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Corona virus - effects on people in need of care

Thursday March 12, 2020

People in need of care and, above all, nursing home residents are people who belong to a risk group at risk for SARS-CoV-2 ("Corona virus"): they are usually very old and have previous illnesses. In the group of people over 80, the current state of affairs is around 15 percent.

The residents of nursing homes must therefore be given special protection. But how should relatives behave now and what are the institutions doing?

No disproportionate measures

Even if the illness poses a serious risk for nursing home residents, one should not panic - neither relatives, residents nor facility staff. The behavior of the individual and general arrangements of the facility must be carefully considered. The regulation in the individual facility is largely guided by the "Protection Strategy for Vulnerable Groups" - that is, risk groups - issued by the Robert Koch Institute and the federal and state governments.

Are visit restrictions permitted due to the corona virus?

Visiting restrictions may be necessary in a particularly affected area or by order of an authority or a recommendation from the Robert Koch Institute. This is now the case in most regions. On March 13th, 2020, the state of Bavaria was the first to issue a far-reaching ban on visitors; a similar regulation was announced later that same day for North Rhine-Westphalia. In the meantime, there are regulations and recommendations for behavior in every federal state, some of which have already been adapted several times. The result is that the regulations tend to become stricter and stricter. Here is an overview.

However, in some cases, unfounded bans on visiting or staying in the home are issued for relatives. Here you have to ask about proportionality. This also raises the question of whether a nursing home can simply impose such a visit restriction. Arbitrarily, without an order from the health authorities or higher-level authorities, this may not be decided, since the residents have self-determination and house rights in their own premises.

In general, in such a case, one has to weigh up the institution's duty of care and the individual's right to self-determination. This must always be done on a case-by-case basis or in a specific region if there are corresponding official instructions there.

Are the protective measures for people in need of care sufficient?

The spread of the corona virus ‘in nursing homes makes it clear that the protective measures for those in need of care have so far not been sufficient. With the generally practiced ban on visits, only one source of infection was avoided. The nursing staff themselves represent an equally great danger for the residents. The BIVA-Pflegeschutzbund therefore demands that all staff be tested regularly at short intervals and that access to the residents only be allowed if the tests are negative or antibodies are detected. The lack of protective masks, clothing and disinfectants in many places has probably also led to the spread in the facilities. This is why these and outpatient nursing services must be given the necessary material as a matter of priority. With sufficient protective material, the ban on visits could perhaps even be partially relaxed.

Lonely through Corona?

In general, the residents must be protected, but the measures must also be proportionate. Because visiting bans have a major impact on residents: loneliness is already a major problem in nursing homes. If you follow the assessment of some virologists, the corona virus will continue to spread at least until autumn, probably until next year. Should the residents be in "solitary confinement" until then? The average length of stay in the nursing home is between one and a half and two years, depending on the statistics. This means that many residents would have to spend a large part of their remaining time alone or that their relatives would only see them in the dying phase. Accordingly, almost all countries continue to allow visits that are medically or ethically-socially necessary. An example of this is usually given as accompaniment during the dying process. In some countries, legal guardians, lawyers or notaries can also be admitted to visit if the visit is necessary for their work.

Terminal care must be possible

If an old person is dying and wants to see their loved ones, a balance between hygiene and human dignity must be made on a case-by-case basis. Any insistence on rigid rules leads to unnecessary human cruelty. For one thing, a dying person no longer needs to be protected from a virus. In addition to palliative medical care, he above all needs human, moral and spiritual support in the very last phase of his life. He must have the opportunity to say goodbye to relatives and, if necessary, to sort out important things. On the other hand, a relative who complies with the necessary protective measures should in any case be granted access to a dying relative. Because with the terminal care he takes on part of the care and is therefore comparable in his role to the nursing staff.

Quality checks suspended - measures to support employees

Some drastic measures have now been decided to relieve the staff in nursing homes in view of the corona epidemic. For example, some countries support the nursing staff by ensuring that their children continue to be cared for, for example by the day-care centers whose general operations have been closed.

Another measure is more far-reaching: the MDK will suspend quality controls until the end of September. "People in need of care need comprehensive care and care in a very special way, so we also have to go unusual ways," said the vice-head of the National Association of Health Insurance Funds, Gernot Kiefer, the editorial network Germany. Normally, the medical service of the health insurance companies (MDK) regularly checks on site how the residents are being cared for. Comprehensive test reports are created from this information and data provided by the nursing homes themselves. However, the controls bind caregivers, which the suspension now prevents.

How should institutions proceed?

It is crucial that the hygiene regulations are complied with one hundred percent at the moment (hand hygiene, disinfection, cough and sneeze labels, etc.). The institutions should not only implement these precisely for their employees, but also educate residents and visitors about them and remind them again and again. You can also seek advice from your local health department before deciding on excessive measures on your own initiative. Depending on the frequency of infection, group activities can be restricted, for example, and a risk assessment should be carried out on a regular basis. It is particularly important that the nursing staff react early if they show symptoms of illness themselves so that they do not infect anyone.

