Care trajectory in homes care users across mortality-risk profiles: an observational study.

Objectives RESPECT is a prognostic tool, developed using linked population-based data, to predict 6-month mortality in community-dwelling older adults. RESPECT is implemented and openly accessible as a web-based tool on ProjectBigLife.ca, where over 700,000 calculations have been performed to date. Our objective was to describe healthcare utilization patterns among home care (HC) users across mortality risk profiles generated from RESPECT to inform care planning for older persons who have varying mortality risks and levels of care needs as they decline. Approach We conducted a retrospective cohort study examining healthcare use among HC users in Ontario, Canada, who received at least one interRAI HC assessment between April 2018 and September 2019.  Using linked health administrative data at the individual level, we examined the use of acute care (hospitalizations and emergency department (ED) visits), long-term care (LTC), and palliative home care within 6-months of each assessment and prognostication using RESPECT. Mortality risk profiles from RESPECT were created based on the median survival. Results The cohort comprised 247,377 community-dwelling older adults; 14.3% died within 6-months of an assessment. Among decedents, half (51.51%) of HC users with a predicted median survival of less than 3-months received at least one palliative care home visit; 39.17%, 34.82% and 13.84% visited the ED, were hospitalized, or were admitted to LTC, respectively. The proportion of assessments that received at least one palliative HC visit declined to 43.11% and 30.28% of assessments with a median survival between 3- and 6-months and those between 6-months and 12-months, respectively.  The proportion of assessments with an acute care use increases with increasing median survival. Conclusion A considerable proportion of people at the end-of-life do not receive any palliative home care and continued to be institutionalized. This may be indication that the reduced life expectancies and palliative care needs of many older adults are not being recognized, thus demonstrating the value of prognostic models like RESPECT to inform care planning  for individuals in their final years of life

Risk Recognition Policies for the Long-Term Care Workforce during the First Year of the COVID-19 Pandemic: A Multi-Country Study

Context: The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community aging care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. Objective: This analysis sought to review policy measures targeting the long-term care workforce across seven high income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work. Method: Environmental scan of publicly available policy documents and government news releases published between March 1, 2020 and March 31, 2021, across seven high income jurisdictions. Findings: While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK. Limitations: Our analysis did not include additional policy measures such as sick pay or recruitment incentives. We also relied primarily on publicly available policy documentation. In some cases, documents had been archived or revised, making it difficult to ascertain and clarify original information and amendments. Implications: While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes

PROTOCOL: Exploring education to support vaccine confidence amongst healthcare and long‐term care staff amidst the COVID‐19 pandemic: A protocol for a living scoping review

Abstract Despite the demonstrated effectiveness of vaccines, varying levels of hesitancy were observed among healthcare and long‐term care workers, who were prioritized in the roll out of COVID‐19 vaccines due to their high risk of exposure to SARS‐CoV‐2 transmission. However, the evidence around the measurable impact of various educational interventions to improve vaccine confidence is limited. The proposed scoping review is intended to explore any emerging research and experiences of delivering educational interventions to improve COVID‐19 vaccine confidence among health and long‐term care workforces. We aim to identify characteristics of both informal and formal educational interventions delivered during the pandemic to support COVID‐19 vaccine hesitancy. Using the guidance outlined by the Joanna Briggs Institute, we intend to search five databases including, Ovid MEDLINE and Web of Science, as well as grey literature. We will consider all study designs and reports in an effort to include a breadth of sources to ensure our review will capture preliminary evidence, as well as more exploratory experiences of COVID‐19 vaccine education delivery. Articles will be screened by three reviewers independently and the data will be charted, and results described narratively

Exploring COVID‐19 education to support vaccine confidence amongst the general adult population with special considerations for healthcare and long‐term care staff: A scoping review

Abstract Background Despite the demonstrated efficacy of approved COVID‐19 vaccines, high levels of hesitancy were observed in the first few months of the COVID‐19 vaccines' rollout. Factors contributing to vaccine hesitancy are well‐described in the literature. Among the various strategies for promoting vaccine confidence, educational interventions provide a foundationally and widely implemented set of approaches for supporting individuals in their vaccine decisions. However, the evidence around the measurable impact of various educational strategies to improve vaccine confidence is limited. We conducted a scoping review with the aim of exploring and characterizing educational interventions delivered during the pandemic to support COVID‐19 vaccine confidence in adults. Methods We developed a search strategy with a medical information scientist and searched five databases, including Ovid MEDLINE and Web of Science, as well as grey literature. We considered all study designs and reports. Interventions delivered to children or adolescents, interventions on non‐COVID‐19 vaccines, as well as national or mass vaccination campaigns without documented interaction(s) between facilitator(s) and a specific audience were excluded. Articles were independently screened by three reviewers. After screening 4602 titles and abstracts and 174 full‐text articles across two rounds of searches, 22 articles met our inclusion criteria. Ten additional studies were identified through hand searching. Data from included studies were charted and results were described narratively. Results We included 32 studies and synthesized their educational delivery structure, participants (i.e., facilitators and priority audience), and content. Formal, group‐based presentations were the most common type of educational intervention in the included studies (75%). A third of studies (34%) used multiple strategies, with many formal group‐based presentations being coupled with additional individual‐based interventions (29%). Given the novelty of the COVID‐19 vaccines and the unique current context, studies reported personalized conversations, question periods, and addressing misinformation as important components of the educational approaches reviewed. Conclusions Various educational interventions were delivered during the COVID‐19 pandemic, with many initiatives involving multifaceted interventions utilizing both formal and informal approaches that leveraged community (cultural, religious) partnerships when developing and facilitating COVID‐19 vaccine education. Train‐the‐trainer approaches with recognized community members could be of value as trust and personal connections were identified as strong enablers throughout the review