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2.
J Clin Ethics ; 32(1): 77-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656460

RESUMO

The level of impairment shown by the 1.3 million residents of nursing homes in the United States varies significantly, and this raises considerable challenges for how to address the sexual and romantic interests and needs of these diverse individuals. Unfortunately, bright-line rules and a one-size-fits-all approach are often taken when addressing these challenges. This article proposes a novel taxonomy for classifying the potential sexual and romantic relationships of cognitively impaired nursing home residents that includes relationships between unmarried residents, relationships between residents and their own spouses, and adulterous relationships. We explore the ethical and logistical challenges distinctive to each category of relationship.


Assuntos
Eticistas , Ética Institucional , Instituição de Longa Permanência para Idosos/organização & administração , Relações Interpessoais , Casas de Saúde/organização & administração , Comportamento Sexual/ética , Cônjuges , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estados Unidos
3.
Health Aff (Millwood) ; 40(3): 378-383, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33646868

RESUMO

Long-term care facilities have been devastated by COVID-19, with one exception: a group of small facilities called Green Houses.


Assuntos
/prevenção & controle , Formação de Conceito , Desinstitucionalização , Planejamento Ambiental , Casas de Saúde/organização & administração , /mortalidade , Humanos
5.
Cien Saude Colet ; 26(1): 159-168, 2021 Jan.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-33533836

RESUMO

The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.


Assuntos
/epidemiologia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Pandemias , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Emprego , Feminino , Serviços de Saúde para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/legislação & jurisprudência , Instituição de Longa Permanência para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/legislação & jurisprudência , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente , Pesquisa Qualitativa , Distribuição por Sexo , Espanha/epidemiologia
6.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567833

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on elderly patients, and thus, adequate treatment plans are essential. This qualitative report provides recommendations for the supportive care and treatment of residents in long-term care facilities (LTCF) with COVID-19. A treatment protocol was developed in response to an outbreak of COVID-19 in an LTCF based in Johannesburg and was implemented over a 3-month period.


Assuntos
/terapia , Instituição de Longa Permanência para Idosos/organização & administração , Controle de Infecções/organização & administração , Assistência de Longa Duração/organização & administração , Casas de Saúde/organização & administração , Administração dos Cuidados ao Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Implementação de Plano de Saúde , Humanos , Controle de Infecções/métodos , Assistência de Longa Duração/métodos , Masculino , África do Sul
7.
Healthc Q ; 23(4): 28-34, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33475489

RESUMO

The long-term care (LTC) sector has been the epicentre of COVID-19 in Canada. This paper describes the leadership strategies that helped manage the pandemic in one COVID-19-free LTC facility in British Columbia. Qualitative interviews with four executive leaders were collected and analyzed. The facility implemented most provincial guidelines to prevent or mitigate virus spread. Crisis leadership competencies and safety prioritization helped this site's successful management of the pandemic. There was room for improvement in communication and staffing practices and policies in the facility.


Assuntos
/epidemiologia , Infecção Hospitalar/prevenção & controle , Assistência de Longa Duração/organização & administração , Colúmbia Britânica/epidemiologia , Humanos , Entrevistas como Assunto , Liderança , Casas de Saúde/organização & administração , Política Organizacional
9.
J Am Med Dir Assoc ; 22(1): 199-203, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33321076

RESUMO

OBJECTIVE: The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line health care professionals during the pandemic. DESIGN: Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes. SETTING AND PARTICIPANTS: A total of 152 nursing home staff from 32 states, including direct-care staff and administrators. METHODS: From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes. RESULTS: Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. CONCLUSIONS AND IMPLICATIONS: Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.


Assuntos
Esgotamento Profissional/psicologia , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Casas de Saúde/organização & administração , Recursos Humanos de Enfermagem/psicologia , /epidemiologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Equipamento de Proteção Individual/estatística & dados numéricos , Reorganização de Recursos Humanos
11.
BMC Geriatr ; 20(1): 421, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33092541

RESUMO

BACKGROUND: The COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes. METHODS: An online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent's LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent's LTC home was also assessed. RESULTS: The overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home. CONCLUSIONS: This study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/psicologia , Casas de Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Assistência de Longa Duração/organização & administração , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pneumonia Viral/epidemiologia , Adulto Jovem
14.
Tijdschr Gerontol Geriatr ; 51(3)2020 Apr 23.
Artigo em Holandês | MEDLINE | ID: mdl-32951401

RESUMO

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study.Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems.The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus , Comunicação , Demência , Desastres , Humanos , Pandemias , Qualidade de Vida
15.
Soins Gerontol ; 25(145): 28-30, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32988484

RESUMO

The health emergency linked to Covid-19 has been stressful for staff working in nursing home, and doubly painful for residents faced with the risk of infection and the reality of family separation. We explore in this article some psychological consequences resulting from their experience in the waning health crisis, hoping that the experience gained will allow greater efficiency in the event of a resumption of the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Casas de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Emergências/psicologia , Relações Familiares , Humanos
16.
J Am Med Dir Assoc ; 21(10): 1365-1370.e7, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32981662

RESUMO

During the first few months of the coronavirus disease 2019 (COVID-19) pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable, and potentially harmful. We reviewed the nursing home visitor policies for Canada's 10 provinces and 3 territories as well as international policies and reports on the topic to develop 10 provi-informed, data-driven, and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.


