Integrated delivery and continuity of care in times of crisis
Ensuring continuity of care in response to the Covid-19 crisis has been a key issue for public health and social care services across Europe. Whilst the implementation of local partnerships for integrated care delivery have been identified as a success factor, in many cases the reality on the ground has been one of a fragmented market. One, where providers of home care, residential care and supported living have been under pressure due to the lack of protective equipment, the fear of infection, and a reduction in the number of professionals.
Still a fragmented un-resourced system
In light of the Covid-19 crisis, care services have been reaping a bitter harvest of years of failure to invest adequately in public health and social care systems. While older people’s care services have been affected across Europe, the situation has been particularly difficult in two countries: the UK and Spain.
In Spain, the national government issued measures and recommendations covering all regions regarding emergency accommodation, home care, and care homes for older people. A protocol was issued to support health services with the discharge of older people; as a result, buildings were adapted to accommodate old people who were discharged from hospital and had additional needs.
However, seven in 10 deaths from coronavirus happened among older people, many of whom lived in care homes. There has been a lack of coordination between hospital and social care. The "Círculo Empresarial de Atención a Personas (CEAPS)" (1), the confederation of employers in people’s care, published a report on the situation faced by care homes during the pandemic. Their analysis highlights that the delivery of personal protection equipment (PPE), masks, gloves, gowns, disinfectant gels, and tests were prioritised for hospitals over nursing homes. This did not comply with government announcements and protocols to deliver PPE in nursing homes following the virus outbreaks in March and April.
There was also a fall in the numbers of care workers in home care for three main reasons. Many fell sick, and it is estimated that there were three times more casualties amongst social care workers. Many were reluctant to work due to fear of becoming infected (exacerbated by a lack of PPE). They were sometimes told not to work and self-isolate even without being tested. Or they moved to work at hospitals where they were paid higher salaries.
In the UK, adult social care providers highlighted that the cost of PPE rose very substantially. Ordering of PPE from existing suppliers became extremely challenging. Whilst the national health service (NHS) had a national system for the distribution of PPE, social care has been reliant on using existing suppliers with the consequent difficulties in accessing protective equipment.
The focus on partnership revolved around discharge hubs that aimed at discharging people who do not need to be in hospital in 2 hours. However, social care settings needed to be well-resourced to treat and contain the infection when accepting hospital discharge. Instead, care homes highlighted that cases were discharged into care settings that were unprepared without the capacity to conduct tests and no PPE to prevent further transmission.
Lessons learnt: reinforce home care and advance coordination
Advancing the coordination of health and social care is one of the key lessons learnt during the Covid-19 crisis. This would involve resourcing social care settings to allow for the integrated provision of hospital-related care and social support in situations of public health emergency. For instance, deploying health workers in social services facilities including those for older people and adults with physical or intellectual disabilities, children’s homes, homeless shelters, and therapeutic communities. Public authorities should reinforce these facilities with robust testing, protective gear, as well as specific prevention and care guidelines for crisis situations like the ones caused by the coronavirus.
In addition to deploying health care workers into other settings, giving social care and social services staff parity of esteem with health care is fundamental. This parity, by recognising them as essential workers, would ensure that national governments in partnership with regional and local authorities will then be required to ensure the supply of protective equipment to workers who provide home care and residential services.
Investing in the adaptation and reinforcement of home care services would certainly contribute to a more integrated delivery of care for those who need it. This would involve at least three main actions. First, focusing on people with little family support and high dependency needs in the provision and preparation of meals, dispensing medication, assistance with postural changes or personal hygiene needs. Second, doing the shopping for older people or people with disabilities to minimise their risk of getting infected or injuring themselves. Third, ensuring the safety of older people in their own homes by intensifying contact with them through the phone and telecare.
All these measures must be carried out to prevent the spread of the virus among those most vulnerable and workers themselves and ease the burden on health systems in future situations of emergency, including a potential second wave of the pandemic.
(1) Círculo Empresarial de Atención a Personas (CEAPS). Available at: http://ceaps.org/descarga-de-documentos/
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