As essential partners in care, family caregivers support feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision-making. 1,2,13,14,15,16,17 Prior to the pandemic, research indicates that on average, 37.4 hours of informal care was provided in LTC per resident each month by informal caregivers, most often described as family. 3 Visitor restrictions inclusive of family caregivers reduced available resources for resident care, intensifying staff shortages.1,2,3,5,13 Designation of essential caregivers, distinct from general visitors, in policy and legislation was in part recognition of these roles and contribution to resident care.1,2,13
Prior to the pandemic, the role family caregivers in providing care for other residents was described as evolving over time as family members and friends become familiar with the needs of other residents. Roles described by family members in their care of other residents include providing companionship, assisting with meals, bring additional food or supplies when brought for their own family member, and assisting with leisure activities. 17
LTC volunteers roles during the pandemic reduced their activities to maintaining (limited) activities for residents, assisting residents with use of technology to communicate with family/physicians, and providing emotional support.4
A commentary article describes an example of family caregivers who were hired on short (90 day) contracts to care for residents during acute staffing shortages (Kensington Health 2021).5 Personal communication intended as an environmental scan (AB and ON) spoke to the variability of staffing needs and the individualized response by LTC homes to address these staffing shortages. If family caregivers were to be invited to provide additional resources in the context of staff shortages, this decision was made by individual homes, in communication with residents and families and aligned with provincial visitation policy.
During the pandemic, a new paid role of comfort care aide was also created by Alberta Health Services The job involved providing comfort, support and assistance to residents, portering residents, mealtime assistance, ensuring PPE was always available, refilling equipment and care supplies as needed, cleaning and disinfecting high touch surfaces, supporting reception duties, supporting screening of staff and visitors, receiving deliveries and stocking supplies, and performing other duties as assigned.6
Myge, I; Ward, H; Tupper, S; Fox, L; Howell-Spooner, B. What are the roles or function of family caregivers in providing care to other residents in LTC? 2022 Jan 27, Document no.: LTC220101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 13 p. (CEST rapid review report).
The majority of studies show elderly persons (>65 years) have significantly longer COVID-19 incubation periods compared to younger adults with a mean difference of +3.9 days (Lieu J et al. 2020; Kong TK et al. 2020; Jiang et al. 2020; Guo et al. 2020). One study showed no difference between those >60 years and younger patients (Lian et al. 2020).
Median incubation period across all studies (all ages) was 5 days (5.4 days mean). Jiang et al. (2020) report a mean incubation period of 7 days for younger adults and 10.9 days for those over age 65.
Upper limit of incubation period is 12-14 days with one study reporting 27 days (Nanda et al. 2020).
Median duration from symptom onset to death is 11.5 days in persons >70 years vs. 14 days in younger adults (Geriatric Emergency department collaborative March 2020).
Older age and more severe infections are associated with higher viral loads; however, viral shedding is not associated with infectivity. (European Centre for Disease Prevention and Control, 2020).
Doubling time of COVID-19 among residents from a single long-term care home was estimated to be 3.4 days compared to 5.5 days in the general population in the surrounding county (Arons et al. 2020).
Infected patients over the age of 65 years remain contagious for a significantly longer period (22 days vs. 19 days, p=0.015; Ziao et al. 2020).
Viral shedding may be longer for immune compromised patients (BC CDC 2020).
Symptom duration varies by nature of the symptom with a median time from diagnosis to discharge from hospital ranging from 13 days (range = 7-17; Ki et al. 2020) to 18.5 days (range = 11-27; Kim et al. 2020).
There is limited information on basic reproduction number in older adult populations. These values vary by region and over time. R0 values for whole populations (all ages) have been reported as low as 0.48 (Ki et al. 2020) to 2.5 (Lewnard et al. 2020)
Please see related reports by the Laboratory Working Group available in the SHA COVID-19 repository (not specific to elderly).
o LAB041601 RR Antibody development, viral shedding and infectiousness.
o LAB040701-01 RR Proportion of disease transmission due to asymptomatic, pre-symptomatic and symptomatic cases.
Tupper, S; Ward, H; Dalidowicz, M; Ellsworth, C. What is the incubation period, rate of spread, and duration of infectivity of COVID-19 in older adults? 2020 Jun 19; Document no.: LTC060202 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 28 p. (CEST rapid review report)
Dalidowicz, M; Ellsworth, C. What is the incubation period, rate of spread, and duration of infectivity of COVID-19 in older adults? 2020 Jun 12; Document no.: LTC060202-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 25 p. (CEST evidence search report)