Dataset Information

COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

ABSTRACT: The COVID-19 pandemic constitutes an exceptional risk to people living and working in nursing homes (NHs). There were numerous cases and deaths among NH residents, especially at the beginning of the pandemic when no vaccines had yet been developed. Besides regional differences, individual NHs showed vast differences in the number of cases and deaths: while in some, nobody was affected, in others, many people were infected or died. We examine the relationship between facility structures and their effect on infections and deaths of NH residents and infections of staff, while considering the influence of COVID-19 prevalence among the general population on the incidence of infection in NHs. Two nationwide German surveys were conducted during the first and second pandemic waves, comprising responses from n = 1067 NHs. Different hurdle models, with an assumed Bernoulli distribution for zero density and a negative binomial distribution for the count density, were fitted. It can be shown that the probability of an outbreak, and the number of cases/deaths among residents and staff, increased with an increasing number of staff and the general spread of the virus. Therefore, reverse isolation of NH residents was an inadequate form of protection, especially at the beginning of the pandemic.

SUBMITTER: Preuß B

PROVIDER: S-EPMC9819748 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

Preuß Benedikt B Fischer Lasse L Schmidt Annika A Seibert Kathrin K Hoel Viktoria V Domhoff Dominik D Heinze Franziska F Brannath Werner W Wolf-Ostermann Karin K Rothgang Heinz H

International journal of environmental research and public health 20221229 1

The COVID-19 pandemic constitutes an exceptional risk to people living and working in nursing homes (NHs). There were numerous cases and deaths among NH residents, especially at the beginning of the pandemic when no vaccines had yet been developed. Besides regional differences, individual NHs showed vast differences in the number of cases and deaths: while in some, nobody was affected, in others, many people were infected or died. We examine the relationship between facility structures and their ...[more]

PMID: 36612931

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Project description:BackgroundDemographic changes are leading to a rise in the demand for care services, with nursing homes (NHs) playing an increasingly important role in end-of-life care. Evidence suggests that NH residents at the end of life significantly benefit from hospice and palliative care and the implementation of advance care planning (ACP). In 2018, Germany passed a law to promote the implementation of ACP in NHs and to enable the refinancing of ACP services by the statutory health insurance funds. The present study aimed at assessing current hospice and palliative care structures, examining the implementation of ACP and identifying barriers to obtain approval for billing for ACP services under this specific legislative (§ 132 g SGB V).MethodsAs a part of the "Gut-Leben" project, the present study administered a cross-sectional quantitative survey in 2023 to evaluate hospice and palliative care structures, the implementation of ACP, and barriers to ACP approval in German NHs. A questionnaire was distributed to a random sample of N = 1,369 NH managers. Responses were analyzed using descriptive statistical methods.ResultsN = 330 NH managers responded to the questionnaire (24.1% response). The majority described the end-of-life care structures in their region as rather good (77.7; n = 256), and very strong collaboration was reported with general practitioners (54.7%), physiotherapists (42.9%), and palliative care physicians (38.6%). Awareness of the legislative for ACP was reported by n = 201 NHs (64.4%), and 100 (50.3%) of these NHs had already obtained approval. The primary barriers to approval identified by 68 NHs included a lack of available staff (48.5%; n = 33) and a small facility size (27.9%; n = 19).ConclusionsAlthough half of the NHs have implemented ACP, there is still a need to enhance awareness of the ACP legislative. These efforts should aim to reduce the existing barriers to approval, which could be achieved, for instance, by fostering collaboration between NHs or by cooperating with external ACP service providers.

Project description:BACKGROUND:Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. METHODS:A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. RESULTS:486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. CONCLUSIONS:Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

Dataset Information

COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

Publications

COVID-19 in German Nursing Homes: The Impact of Facilities' Structures on the Morbidity and Mortality of Residents-An Analysis of Two Cross-Sectional Surveys.

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