Hybrid simulation modelling of networks of heterogeneous care homes and the inter-facility spread of Covid-19 by sharing staff

Although system dynamics [SD] and agent-based modelling [ABM] have individually served as effective tools to understand the Covid-19 dynamics, combining these methods in a hybrid simulation model can help address Covid-19 questions and study systems and settings that are difficult to study with a single approach. To examine the spread and outbreak of Covid-19 across multiple care homes via bank/agency staff and evaluate the effectiveness of interventions targeting this group, we develop an integrated hybrid simulation model combining the advantages of SD and ABM. We also demonstrate how we use several approaches adapted from both SD and ABM practices to build confidence in this model in response to the lack of systematic approaches to validate hybrid models. Our modelling results show that the risk of infection for residents in care homes using bank/agency staff was significantly higher than those not using bank/agency staff (Relative risk [RR] 2.65, 95% CI 2.57–2.72). Bank/agency staff working across several care homes had a higher risk of infection compared with permanent staff working in a single care home (RR 1.55, 95%CI 1.52–1.58). The RR of infection for residents is negatively correlated to bank/agency staff’s adherence to weekly PCR testing. Within a network of heterogeneous care homes, using bank/agency staff had the most impact on care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Forming bubbles of care homes had no or limited impact on the spread of Covid-19. This modelling study has implications for policy makers considering developing effective interventions targeting staff working across care homes during the ongoing and future pandemics.

Book Review: From the inside out: The fight for environmental justice within government agencies by Jill Harrison

In From the Inside Out: The Fight for Environmental Justice within Government Agencies (MIT Press, 2019), Jill Harrison offers a nuanced study of why U.S. state agencies fail at implementing robust environmental justice (EJ) policies. Through a rigorous interview and ethnographic based methodology Harrison details the discourses, ideologies, and everyday practices and through which government agency staff, daily, undermine and even outright reject EJ policies and programs. The book is a richly empirical study that makes valuable contributions to academic and activist understandings of the government's failure to respond meaningfully to environmental injustices, and offers specific recommendations for how to reform government agencies. It is a timely monograph as EJ advocates seek to reimagine government agencies in the wake of the Trump administration, and in the context of an expanded public consciousness of racism following the killing of George Floyd and subsequent uprisings during the summer of 2020.

Exploring coaching and follow-up supports in community-implemented caregiver-mediated JASPER intervention

Although a growing number of caregiver-mediated intervention models for families with children with autism are being examined in efficacy trials, few have been transferred to community implementation. Furthermore, little testing has explored implementation strategies to support caregivers’ strategy use with their children. In partnership with a publicly funded intervention agency in Canada, this pilot project explored intervention implementation strategies and follow-up supports. Dyads were randomized at entry to coaching or observe then add coaching and at intervention exit to individual or group follow-up booster. The caregiver-mediated Joint Attention, Symbolic Play, Engagement and Regulation intervention was provided by agency staff to a diverse community sample of families with young children awaiting or diagnosed with autism spectrum disorder. Independent agency staff delivered assessments and recorded a caregiver–child interaction. Blinded raters scored children’s initiations of joint attention, play actions, joint engagement, and caregivers’ strategy implementation. Practitioners implemented the intervention and coaching strategies well ( M = 83%). Overall, caregivers made significant gains in strategy use and children showed significant growth in joint engagement, play diversity, and joint attention across conditions through public caregiver-mediated intervention services. Caregivers’ strategy use supported gains in children’s joint engagement. Lay abstract The next step for communication interventions for young children with autism include coaching/teaching for caregivers that have been tested in university clinics and testing these interventions in real world systems with early intervention providers who serve children and families in their communities. However, there are few projects that have tested how well the intervention can be transferred to community providers and what types of progress children and caregivers make in these services. This project took place in partnership with a community early intervention agency in the province of Ontario, Canada. The agency provided government-funded public health services. The agency was funded to take part in a pilot program to try out one of four early intervention models that included coaching for caregivers and was designed to support children’s social engagement, play, and communication skills. The team decided to test two ways to start the intervention: (a) begin with observation of the practitioner for 4 weeks and then start coached practice with the child and (b) start coaching immediately. The team also tested two ways to support families for 3 months after intervention: (a) group booster sessions and (b) individual visits. The practitioners delivered the intervention well ( M = 83%), and overall, caregivers and children made significant gains by the end of intervention in both observation + coaching and coaching. Attendance for follow-up boosters was variable with fewer families attending groups. More research is needed to test different strategies and roles to individualize interventions for caregivers with a range of goals and learning styles.