Assuntos
Infecções por Coronavirus/prevenção & controle , Solidão/psicologia , Casas de Saúde/organização & administração , Pandemias/prevenção & controle , Segurança do Paciente/normas , Pneumonia Viral/prevenção & controle , Isolamento Social/psicologia , Envelhecimento/psicologia , Betacoronavirus , Canadá , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia
17.
J Am Med Dir Assoc ; 21(10): 1371-1377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32981663

RESUMO

OBJECTIVES: During the Coronavirus Disease 2019 (COVID-19) pandemic, US nursing homes (NHs) have been under pressure to maintain staff levels with limited access to personal protection equipment (PPE). This study examines the prevalence and factors associated with shortages of NH staff during the COVID-19 pandemic. DESIGN: We obtained self-reported information on staff shortages, resident and staff exposure to COVID-19, and PPE availability from a survey conducted by the Centers for Medicare and Medicaid Services in May 2020. Multivariate logistic regressions of staff shortages with state fixed-effects were conducted to examine the effect of COVID-19 factors in NHs. SETTING AND PARTICIPANTS: 11,920 free-standing NHs. MEASURES: The dependent variables were self-reported shortages of licensed nurse staff, nurse aides, clinical staff, and other ancillary staff. We controlled for NH characteristics from the most recent Nursing Home Compare and Certification and Survey Provider Enhanced Reporting, market characteristics from Area Health Resources File, and state Medicaid reimbursement calculated from Truven data. RESULTS: Of the 11,920 NHs, 15.9%, 18.4%, 2.5%, and 9.8% reported shortages of licensed nurse staff, nurse aides, clinical staff, and other staff, respectively. Georgia and Minnesota reported the highest rates of shortages in licensed nurse and nurse aides (both >25%). Multivariate regressions suggest that shortages in licensed nurses and nurse aides were more likely in NHs having any resident with COVID-19 (adjusted odds ratio [AOR] = 1.44, 1.60, respectively) and any staff with COVID-19 (AOR = 1.37, 1.34, respectively). Having 1-week supply of PPE was associated with lower probability of staff shortages. NHs with a higher proportion of Medicare residents were less likely to experience shortages. CONCLUSIONS/IMPLICATIONS: Abundant staff shortages were reported by NHs and were mainly driven by COVID-19 factors. In the absence of appropriate staff, NHs may be unable to fulfill the requirement of infection control even under the risk of increased monetary penalties.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Casas de Saúde/organização & administração , Recursos Humanos de Enfermagem/provisão & distribução , Reorganização de Recursos Humanos/estatística & dados numéricos , Pneumonia Viral/enfermagem , Recursos Humanos/organização & administração , Infecções por Coronavirus/terapia , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/terapia , Qualidade da Assistência à Saúde , Estados Unidos
18.
J Am Med Dir Assoc ; 21(10): 1378-1383.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32981664

RESUMO

OBJECTIVE: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. DESIGN AND PARTICIPANTS: Retrospective cohort study (March 16, 2020 to May 8, 2020). SETTING: Academic long-term chronic care facility (Boston, MA). PARTICIPANTS: Long-term care residents. METHODS: Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. RESULTS: Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). CONCLUSIONS AND IMPLICATIONS: Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Assistência de Longa Duração/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
20.
J Am Med Dir Assoc ; 21(10): 1384-1386, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32883596

RESUMO

OBJECTIVES: Lung ultrasonographic (LUS) imaging may play an important role in the management of patients with COVID-19-associated lung injury, particularly in some special populations. However, data regarding the prognostic role of the LUS in nursing home residents, one of the populations most affected by COVID-19, are not still available. DESIGN: Retrospective. SETTINGS AND PARTICIPANTS: Nursing home residents affected by COVID-19 were followed up with an LUS from April 8 to May 14, 2020, in Chioggia, Venice. METHODS: COVID-19 was diagnosed through a nasopharyngeal swab. LUS results were scored using a 12-zone method. For each of the 12 zones (2 posterior, 2 anterior, 2 lateral, for both left and right lungs), the possible score ranged from 0 to 3 (1 = presence of B lines, separated, with <50% of space from the pleural line; 2 = presence of B lines, separated, with >50% of space from the pleural line; 3 = lung thickening with tissuelike aspect). The total score ranged from 0 to 36. Mortality was assessed using administrative data. Data regarding accuracy (and related parameters) were reported. RESULTS: Among 175 nursing home residents, 48 (mean age: 84.1 years; mainly female) were affected by COVID-19. Twelve died during the follow-up period. The mean LUS score was 3. The area under the curve of LUS in predicting mortality was 0.603 [95% confidence interval (CI): 0.419-0.787], and it increased to 0.725 (95% CI: 0.41-0.99) after including follow-up LUS controls. Taking an LUS score ≥4 as exposure variable and mortality as outcome, the sensitivity was 58.33% and specificity 63.89%, with a positive likelihood ratio of 1.62 and a negative of 0.65. CONCLUSIONS AND IMPLICATIONS: LUS is able to significantly predict mortality in nursing home residents affected by COVID-19, suggesting that this simple tool can be routinely used in this setting instead of more invasive techniques available only in hospital.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Casas de Saúde/organização & administração , Pneumonia Viral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pandemias , Estudos Retrospectivos , Ultrassonografia
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