Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review

• Published in: Health and social care delivery research 2024-11, Vol.12 (45), p.1-164
• Main Authors: Fitzpatrick, Joanne M, Rafferty, Anne Marie, Hussein, Shereen, Adams, Richard, Rees, Lindsay, Brearley, Sally, Sims, Sarah, Desai, Amit, Harris, Ruth
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; care homes; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 - transmission; covid-19 pandemic; England - epidemiology; Female; Focus Groups; Homes for the Aged - organization & administration; Humans; isolation measures; Male; mixed-methods; Nursing Homes - organization & administration; older people; Physical Distancing; SARS-CoV-2; social distancing; Social Isolation - psychology
• ISSN: 2755-0079; 2755-0079
• DOI: 10.3310/YNTW4569

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources. A mixed-methods, phased design. Six care homes in England caring for older adults. Care home staff ( = 31), residents ( = 17), family members ( = 17), senior health and care leaders ( = 13). A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics. The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents' physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, commu