scholarly journals COVID-19 in Scottish care homes: A metapopulation model of spread among residents and staff

2021 ◽  
Author(s):  
Matthew Baister ◽  
Ewan McTaggart ◽  
Paul McMenemy ◽  
Itamar Megiddo ◽  
Adam Kleczkowski
Keyword(s):  
General Population ◽  
Care Home ◽  
Home Visitation ◽  
Care Homes ◽  
Health Board ◽  
Reproduction Rate ◽  
Metapopulation Model ◽  
Hospital Discharges ◽  
Vulnerable Communities ◽  
The Uk

AbstractCare homes in the UK were disproportionately affected by the first wave of the COVID-19 pandemic, accounting for almost half of COVID-19 deaths over the course of the period from 6th March – 15th June 2020. Understanding how infectious diseases establish themselves throughout vulnerable communities is crucial for minimising deaths and lowering the total stress on the National Health Service (NHS Scotland). We model the spread of COVID-19 in the health-board of NHS Lothian, Scotland over the course of the first wave of the pandemic with a compartmental Susceptible - Exposed - Infected reported - Infected unreported - Recovered - Dead (SEIARD), metapopulation model. Care home residents, care home workers and the rest of the population are modelled as subpopulations, interacting on a network describing their mixing habits. We explicitly model the outbreak’s reproduction rate and care home visitation level over time for each subpopulation, and execute a data fit and sensitivity analysis, focusing on parameters responsible for intra-subpopulation mixing: staff sharing, staff shift patterns and visitation. The results suggest that hospital discharges were not predominantly responsible for the early outbreak in care homes, and that only a few such cases led to infection seeding in care homes by the 6th of March Sensitivity analysis show the main mode of entry into care homes are infections by staff interacting with the general population. Visitation (before cancellation) and staff sharing were less significant in affecting outbreak size. Focusing on the protection and monitoring of staff, followed by reductions in staff sharing and quick cancellations of visitation can significantly reduce future infection attack rates of COVID-19 in care homes.Author SummaryCOVID-19 has spread throughout care homes in the UK, leading to many deaths of those most vulnerable in our population. This has sparked the need for further understanding of how infectious diseases spread throughout vulnerable communities such as care homes. We developed a model focused on the first wave in the Scottish health board of Lothian, which indicated pathways most likely leading to COVID-19 establishment within care homes. We found that care home visitation and hospital discharges did not significantly affect total COVID-19 cases in care home residents. The most significant route of entry for COVID-19 into care homes was through staff infections from the general population. We suggest to prioritise minimising infections in this pathway to reduce the number of outbreaks in care homes. Our model indicated that care homes were three weeks behind the general population in reducing the reproduction rate of COVID-19. This delay emphasises the need for more planning and support for care homes in organising effective responses to emerging pandemics.

scholarly journals Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19

2021 ◽  
Author(s):  
Clarissa Marie Giebel ◽  
Kerry Hanna ◽  
Jacqueline Cannon ◽  
Paul Marlow ◽  
Hilary Tetlow ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Care Home ◽  
Home Visitation ◽  
Control Measures ◽  
Care Homes ◽  
Family Carers ◽  
Care Home Staff ◽  
The Uk ◽  
The Impact

Background: Vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods: Family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results: Across 62 baseline and follow-up interviews with family carers (n=26; 11) and care home staff (n=16; 9), five core themes were developed: Delayed and inconsistent offers of face-to-face visits; Procedures and facilitation of visits; Frustration and anger among family carers; Variable uptake of the COVID-19 vaccine; Misinformation, education, and free choice. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions: We make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff.

scholarly journals Psychometric properties and feasibility of use of dementia specific quality of life instruments for use in care settings: a systematic review

2019 ◽  
pp. 1-15 ◽  
Author(s):  
Laura J. Hughes ◽  
Nicolas Farina ◽  
Thomas E. Page ◽  
Naji Tabet ◽  
Sube Banerjee
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Psychometric Properties ◽  
Care Home ◽  
Care Homes ◽  
Cosmin Checklist ◽  
Many Instruments ◽  
The Uk ◽  
Quality Instruments