The Robert Koch Institute has published information on the prevention and management of diseases in nursing homes on its website (as of April 3, 2020). Accordingly, the following applies:

  • Even outside of the direct care of COVID-19 patients, the general wearing of mouth and nose protection is recommended by all staff who have direct contact with particularly vulnerable groups for reasons of patient protection during the pandemic.
  • If respiratory diseases or febrile illnesses occur, clarification for SARS-CoV-2 should be considered
  • Put up information for visitors (e.g. notices) that they should not go to the nursing home if they have an acute respiratory disease.
  • Visiting regulations should, if necessary, be coordinated with the health authorities.
  • Employees with acute respiratory illnesses should stay at home
  • The health status of newly admitted residents should be ascertained; people with respiratory illnesses or febrile illnesses should be presented to the attending physician so that they can decide how to proceed.
  • Sick residents with respiratory illnesses or febrile illnesses should be cared for in the room.
  • General information for employees, residents and their visitors about the efforts made to protect the residents.
  • Hand disinfectants and disposable handkerchiefs should be available in all areas, including the residents' living areas.
  • Appropriate protective equipment should be used when caring for people with fever or respiratory diseases.
  • Protective equipment and instructions for its use should be placed immediately in front of the living areas.
  • Rubbish bins for disposing of single-use items should be placed inside in front of the door.
  • If you are taken over by or transferred to another facility, you should be informed in advance about a respiratory disease or a suspected COVID-19 disease.
  • The health of the staff must be monitored.

You can find this and other information on the website of the Robert Koch Institute.

What should relatives consider now?

We recommend all relatives to keep themselves informed, to strictly follow the hygiene rules and to skip a visit with cold symptoms. The regulations, decrees and recommendations of the individual federal states can be found bundled on a separate page.

If the risk situation makes a visit impossible, you should contact the facility. Maybe you can at least hand in the fresh laundry you need, have a video call or just write a letter so that the resident doesn't feel so lonely. In many cases, residents can leave the facility for a walk, for example. Check with the facility to see if you can join them at a safe distance. Some institutions have also developed new ideas for establishing contacts.

Exaggerated reactions - both insisting on the visit in spite of one's own illness, as well as completely stopping the visits by the facility for no further reason - are not very effective and may even be harmful. Scare tactics do not help anyone and can be an additional burden in the nursing home. It is also important to take the psychological stress off people who are older and in need of care in many ways particularly at risk. Now completely turning everyday life inside out will certainly increase their stress. Relatives who are refused a visit due to an unauthorized decision by the facility can get support from the BIVA advisory service.

What can relatives do?

Relatives can do something for their relatives in the nursing home despite the restrictions and bans on visits. Here are some tips:

  • Take your time and explain the Covid 19 disease to your relatives and why the current measures need to be taken. Assure them that you will think of them intensely and that contact will be maintained in other ways.
  • Regular telephone calls, possibly with pictures, letters, photos or pictures painted by the grandchildren can help to compensate for the missing visits.
  • Involve your relatives as much as possible in everyday life, ask them for your opinion and their wishes.
  • Show your solidarity through symbolic actions such as shopping services etc. It should also still be possible to hand in fresh laundry. The best thing to do is to contact the facility management to determine which approach is preferred.

Vaccination protection is more important than ever

Due to the current restrictions on visits to nursing homes, vaccinations may not be possible. After the crisis at the latest, everyone should check their vaccination protection and that of their relatives.

More than ever, comprehensive vaccination protection is of great importance for the vulnerable group of residents of care facilities. This also applies to relatives and nursing staff in order to keep the risk of infection as low as possible. Even if a vaccine against the Sars-CoV-2 virus is not yet available, vaccinations can prevent additional infections that can be associated with a disease caused by COVID-19.

The often neglected pneumococcal vaccination, which can protect against bacterial pneumonia and sepsis, has long been recommended by the Robert Koch Institute for older people aged 60 and over. Now this vaccination is of particular importance for seniors. With COVID-19 particularly affecting the respiratory tract, everything should be done to prevent additional infection from pneumococci, which attack the lungs. Relatives should ensure their own vaccination protection in order to keep the risk of infection for their loved ones as low as possible. If the nursing home resident himself is not vaccinated, relatives can arrange for such a vaccination to be given.

The nursing staff themselves are not allowed to carry out these vaccinations. A doctor must always be present. In order to organize this, it is advisable to talk to the management of the facility. Relatives should also ask to what extent the staff themselves have been vaccinated.

Good vaccination protection for residents also includes the current flu vaccination, which must be renewed annually. It is important for residents, relatives and caregivers. Even if the vaccination protection only has an effect of 50 to 60 percent, it can still be of crucial life-saving importance for some of those affected. A double infection by flu and corona viruses would drastically increase the threat to health.

Nursing rescue parachute supports the care of those in need of care

The corona pandemic also poses major financial challenges for society. The nursing care funds therefore support the nursing homes, outpatient nursing services and also those in need of care themselves with a financial rescue package and temporarily forego various formalities. You can find detailed information on this from the National Association of Statutory Health Insurance Funds here.

The BIVA care protection association

supports people in need of care and their relatives with information, training and advice on a case-by-case basis and strengthens their rights through political lobbying. The association is independent and non-profit.

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