Aged Care Facilities Research Articles

Elderly Care Provision under National Policy on Older Persons 2013: A Cross-Sectional Study in Dhaka City, Bangladesh

Bangladesh is undergoing a notable demographic transition, characterized by a substantial rise in the proportion of elderly individuals within its population. This demographic transition presents a range of economic, social and cultural issues that necessitate prompt attention and intervention. The aim of this study was to examine the current state of elderly care services and facilities available for older adults in urban landscape by taking into account the ‘National Policy on Older Persons 2013.’ This study was conducted in Dhaka city by employing a cross-sectional study design. The study population covers elderly people aged 60+ years, living in Dhaka City for more than five years continuously and are able to speak well with someone. The study was based on a sample of 240 and the respondents were chosen using convenient sampling technique. The data were collected through face-to-face interview using structured questionnaire and they were analyzed utilizing descriptive statistics. This study found that the existing elderly care services and available opportunities are below the satisfactory level for most of the older adults of the city, even though the ‘National Policy on Older Persons 2013’ was adopted a decade ago. The elderly people in Dhaka city encountered a number of difficulties considering their physical health, psychological and social well-being. In the case of availability of the affordable and quality healthcare services for older adults in their community, 30.4% of the respondents said that the availability, accessibility and affordability of quality healthcare services are very poor, followed by 24.6% below average and 26.3% at the average level. Nearly 75% of the study people said that they had ever experienced unfair treatment for being aged. Indeed, they receive care and support in an inconsistent, disorganized and incoherent manner. The study clearly revealed that there is a need to prioritize person-centered care as well as integrated care system for the effective management of the ageing population in Bangladesh. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 118−134

Managers of Aged Care Residential Services in Australia 2006-2021: Transformation reform

Objectives: This article provides analyses of the number and characteristics of managers of aged care residential services in relation to number of aged people, residents of aged care facilities and people employed in them. Design: The research design follows specifications provided by the authors for tabulations prepared by the Australian Bureau of Statistics (ABS) from the censuses of population conducted by ABS in 2006 and 2021. Analyses undertaken by the authors show changes that have taken place in the number of managers of aged care residential facilities in relation to the number of aged people, residents of aged care facilities, and people employed in them. Further, the analyses examine changes in the demographic characteristics of managers, their working hours and income, over time. Findings: There was a substantial decline in the proportion of the growing number of people aged 70 years and over who lived in aged care residential services during the 15-year period. While there was a large increase in the number of employees and managers per resident, and a slight increase in the number of managers per employee. The proportion of female managers fell, and the average age of managers increased slightly. The proportion of managers at graduate level rose substantially. Although the average income of aged care residential services managers was similar to that in all industries in 2021, their increase was larger than in all industries during the 15-year period. Average hours worked remained similar over time. The proportion of Australia-born managers declined while that of managers born in Asia rose substantially, and the proportion of indigenous managers about doubled during the 15-year period. Implications: Relevance to those concerned with the evolving transformation of aged care in Australia and those interested with management training of the growing number of managers of aged care residential services.

A Focused Literature Review of Missed Care in Residential Aged Care

Missed care is any aspect of required care that is omitted (either in part or whole) or delayed. Residential Aged Care Facilities (RACFs) are susceptible to missed care due to a range of factors, including residents’ complex needs, workforce composition, and constraints placed on resource availability. This focused literature review aims to evaluate the current evidence on missed care, including an analysis of the concept, causes, and outcomes of missed care in residential aged care in Australia. Within most of the available literature, missed care is typically considered only within the context of nursing. It is noted that although the nature and identification of missed care were discussed extensively to provide a broad picture of the phenomenon, including possible prevalence and outcomes, they need to explicitly discuss the impact of missed care on residents, families, and other clinical and operational staff. Further research is needed to inform and improve the care of the elders in RACFs, considering this gap in the literature. This review has identified potential areas for enquiry into missed care to inform policy and practice to improve the care of elderly residents in RACFs.

Both Ends of the Leash: Animals in Australian Residential Aged Care Facilities, Views of Experienced Animal Trainers/handlers Working in Residential Aged Care Facilities

ABSTRACT Research on animals in residential aged care facilities (RACFs) mainly focuses on the residents with little concern for animal welfare. Australian RACFs cannot care for residents, making it unlikely they can maintain animal welfare. The One-Health/One-Welfare frameworks support developing animal policies in RACFs. However, inadequate policies places residents and animals at risk. To understand animals’ lived experiences in RACFs, experienced dog-trainers who worked in RACFs were interviewed. These experts were recruited using snowball sampling, with nine participating in semi-structured interviews providing opinions and experiences of visiting and live-in animals in Australian RACFs. The initial inductive coding produced six themes (residents, animals, handlers, staff, facility and policy). However, they noted animal welfare issues and explored them further using deductive coding, re-coding the quotes into four areas: handler, environment, participants and intervention. When residents were the focus of animal interactions, animal welfare became compromised, with dogs being frightened and one accidentally poisoned. Animals in RACFs could suffer poor welfare because of inadequate staffing, training and oversight. To provide safe, ethical animal contact, legislation and guidelines must support policy development for animals in RACFs.