ABSTRACTBackground:Over 400,000 people live in care home settings in the UK. One way of understanding and improving the quality of care provided is by measuring and understanding the quality of life (QoL) of those living in care homes. This review aimed to identify and examine the psychometric properties including feasibility of use of dementia-specific QoL measures developed or validated for use in care settings.Design:Systematic review.Methods:Instruments were identified using four electronic databases (PubMed, PsycINFO, Web of Science, and CINAHL) and lateral search techniques. Searches were conducted in January 2017. Studies which reported on the development and/or validation of dementia specific QoL instruments for use in care settings written in English were eligible for inclusion. The methodological quality of the studies was assessed using the COSMIN checklist. Feasibility was assessed using a checklist developed specifically for the review.Results:Six hundred and sixteen articles were identified in the initial search. After de-duplication, screening and further lateral searches were performed, 25 studies reporting on 9 dementia-specific QoL instruments for use in care home settings were included in the review. Limited evidence was available on the psychometric properties of many instruments identified. Higher-quality instruments were not easily accessible or had low feasibility of use.Conclusions:Few high-quality instruments of QoL validated for use in care home settings are readily or freely available. This review highlights the need to develop a well-validated measure of QoL for use within care homes that is also feasible and accessible.

scholarly journals Optimisation of dementia care in care homes: Dementia care framework (innovative practice)

Dementia ◽  
2017 ◽  
Vol 19 (4) ◽  
pp. 1316-1324
Author(s):  
Claire Royston ◽  
Gary Mitchell ◽  
Colin Sheeran ◽  
Joanne Strain ◽  
Sue Goldsmith
Keyword(s):  
Care Home ◽  
Evidence Base ◽  
Dementia Care ◽  
Care Homes ◽  
Spiritual Needs ◽  
Four Seasons ◽  
Care Partners ◽  
The Uk ◽  
Robust Evidence

There are an increasing number of people living with dementia in care home settings. Recent reports suggest that people who deliver care to residents living with dementia in care homes require specialist support to provide optimum care. To address this need Four Seasons Health Care, the largest provider of care homes within the UK today, sought to design a dementia care framework that enhanced the quality of life for people living with dementia in their care homes. The framework was designed using a robust evidence base, engagement with people living with dementia, their care partners, policy-writers, multidisciplinary professionals and people within the organisation. This paper describes the methodology behind the dementia care framework and outcomes data from the first phase (of 20 care homes that included the care of 451 people living with dementia). The main outcome was a significant improvement in the quality of the lives of residents across biological, psychological, social and spiritual needs.

scholarly journals Malnutrition in the UK: where does it begin?

2010 ◽  
Vol 69 (4) ◽  
pp. 465-469 ◽  
Author(s):  
C. A. Russell ◽  
M. Elia
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Care Home ◽  
Healthcare Services ◽  
Care Homes ◽  
Sheltered Housing ◽  
Nutrition Screening ◽  
Good Opportunity ◽  
Outpatient Departments ◽  
The Uk

More than 3 million individuals are estimated to be at risk of malnutrition in the UK, of whom about 93% live in the community. BAPEN's Nutrition Screening Week surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’) revealed that 28% of individuals on admission to hospital and 30–40% of those admitted to care homes in the previous 6 months were malnourished (medium+high risk using ‘MUST’). About three quarters of hospital admissions and about a third of care home admissions came from their own homes with a malnutrition prevalence of 24% in each case. Outpatient studies using ‘MUST’ showed that 16–20% patients were malnourished and these were associated with more hospital admissions and longer length of stay. In sheltered housing, 10–14% of the tenants were found to be malnourished, with an overall estimated absolute prevalence of malnutrition which exceeded that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. These studies have helped establish the magnitude of the malnutrition problem in the UK and identified the need for integrated strategies between and within care settings. While hospitals provide a good opportunity to identify malnourished patients among more than 10 million patients admitted there annually and the five- to six-fold greater number attending outpatient departments, commissioners and providers of healthcare services should be aware that much of the malnutrition present in the UK originates in the community before admission to hospitals or care homes or attendance at outpatient clinics.

