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Document Type
Rapid Review
Review Code
LTC220101 RR
Question Submitted
January 19, 2022
Date Completed
January 27, 2022
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC220101 RR
Question Submitted
January 19, 2022
Date Completed
January 27, 2022
Status
3. Completed
Research Team
Long Term Care
Key Findings
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
Category
Administration
Healthcare Services
Subject
Long Term Care
Family
Elderly
Health Planning
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 2 One week (7 days)
Cite As
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).
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Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
No evidence was found as rationale for the 14-day isolation period on resident transition to LTC. This requirement likely arose from evidence that active monitoring for 14 days is sufficient to identify symptom onset in 99% of COVID-19+ cases (1).
No alternatives were found in Canada to a 14-day isolation period on transition of a resident into LTC. A rapid review of viral shedding and the need for isolation recommends a minimum 10-day isolation period, with additional consideration for high risk groups (36). The Centers for Disease Control and Prevention (2) in the US is considering decreasing the standard 14-day quarantine period to 7-10 days in recognition that the general two-week quarantine rule is onerous for many people and most of the benefit of quarantine to public health could be gained with a more flexible and contextual approach. Implications for changes in Public Health Agency of Canada’s (PHAC) policy on quarantine or duration of isolation for admission to LTC are not yet established.
The Canadian policies at the provincial government levels align with the PHAC’s recommendation of 14 days of isolation (14). Most jurisdictions across Canada follow guidelines requiring a resident to have a negative test on admission, and 14 days of self-isolation with contact and droplet precautions (4, 17).
However, a few jurisdictions stratify the level of precaution or need for isolation by community transmission (3, 5). For example, the Province of Alberta’s (5) Operational and Outbreak Standards for LTC recommends the following safety precaution: for residents with low or unknown risk of exposure, twice daily symptom checks for 14 days; for residents with medium risk, continuous use of a mask for 14 days while out of resident room; for residents with high risk, quarantine for 14 days. Best practices on transition to LTC to support residents’ well-being
Some Canadian policies state the importance of protecting resident well-being on transition to LTC but provide little guidance on how to ensure this is done. For residents who might find self-isolation challenging (e.g. those with cognitive challenges), Government of New Brunswick (18) recommends taking efforts to ensure adequate staffing level and support residents’ individualized care plan.
Residents in LTC who have cognitive impairments will have difficulties understanding the need for isolation and absence of families and friends, and complying with isolation procedures (31). There is little guidance for long-term care facilities on how to support safe isolation of those living with cognitive impairments, while maintaining the human dignity and personhood of the individual. Strategies need to be developed to have an isolation care planning that is effective, safe, and compassionate (31).
Maintaining connections between residents and their families should be supported under safety, socio-emotional, and ethical grounds (39). Several provinces and international jurisdictions designate Essential Family Caregivers (EFCs), who are present not for social visits but to provide services and brought into the facilities under the same specific protocols as staff (39, 49, 50, 51).
Category
Infection Prevention and Control
Administration
Subject
Facilities
Self-Isolation
Long Term Care
Health Planning
Elderly
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 5 completed within 2 weeks
Cite As
Gao, Y; Ward, H; Tupper, S; Boden, C; Miller, L; Mueller, M. What is the evidence for 14-day isolation upon move-in to long-term care during COVID-19 pandemic? 2020 Dec 13; Document no.: LTC090801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
LTC060202 RR
Question Submitted
June 2, 2020
Date Completed
June 19, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC060202 RR
Question Submitted
June 2, 2020
Date Completed
June 19, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
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.
Category
Epidemiology
Healthcare Services
Subject
Clinical Presentation
Transmission
Infection Prevention and Control
Elderly
Priority Level
Level 5 completed within 2 weeks
Cite As
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)
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Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
· Overall, there is a lack of high quality evidence to support recommended pandemic preparedness strategies (checklist items) to prevent or mitigate respiratory infection outbreaks in LTC. · In the absence of high-quality or mixed evidence to support strategies for pandemic preparedness, it is advisable to follow clinical practice guideline recommendations that have been based on expert opinion (key sources are identified in red). This is particularly the case for infection control interventions that are likely to have no negative impacts on LTC residents (e.g. hand hygiene, cough etiquette). Strategies that have a potential negative impact on LTC residents (e.g. visitor restrictions) must be handled with more flexibility and individual assessment to determine how infection control can be preserved while minimizing negative consequences for residents and families. · Internationally recognized pandemic/outbreak preparedness checklists for LTC (e.g. CDC 2020, Buynder et al. 2017) share many similarities to the current SHA Annex R checklists. · Consideration should be given to converting the checklist into a planner with accountabilities to demonstrate how each item is being addressed (similar to CDC 2020). Links can be embedded in the planner/checklist to more detailed information, such as the PPE burn calculator (CDC 2020), education/training materials (WHO 2020), and communication materials for families (CDC 2020, WHO 2020, Buynder et al. 2017). · Consider the addition of specific detail to the SHA pandemic preparedness checklists on the date of the next pandemic plan/checklist review, contact names for local resource acquisition or assistance with staffing, tracking forms for dates of education/training with staff and residents, tracking of audits/observation of infection control practices, surge capacity planning items, and expanded items for communication (see attached recommendations from family caregivers of the Saskatchewan LTC Network). · Discrepancies exist between reported (77-100%) and observed (25-63%) adherence to infection control practices, indicating a need for independent audits. Adherence rates improve with direct observation, frequent education reminders and prompts. · Even when there is not an outbreak in a home, the pandemic response results in increased workload demands on staff due to infection control practices (e.g. PPE and hand hygiene), loss of family caregiver assistance with resident care, enhanced care needs of residents due to anxiety, increased communication with family caregivers and other members of the care team, monitoring and restricting resident movement in the home, enhanced cleaning, staff absenteeism, and education/training. Consideration is needed for a provincial process for evaluation of needs within individual homes, and allocation of additional human resources, disposable supplies, equipment, or funding to ensure that both infection control and usual care needs of residents are consistently met. · Maintaining public confidence through communication is a defined infection control strategy. Communication strategies include individual communication between family members and staff, public communication strategies by individual facilities and provincially through dedicated pandemic information pertaining to LTC (e.g. dedicated LTC section on provincial websites).
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST rapid review report)
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