Could we have done better with COVID-19 in nursing homes?

Abstract

According to a communication published on June 4, 2020 by The European Centre for Disease Prevention and Control (ECDC), 31-66% of all deaths, depending on country, due to COVID-19 were among residents in long-term care facilities (LTCF) [1]. The COVID-19 pandemic has uncovered many challenges that have probably existed in LTCF for years, yet few people would have thought they could lead to such dramatic effects. One may blame the new coronavirus for the tragic outcomes, but the bottom line is that LTCFs were simply not prepared for the outbreak, and they were "abandoned" at the time when all health care settings struggled with shortage of personal protective equipment (PPE) and testing [2]. The epidemic is not over yet. Moreover, during the potential next wave, we may once again witness a disaster, if we do not back-reflect on the events of the past months and learn a lesson on how to avoid such a scenario. Therefore, right now is the time to analyse which features of LTC did and did not work, and specify which measures may be undertaken in the nearest weeks, and in the future.

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

“…In some cases, the resident will have no relatives and an LTCF staff member becomes his/her very close everyday caregiver. In this case, the death of the resident may have a detrimental impact on the mental health of the care assistants/nurses, justifying the need to develop programmes allowing reflection and relief of emotions to reduce the burden for both the relatives and the nursing home staff [ 51 ].…”

COVID-19 has hit nursing homes hard

“…The facilities may be managed in a situation where carers are on sick leave or in quarantine, and substitutes are difficult to obtain or also represent a risk for residents. The pandemic also exposes staff to heavy emotional and ethical burdens [5]. Fears for personal safety in the pandemic, bereavement at their patients dying, and feelings of inadequacy to help the patients may have detrimental effects on the mental health of carers in nursing homes [5].…”

“…The pandemic also exposes staff to heavy emotional and ethical burdens [5]. Fears for personal safety in the pandemic, bereavement at their patients dying, and feelings of inadequacy to help the patients may have detrimental effects on the mental health of carers in nursing homes [5]. The staff in nursing homes should be supported and allowed reflection to alleviate their emotional burden.…”

“…In most countries the first wave of COVID-19 mainly killed people in nursing homes. Whereas the nursing home population represents less than 1% of the total population in European countries, nursing home residents accounted for 31–80% of all deaths during the first wave in various countries [ 1 – 5 ]. In fact, the reported COVID-19 deaths may be an underestimate since these deaths have accounted only for two-thirds of excess deaths [ 6 ].…”

Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries

“…It would be crucial to provide common guidelines about the protective measures to prevent SARS-CoV-2 infections in nursing homes, the priorities (material and human resources) in dealing with outbreaks, the measures for testing and monitoring both older residents and workers, and measures to control infection once it has entered a facility (e.g. isolation protocols) and ensure tailored acute and/or palliative measures for residents with COVID-19 [42].…”