The Impacts of the COVID-19 Pandemic on Family Caregivers' Care Work, Anxiety, and Loneliness

Our study examined the effects of COVID-19 pandemic and public health measures on family caregivers (FCGs) of frail older adults; specifically, their care work, anxiety, and loneliness all of which are associated with decreased wellbeing. Approximately 604 FCGs completed the survey and findings evidenced COVID-19 creating two solitudes. First, 73% of FCGs for individuals living with them were providing significantly more care during COVID-19. Second, those caring for residents in congregate settings were unable to care. Both situations, community-dwelling and congregate care, increased FCG distress and decreased wellbeing. Anxiety significantly increased from 36% pre COVID-19 to 54% during COVID-19. Loneliness increased from 46% to 85%. FCGs report their mental (58%) and physical (48%) health deteriorated. The detrimental impact of the pandemic and public health measures on FCGs caring at home and in congregate care, and their related needs, need immediate attention from both the health and social systems of care.

Viral Culture in Hospitalized Congregate Care Patients With Prolonged SARS-CoV-2 Viral RNA Detection

Prolonged detection of SARS-CoV-2 viral RNA has been observed in hospitalized congregate care patients following resolution of clinical symptoms. It is unknown whether patients with persistent PCR positivity pose a risk for COVID-19 transmission. The purpose of this study was to examine the results of serial PCR testing, viral load, and viral culture in patients awaiting discharge prior to a negative PCR test. We sampled 14 patients who were admitted from skilled nursing and/or rehabilitation facilities to a large academic medical center, had clinical signs and symptoms of COVID-19, and had multiple PCR-positive tests separated by at least 14 days. PCR-positive nasopharyngeal swabs were obtained from each patient for viral load quantification and viral culture. The mean age of patients was 72.5 years (55 – 92), with a mean peak SOFA score of 5.6 (1 – 11). Patients were hospitalized for a mean of 37.0 days (25 – 60). RNA was detected by PCR for a mean of 32.9 days (19 – 47). Mean viral load for the first PCR-positive nasopharyngeal swab collected at our hospital was 5.81 genomic copies/mL (2.12 – 9.72). Viral load decreased significantly with days from clinical symptom onset (R = -0.69, 95% CI, -0.80 – -0.55). Four out of 28 samples grew active virus via culture, with no active virus isolates after 2 days of symptom onset. Our viral culture data suggests that persistent PCR positivity may not correlate with infectivity, which has important implications for COVID-19 infection control precautions among older congregate care patients.

804. Infection Control and Clinical Support in Long-Term Care Homes During the COVID-19 Pandemic in North Toronto: A Quasi-Experimental Study

Background Wave one of the COVID-19 pandemic in Ontario, Canada, resulted in significant institutional outbreaks associated with high case fatality among older adults. Our hospital formally partnered with congregate care homes in north Toronto to support infection control and clinical management before wave two of the COVID-19 pandemic. Our aim was to evaluate the impact of this program on resident and healthcare worker (HCW) outcomes. Methods A multicentre quasi-experimental study was conducted comparing outcomes between wave one (March-June, 2020) and wave two (October-December, 2020) among 17 congregate care homes (4 long term care homes and 13 residential homes). During wave two, weekly meetings and 42 on-site visits were conducted along with on-site daily hospital presence for all COVID-19 outbreaks to support infection control and resident management. The primary outcomes included COVID-19-case fatality rate as well as overall resident fatality including COVID-19 and non-COVID-19 related causes. Secondary outcomes included healthcare worker COVID-19 infections, and infection control practices among homes with paired audits (n=6), including hand hygiene, use of personal protective equipment, environmental cleaning and physical distancing practices. Results Among 2203 residents during wave one and 2287 residents during wave two, there was reduction in COVID-19 case fatality rate (38.1% vs. 13.4%; p< 0.01), overall COVID-19-related fatality (2.3% vs. 1.0%; p< 0.01) and non COVID-19 related fatality (8.3% vs. 3.5%; p< 0.01). Weekly staff testing and increased syndromic surveillance was implemented during wave two. Among 2590 staff, there were 2.6% vs.4.2% staff who tested positive for COVID-19 during wave one and two, respectively. Changes in infection control practice were observed in regard to directly observed hand hygiene (83.3% vs. 100%), use of personal protective equipment (16.7% vs. 83.3%), environmental cleaning (66.7% vs. 100%) and physical distancing (66.7% vs. 83.3%). Conclusion Integration of hospital with community congregate care homes was associated with improvements in resident outcomes during wave two of the pandemic. Further longitudinal support and evaluation is needed to ensure sustainability. Disclosures All Authors: No reported disclosures

A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care

We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.

Model-based Evaluation of Continued COVID-19 Risk at Long Term Care Facilities

The COVID-19 pandemic severely impacted long-term care facilities resulting in the death of approximately 8% of residents nationwide. As COVID-19 case rates decline and state and county restrictions are lifted, facility managers, local and state health agencies are challenged with defining their own policies moving forward to appropriately mitigate disease transmission. The continued emergence of variants of concern has highlighted the need for a readily available tool that can be employed at the facility-level to determine best practices for mitigation and ensure resident and staff safety. To assist leadership in determining the impact of various infection surveillance and response strategies, we developed an agent-based model and an online dashboard interface that simulates COVID-19 infection within congregate care settings under various mitigation measures. In this paper, we demonstrate how this dashboard can be used to quantify the continued risk for COVID-19 infections within a facility given a designated testing schedule and vaccine requirements. Our results highlight the critical nature of testing cadence, test sensitivity and specificity, and the impact of removing asymptomatic infected individuals from the workplace. We also show that monthly surveillance testing at long-term care facilities is unlikely to successfully mitigate SARS-CoV-2 outbreaks in congregate care settings.

Who Counts? Old Age in COVID Times

People over sixty-five have been singled out as a uniquely vulnerable risk group for the novel coronavirus. Yet the discourse of risk obscures (and exacerbates) socially created dangers of congregate care in the United States: poorly paid workers holding down multiple jobs and the endemic “plagues” of loneliness, boredom, and hopelessness. Humorous memes about who counts as old point out structural inequalities, while millions of able-bodied “shut-ins” (due to lockdowns and job losses) may experience forced empathy: fuel for new imaginings about how to care for—and value—elders moving forward.

Does Context Matter? Differences in the Use of Congregate Care by Black, White, and Hispanic Youth

<p>In the paper, we examine the relationship between county context and the use of congregate care by White, Black, and Hispanic youth, aged between 10 and 17. We measure the use of congregate care as the probability a young person will be placed in congregate care during an out-of-home care spell. We define county context in three ways: urbanicity, social disadvantage, and the supply effect on demand. We also include whether states mandate the use of an assessment to regulate entry into congregate care. Our primary interest is organized around differences in county context, the rate of congregate care utilization, and the connection between context and disparity. We find that, regardless of race, congregate care placement rates tend to be higher in counties where supply affects demand. However, in those counties, the Black/White disparity tends to be lower and the Hispanic/White disparity tends to be higher. The association between a mandatory assessment policy and congregate care placement is in the expected direction. After describing the study limitations, we discuss implications for future research and policy.</p>