Care homes for older people

2013 ◽  
Author(s):  
Tom Dening ◽  
Alisoun Milne
Keyword(s):  
Older People ◽  
Residential Care ◽  
Physical Disability ◽  
Care Home ◽  
Developed Countries ◽  
Care Homes ◽  
Standards Of Care ◽  
Ageing Population ◽  
Behavioural Disturbance ◽  
The Uk

Although only 5% of the total over 65 population in developed countries lives in a care home, the lifetime risk of needing residential care is considerable. In the UK, 418 000 older people occupy nearly 12 000 care homes; the sector has a total value of around £14 billion. Care home residents tend to be very old, most are women, and most have complex co-morbid needs. Most people enter a care home because they can no longer live independently due to ill health, notably dementia. Dementia affects over two thirds of all residents; physical disability and functional impairment are also common. Behavioural disturbance is common as is depression. There are concerns about excessive reliance on medication, and more emphasis recently has been placed on improving standards of care. Evidence suggests that training and good leadership is effective. With the ageing population, the provision and the funding of care home places will come under increasing pressure. The solutions to this are yet to be determined.

scholarly journals GPs’ involvement to improve care quality in care homes in the UK: a realist review

2021 ◽  
Vol 9 (20) ◽  
pp. 1-76
Author(s):  
Neil H Chadborn ◽  
Reena Devi ◽  
Christopher Williams ◽  
Kathleen Sartain ◽  
Claire Goodman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
General Practitioner ◽  
Health Services ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Care Home ◽  
Care Homes ◽  
Life Care ◽  
The Uk

Background Organising health-care services for residents living in care homes is an important area of development in the UK and elsewhere. Medical care is provided by general practitioners in the UK, and the unique arrangement of the NHS means that general practitioners are also gatekeepers to other health services. Despite recent focus on improving health care for residents, there is a lack of knowledge about the role of general practitioners. Objectives First, to review reports of research and quality improvement (or similar change management) in care homes to explore how general practitioners have been involved. Second, to develop programme theories explaining the role of general practitioners in improvement initiatives and outcomes. Design A realist review was selected to address the complexity of integration of general practice and care homes. Setting Care homes for older people in the UK, including residential and nursing homes. Participants The focus of the literature review was the general practitioner, along with care home staff and other members of multidisciplinary teams. Alongside the literature, we interviewed general practitioners and held consultations with a Context Expert Group, including a care home representative. Interventions The primary search did not specify interventions, but captured the range of interventions reported. Secondary searches focused on medication review and end-of-life care because these interventions have described general practitioner involvement. Outcomes We sought to capture processes or indicators of good-quality care. Data sources Sources were academic databases [including MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Cumulative Index to Nursing and Allied Health Literature, PsycInfo® (American Psychological Association, Washington, DC, USA), Web of Science™ (Clarivate Analytics, Philadelphia, PA, USA) and Cochrane Collaboration] and grey literature using Google Scholar (Google Inc., Mountain View, CA, USA). Methods Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were followed, comprising literature scoping, interviews with general practitioners, iterative searches of academic databases and grey literature, and synthesis and development of overarching programme theories. Results Scoping indicated the distinctiveness of the health and care system in UK and, because quality improvement is context dependent, we decided to focus on UK studies because of potential problems in synthesising across diverse systems. Searches identified 73 articles, of which 43 were excluded. To summarise analysis, programme theory 1 was ‘negotiated working with general practitioners’ where other members of the multidisciplinary team led initiatives and general practitioners provided support with the parts of improvement where their skills as primary care doctors were specifically required. Negotiation enabled matching of the diverse ways of working of general practitioners with diverse care home organisations. We found evidence that this could result in improvements in prescribing and end-of-life care for residents. Programme theory 2 included national or regional programmes that included clearly specified roles for general practitioners. This provided clarity of expectation, but the role that general practitioners actually played in delivery was not clear. Limitations One reviewer screened all search results, but two reviewers conducted selection and data extraction steps. Conclusions If local quality improvement initiatives were flexible, then they could be used to negotiate to build a trusting relationship with general practitioners, with evidence from specific examples, and this could improve prescribing and end-of-life care for residents. Larger improvement programmes aimed to define working patterns and build suitable capacity in care homes, but there was little evidence about the extent of local general practitioner involvement. Future work Future work should describe the specific role, capacity and expertise of general practitioners, as well as the diversity of relationships between general practitioners and care homes. Study registration This study is registered as PROSPERO CRD42019137090. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 20. See the NIHR Journals Library website for further project information.