The Attitudes, Beliefs and Perspectives of Registered Nurses on Sleep Health Management in Residential Aged Care Facilities: A Qualitative Study.

To explore the attitudes, beliefs and perspectives of registered nurses (RNs) regarding sleep health and sleep health management of residents living in aged care settings in Australia. Qualitative inductive thematic analysis of semi-structured interviews. Semi-structured interviews were conducted with RNs working in residential aged care facilities using a topic guide between August 2021 and April 2022. Participants were recruited using a convenience-based and snowball sampling approach. Interviews were audio-recorded, transcribed verbatim and inductively analysed for emergent themes. Eighteen interviews were conducted with RNs working in aged care. Thematic analysis of the data derived three main themes: (i) Awareness and observations of sleep health, (ii) assessment and management of sleep disturbances and (iii) barriers to implementing evidence-based sleep health management. It was found that the most common barrier to providing evidence-based sleep health practices was related to workplace constraints. Participants detailed the limitations of the RN's professional role and ability to work autonomously in sleep health practices. Despite the intentions of RNs to implement evidence-based non-pharmacological strategies for sleep health management, pharmacological interventions prevail. Systemic efforts to address organisational constraints in aged care may improve sleep disturbance management and assist with shifting the current attitudes around sleep health in aged care facilities. This study highlights that current sleep health management of residents in residential aged care is inadequate. Upskilling nurses in sleep health care techniques and improving organisational commitment to such care provision are issues urgently required to enhance the sleep health of residents. Current sleep health practices are not evidence-based in residential aged care. Optimising sleep practices in residential aged care that are person-centred is likely to improve quality of life and healthy ageing. No patient or public contribution.

The Psychosocial Impacts of Co-Designed Healing Gardens Among Aged Care Residents With and Without Dementia in Nigeria

Healing gardens are green spaces that support the interaction of humans and elements of nature to improve well-being and quality of life. However, little is known about healing garden use and outcomes in African countries. This study aimed to design a healing garden intervention and measure its impact on psychosocial factors and quality of life of residents and care staff within two residential aged care facilities in Lagos, Nigeria. Each facility’s staff completed the psychosocial measurement tools by proxy for participants between ages 60 and 99, with or without dementia, at baseline and three months following interaction with the garden and completed the garden use observational survey to determine the effect on and use of the garden by care staff and residents. Results revealed an improvement in the quality of life and experiences of agitation but no beneficial change in depression among residents with and without dementia. Further, care staff reported a positive benefit of the garden on their work-life experience and the residents’ well-being. This study provides the base for future research on assessing the impact of healing gardens on persons living with dementia in Africa.

The Pathways to Community Living Initiative (PCLI) for older adults: implementation and outcomes.

To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service. A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.

Medicine communication from hospital to residential aged care facilities: a cross-sectional survey of aged care facility staff.

Continuity of medicines management can be compromised when older people are transferred between hospital and residential aged care facilities. This study explored medicines management practices at facilities during patients' transfer of care from hospital, and staff experiences with medicines information handover from hospitals. An electronic cross-sectional questionnaire sent to all residential aged care facilities within a metropolitan region in Australia, in February 2022. The questionnaire comprised 23 questions covering facilities' profiles, medicines management practices, and medicines management at transfer of care from 2 public hospitals. Of 53 listed facilities, 31 [58.5%] responded. Facilities varied in size ranging between < 50 and up to 200 beds. Twenty-seven [87.1%] facilities offered more than one level of care. Of those 27 facilities, 26 [96.3%] offered dementia care, and 23 [85.2%] offered palliative care. Six (19.4%) solely used hardcopy medication charts. Handover from hospitals to manage patients' medicines at transfer was inconsistent with only 15 [48.4%] reporting consistently receiving appropriate documentation. Residential aged care facilities varied in size and level of care. Diverse processes exist for medicines management. There is inconsistency in information received when residents transfer from hospital to facilities, potentially compromising patient safety.

Modified Oral Health Assessment Tool (M-OHAT) for Residential Aged Care: A Co-Design Protocol

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

COVID-19 and Its Influence on Prevalence of Dementia and Agitation in Australian Residential Aged Care: A Comparative Study

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise.

Antibiogram development for Australian residential aged care facilities.