It Was Trial by Fire: Recommendations for Building a Stronger Nursing Home Workforce After COVID-19

The COVID-19 crisis showed the urgent need for a unified, well-supported nursing home workforce. The objective of this qualitative study was to examine the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19 to identify best practices moving forward. Six administrator interviews and 10 remote focus groups with CNAs at 5 nursing homes (N=56) were examined through directed content analysis. Based on priorities identified by CNAs and administrators, the following practices may be most impactful: 1) ongoing and responsive staff training; 2) transparent, direct, and two-way communication channels; 3) prioritizing hiring permanent staff to avoid shortages and reliance on agency staff; 4) building collaborative staff-management relationships; 5) providing flexible job benefits; 6) providing staff-centered emotional support resources; and 7) appraising COVID-19 innovations. Our results suggest that rather than returning to “business as usual,” nursing homes can draw on these lessons to build a more sustainable workforce and industry.

The Financial and Operational Effects of COVID-19 on Ohio’s Long-Term Care Residential Settings

The COVID-19 pandemic has had a drastic impact on Ohio’s long-term care facilities. Yet, months into the crisis, the financial ramifications and workforce shortage were unknown. In partnership with the Scripps Gerontology Center at Miami University, LeadingAge Ohio and the Ohio Health Care Association developed an online survey that was launched in July 2021. Response rates were 46.4% for skilled nursing facilities (SNFs; N=446) and 35.8% for residential care facilities (RCFs; N=287). Core questions compared the first quarters of 2020 and 2021. Declines in operating revenues (-11.7% SNFs; -10% RCFs) and rising labor costs per patient day (17.9% SNFs; 16.1% RCFs) contributed to most providers experiencing a financial loss in the most recent month (78% SNFs; 66% RCFs). The increased documented use of agency staff is an important finding of this work; 62% of SNFs and 34% of RCFs spent money on agency staff. Despite increases in starting wages, the labor crisis remains severe. As of July 2021, SNFs had an average of 19.51 open positions, of which 9.82 were for state-tested nurse aides and 5.65 were for nurses. RCFs had an average of 8.83 open positions, of which 4.24 were for resident care assistants and 1.89 were for nurses. The challenges faced by the long-term care industry have rightly focused on the deleterious impacts of COVID on residents and staff. But these data also suggest that the financial impacts on the industry are serious and will likely shape access and provision of care in the future.

Rethinking Employer Communication and Support for Home Care Aides: A Case Study of Pandemic Group Support Calls

This case study explores an employer-initiated biweekly group support call for home care aides implemented by a large New York City-based home care agency during the COVID-19 pandemic. Specifically, we investigate how agency staff used information gathered through these calls to intervene into existing agency communication and support systems for aides. Our single-site case study analyzes detailed notes from almost 100 support calls that took place between April 2020 and March 2021, as well as interviews with agency staff from communications, human resources, nursing, and other departments that support aides. We compare and contrast new communication and support mechanisms advanced in conjunction with these calls with agency systems pre-pandemic. Our findings suggest that while calls were initially targeted toward providing emotional and operational support, staff also advocated for more systemic supports. We discuss the sustainability of these new efforts, as well as ongoing barriers and gaps.

Diagnosing Obstacles to Speed and Reliability with High-Resolution Automatic Vehicle Locator Data: Bus Time Budgets

Transit riders consistently rate speed and reliability of service as primary drivers of satisfaction, and transit agencies can help retain and grow ridership by improving these components of service. The challenge for transit agency staff is to identify when and where they should focus efforts to improve service quality. Here we propose an approach to data analysis that identifies and isolates specific aspects of service that are limiting speed and reliability. In-vehicle travel time can be decomposed into time spent in motion and time stopped. Time in motion is often dependent on factors common to general traffic, whereas time stopped has some features in common with general traffic (i.e., traffic signals) and some unique to buses (i.e., passenger dwell). Other sources of delay from serving a bus stop include deceleration, acceleration, and signal delay. To improve overall travel time, transit agencies must prioritize interventions that will contribute the most to improving speed and reliability. We used high-resolution automatic vehicle locator data to assign components of speed and reliability within a trip-level “time budget.” We compared typical time budget components across service types, and used the time budget approach to evaluate local service and Rapid bus service operating simultaneously on the same alignment. Results of the delay and variability quantifications suggested particular interventions, as well as the expected size of the resulting effect. With limited resources, the bus time budget approach could aid understanding and prioritization of transit agency efforts to improve speed and reliability.