scholarly journals Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: a national cohort analysis

2020 ◽  
Author(s):  
Chris Emmerson ◽  
James P Adamson ◽  
Drew Turner ◽  
Mike B Gravenor ◽  
Jane Salmon ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Cox Regression ◽  
Care Home ◽  
Cohort Analysis ◽  
Time Dependent ◽  
Care Homes ◽  
Health Board ◽  
High Morbidity ◽  
Discharge From Hospital ◽  
The Impact

Abstract Background Adult residential and nursing care homes are settings in which older and often vulnerable people live in close proximity. This population experiences a higher proportion of respiratory and gastrointestinal illnesses than the general population and has been shown to have a high morbidity and mortality in relation to COVID-19. Methods We examined the number of hospital discharges to all Welsh adult care homes and the subsequent outbreaks of COVID-19 occurring over an 18 week period 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on the incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics (including size, type of provision and health board). Results A total of 1068 care homes were monitored; 330 homes experienced an outbreak of COVID-19, and 511 homes received a discharge from hospital over the study period. The exposure to discharge from hospital was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.49, p = 0.28), after adjusting for care home size, which was by far the most significant predictor. Hazard ratios (95% CI) in comparison to homes of <10 residents were: 3.4 (2.0, 5.8) for 10-24 residents; 8.3 (5.0, 13.8) for 25-49 residents; and 17.3 (9.6, 31.1) for homes of 50+ residents. When stratified for care home size, the outbreak rates were very similar for periods when homes were exposed to a hospital discharge, in comparison to periods when homes were unexposed. Conclusion Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk. Keywords: COVID-19, care homes, hospital discharge, outbreak, time dependent Cox regression

The benefits of raising awareness of lymphoedema among care home staff

2020 ◽  
Vol 29 (4) ◽  
pp. 190-198
Author(s):  
Melanie Thomas ◽  
Karen Morgan ◽  
Ioan Humphreys ◽  
Karl Hocking ◽  
Diane Jehu
Keyword(s):  
One Health ◽  
Care Home ◽  
Pilot Project ◽  
Care Staff ◽  
Care Homes ◽  
Health Board ◽  
Care Home Staff ◽  
Raising Awareness ◽  
History Of ◽  
Education Tool

Background: Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff. Aims: To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema. Methods: An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents. Results: Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema. Conclusion: This educational project has identified the value of raising awareness of lymphoedema within care homes.

scholarly journals Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands

2020 ◽  
Vol 17 (20) ◽  
pp. 7601 ◽  
Author(s):  
Reena Devi ◽  
Graham Martin ◽  
Jay Banerjee ◽  
Louise Butler ◽  
Tim Pattison ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Home ◽  
Care Homes ◽  
Collaborative Teams ◽  
Quality Improvement Collaborative ◽  
Team Members ◽  
Job Roles ◽  
Healthcare Settings ◽  
Home Context ◽  
The Uk

The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members’ job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting.

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