Knowledge of local antibiotic resistance data, provided by antibiograms (a cumulative summary of in vitro-antimicrobial-susceptibility-test results), can aid prescribing of appropriate empirical antibiotics. This study aimed to explore the feasibility of antibiogram development for residential aged care facilities (RACFs). Retrospective observational study of culture and sensitivity data. Nine RACFs in Queensland, Australia. Available antimicrobial susceptibility results were collected retrospectively for all residents of recruited RACFs from January 1, 2020, to December 31, 2022. Data were managed and analyzed with WHONET software®, and antibiograms were developed in accordance with the CLSI-M39 guidelines. Antibiogram data beyond the standard 12-months and pooling of data from geographically similar RACFs were explored as options to improve feasibility and validity of the antibiograms. The most prevalent bacteria in the RACFs were Escherichia coli and Staphylococcus aureus. Due to the low number of positive cultures (less than 30) for individual RACFs, an annual antibiogram was not feasible. Extending the time-period to three years improved feasibility of antibiograms for E.coli in seven RACFs and S.aureus in five RACFs. Combining the data from closely located RACFs allowed for sufficient urinary and skin swab isolates to produce annual pooled antibiograms for all three years. Use of extended time period antibiograms can provide RACF specific urinary and skin/soft tissue resistance data without the necessity of private pathology provider input. However, pooled syndromic antibiograms can be made available on an annual basis, which may be the preferred option.

Effects of graphene far-infrared and social network interventions on depression, anxiety and dementia in older adults

BackgroundFive-guaranteed elderly individuals are a special group of the elderly Chinese population faced with unique challenges; these individuals lack any financial resources (including support by relatives), and are solely reliant on the government to provide food, clothing, medical care, and housing as well as burials. In this article, we aim to investigate mood problems (depression, anxiety) and cognitive functioning in Five-guaranteed elderly individuals, and to validate the effectiveness of two promising interventions, graphene far-infrared intervention (GFII; an exploratory and noninvasive technique) and social network intervention (SNI), for elderly people to lay the foundation for future social service work.MethodsTo address the emotional and cognitive difficulties experienced by this special group, we designed this study, which is the first to apply GFII in this population. We also administered SNI given the social isolation of these individuals, in addition to a corresponding control group. 108 elderly individuals in 3 elder care facilities were screened to evaluate eligibility to participate in the current study, including 44 from Facility A (allocated to the GFII group), 43 from Facility B (allocated to the SNI group), and 21 from Facility C (allocated to the control group). GFII lasts for four weeks, with professionally trained carers putting on and removing intervention caps for half an hour each day. SNI lasts for three weeks, three times a week, and consists of a total of nine themed activities. The length of an activity is 90 min. We also did pre- and post-test comparisons of depression, anxiety and cognition in each group of older adults.ResultsThe results showed that GFII led to immediate improvements in anxiety and cognitive impairment in the five-guaranteed elderly individuals, and the improvement in cognitive function was sustained over time. Moreover, SNI group showed significant improvements in cognitive function after the intervention period.ConclusionsThe GFII is a promising intervention that can be applied to intervene in cognitive and mood disorders in older adults. The GFII has short-term interventions for anxiety in older adults, but long-term effects for cognitive impairment. SNI also had an interventional effect on cognition.

Exploring determinants influencing the selection of geriatric nursing care services in Thailand Bangkok metropolitan area

The global population structure is undergoing a significant transformation, marked by an increasing number of elderly individuals. Thailand, in particular, is transitioning into an aging society and exhibits the third-highest growth rate in Asia, following Japan and Singapore. This phenomenon is driven by various factors, including economic and social conditions, technological advancements, family dynamics, and evolving lifestyles. Consequently, a growing number of elderly individuals are either living alone or require caregivers and elderly care facilities if they are dependent. This study is prompted by a keen interest in the elderly care service industry, which demonstrates significant potential both currently and in the future. The primary objective of this research is to explore the determinants influencing the selection of Geriatric nursing care and to identify the challenges encountered in delivering these services. The study investigated demographic and social factors, the necessity for elderly care, and the decision-making process in selecting geriatric nursing care. Data was collected through online questionnaires and analyzed, employing both descriptive and inferential statistics, including factor analysis, reliability analysis, and correlations between variables. The target population comprises Thai individuals aged 50 and above residing in Bangkok and its metropolitan areas with a sample size of 426 participants. Findings suggest that demographic factors, excluding occupation, along with social factors, the necessity for dependency, and the decision-making process, affect the selection of Geriatric nursing care in the studied regions.