PERCEIVE – Patterning Employment, Race, and Clinical Experience In Violence against Employees

AimsPERCEIVE is a service evaluation counting whether nurse demographics correlate with reported subjection to violence and verbal aggression. The setting was a large mental health, learning disability and neuropsychiatry NHS trust in England. This continues our work to understand correlations reported in the literature between temporary staff and violence.MethodWe consulted the Caldicott, legal, equality & diversity, teams and gained service evaluation permission SER-19-031 from CNTW R&D department. We briefly consulted with staff regarding themes relevant to temporary nurse workers. They expressed concern that staff perceived to be “other” would be at more risk.Employees’ age, ethnicity, employment status, nationality, length of service and seniority are routinely collected for the running of the trust. Therefore, these were anonymously collated then cross-referenced with violence and aggression incident reports (VA IR1s). Chi-squared was used to identify statistical significance. Ethno-national status was taken from self-report. We could not control for hours worked nor could we get agency staff demographic data.We compared “exposure to at least one violent incident” in June, July and August 2019 against the following demographic categories:Substantive vs bank staffBand 5 and above vs band 4 and belowStaff with < 1 year of service vs staff with ≥ 1 year of service“White British” staff vs Non-“White British” staff“British” staff on self-report vs “Non-British” staffAge ≤30 years vs ≥ 31yearsA minimum of 1682 nursing staff were analysed for each category in each month.ResultSubstantive staff, “White British”, “British”, younger, and staff of shorter employment length had greater frequencies of at least one VA IR1s compared to the complementary groups. Length of service was significant only in two months but judged significant overall. There was no statistically significant correlation with seniority. Substantive staff have three times the risk vs bank staff, perhaps mediated by hours worked. Other risk ratios were in the region x1.2 to x1.8.ConclusionBeing British, White British, younger, less experienced or substantive staff correlate with subjection to reported aggression. This did not fit with staff speculation during consultation. Survival effects may be relevant. We are working to get more detailed information. Induction may help reduce aggression against newer staff.

I Can for Kids: Experiences and Perceived Outcomes of a Summer Food Program for Low-Income Households at Risk of Food Insecurity in Calgary, Alberta, Canada

Objectives The prevalence of household food insecurity increases in the summer when school meals are no longer accessible, which can negatively impact children's health and wellbeing. Summer food programs, such as I Can for Kids (IC4K) in Calgary, Alberta, Canada, aim to reduce food insecurity in low income households with school-aged children during the summer months. Qualitative studies have not yet examined whether or how grocery gift cards (GGC) can reduce experiences of food insecurity among low-income households. We explored recipients’ and agency staff experiences and perceived outcomes of receiving or distributing GGC from IC4K. Methods This study used qualitative descriptive methodology. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Semi-structured interviews were conducted between August and November 2020 with 38 primary caregivers (i.e., GGC recipients) and 17 agency staff who distributed GGC. Directed content analysis was used to analyze the data from each set of interviews using a deductive-inductive approach. Codes were combined into themes that summarized GGC recipients’ and agency staff's experiences and perceived outcomes of receiving or distributing GGC, and feedback to improve program delivery. Results Three themes were generated from the data. The first theme was Financial Relief and reflected increased self-efficacy, improved diet quality, and reduced household stress from receiving GGC. The second theme was Social Connectedness and described enriched family relationships, enhanced rapport between staff and recipients, and increased recipient social capital. The last theme was Program Enhancements and described feedback to improve program delivery by extending program duration, increasing strategic direction to staff on GGC distribution, and additional promotional efforts to increase awareness of GGC availability. Conclusions GGC recipients and agency staff perceived that GGC offered financial relief and enhanced social connections for recipients, and suggested areas for program improvements. Study findings can inform improvements to summer food programs that deliver GGC to reduce food insecurity among low-income households in the summer. Funding Sources Funding provided by the O'Brien Institute for Public Health at the University of Calgary.