presents an opportunity to address disparities in internet access that adversely affect vulnerable populations ( Duong & Karlawish, 2020 ).…”

A Remote Assessment of Anxiety on Young People: Towards Their Views and Their Different Pet Interaction

“…The lockdown was never experienced before by Italian people. During the lockdown and the pandemic evolution, mobile technology ( mTech ) was crucial for tolerating the social distance imposed by the COVID-19 [ 2 , 3 ]. The mTech was useful (and is currently useful): to support teaching, work, and the relational activities [ 4 , 5 ]; to provide the mobile health and solutions for managing and following the spread of the pandemic [ 6 , 7 , 8 ].…”