An agent-based approach to simulating evacuation in elderly care facilities with disabled older adults

Emergencies in elderly care facilities are not uncommon. However, conducting evacuation drills for disabled older adults poses significant challenges due to their physical limitations. While simulation approaches offer a viable alternative, there is a dearth of research focused on evacuation simulation models considering the presence of disabled older adults. This study introduces an agent-based approach designed to simulate the evacuation of older adults within elderly care facilities. The approach incorporates the distinct characteristics and behaviors of nursing staff, self-sufficient, semi-disabled, and disabled older adults during evacuation. The simulation environment replicates the typical architectural layout of single-story elderly care facilities. Two evacuation strategies, specifying the order in which nursing staff assist disabled older adults during evacuation, are proposed. The performance of these strategies under scenarios with varying proportions of disabled older adults and caregiver ratios is compared through simulation experiments. The results indicate that the strategy requiring nursing staff to initially assist the disabled older adults under their responsibility and then seek out and aid the nearest disabled older adults is more effective in reducing total evacuation time in most cases. Furthermore, the impact of the spatial layout of disabled rooms on evacuation efficiency and safety is discussed. The results reveal that the opposite-side center concentration pattern of disabled rooms outperforms other spatial layout patterns of disabled rooms in terms of evacuation efficiency and safety. These findings contribute to the optimization of evacuation strategies and spatial layouts within elderly care facilities by providing quantitative evidence to support decision-makers.

How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system

BackgroundGroup allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context.MethodsAn umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised.ResultsTwo thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control.ConclusionsPrescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions.

Qualitative Comparative Analysis of exercise interventions for fall prevention in residential aged care facilities

BackgroundExercise interventions are highly effective at preventing falls in older people living in the community. In residential aged care facilities (RACFs), however, the evidence for effectiveness is highly variable, warranting exploration of drivers of successful trials. This study aims to identify the conditions of randomised controlled trials (RCTs) that are associated with reducing falls in RACFs and test whether it can explain the variability.MethodsRCTs testing exercise interventions in RACFs compared to usual care, reporting rate or risk of falls from the 2018 Cochrane Collaboration review and a search update to December 2022 were included. Two authors independently extracted and coded trial conditions and outcomes according to a theory developed from prior Intervention Component Analysis. Trial outcomes were coded as successful or unsuccessful based on point estimates for the rate or risk ratio for falls, or p value. Qualitative Comparative Analysis (QCA), utilising Boolean minimisation theory, was conducted to determine the key conditions driving trial success. A subgroup meta-analysis and the GRADE approach was applied to the final theory.ResultsEighteen trials undertaken in 11 countries with 2,287 residents were included. Participants were predominately ambulant females aged 70 to 80 with cognitive impairment. Most interventions were fully supervised or supervised at the start of the intervention. QCA identified two configurations as drivers of successful exercise falls prevention programs: (i) group exercise that is moderate or low intensity, or (ii) for independent ambulatory residents, exercise for more than 1 h per week. The combination of configuration (i) and (ii) had consistency and total coverage scores of 1, indicating all trials were explained. This combination was associated with a reduction in falls (rate ratio 0.45, 95%CI 0.34 to 0.59; risk ratio 0.66, 95%CI 0.53 to 0.82; low certainty evidence).ConclusionTo successfully reduce falls in RACFs, exercise programs should provide continuous supervised moderate-intensity group exercise. For programs that mostly include independent ambulatory residents, exercise for at least 80 min per week should be provided. As many current residents are frail, tailored exercise is likely necessary and an individualised dose may be required. Future trials should test exercise interventions for less mobile residents.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns

IntroductionDuring 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.MethodsA longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.ResultsDuring the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.ConclusionThese findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents’ care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.

Building a culture of safety in Australian residential aged care facilities: protocol for a longitudinal mixed methods research programme

IntroductionThe quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is...

COVID-19 hits care homes: A cross-national study of mortality rates

The COVID-19 outbreak, which most severely impacted older citizens, served as a stress test for residential eldercare facilities. The mortality rates of care home residents varied widely across countries in 2020 before vaccinations became available. Why have some countries been better (or less) able to protect their older citizens in care homes? This article examines the role of specific characteristics of national systems of residential care in enhancing or weakening the capacity of these systems to protect their residents from the pandemic and seeks to draw some lessons for the future. Because the mortality rate in care homes strongly correlates with the overall infection rate within the community, this article adopts an innovative approach to conceptualize and measure the protection capacity of national residential care systems more specifically – that is net of mortality rates within the community. The study makes important contributions to the care policy field. The traditional care regime typology fails to explain cross-national variations in the protective capacity of care homes. Governmental spending on long-term care systems certainly matters for protective capacity but we find that a factor previously neglected by care regime scholars also matters. More specifically, we show that the pattern of staff organization affects protective capacity. Our findings call for a rethinking of care systems in the face of future pandemics.

A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities

BackgroundResidential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.MethodsIn consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government’s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.ResultsIn the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.ConclusionsUnder realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.