Old-age care homes in western India seemed to have a very low infection rate and lower number of Covid-19 deaths, a new study by the Indian Institute of Public Health (IIPH) at Gandhinagar has found. Only four deaths and 146 Covid infections among a total of 1,573 residents were reported at the 44 care homes included in the study.
Dr Dileep Mavalankar, Director of IIPH and Dr Jallavi Panchamia, assistant professor at the institute studied the impact of Covid-19 on 44 old-age care homes across Gujarat, Maharashtra and Rajasthan during September-November 2020.
Of the 44 homes, 17 were included from Maharashtra, 14 from Rajasthan and 13 from Gujarat. There were 2,114 persons at the homes before the lockdown in March this year. However, to stave off the infection spread among the inmates, an average 26% of the occupants were sent back home to decongest the care homes. Of the 1,573 persons at the homes, 598 were from Maharashtra, 525 from Gujarat and 450 from Rajasthan. A total of 146 persons got infected with Covid, of which 71 were from care homes in Maharashtra, 41 from Gujarat and 34 from Rajasthan. A total of four died, of which two were from Gujarat and one each from Rajasthan and Gujarat.
Researchers pointed out that in the initial months of the pandemic, community care facilities, including nursing and residential homes, were termed as “hubs” and “besieged castles” in North America and Europe, having experienced large outbreaks due to rapid transmission of SARS-CoV-2. whereas, Canada experienced a high number of coronavirus-related deaths in elderly care homes, as per a Canadian Institute for Health Information report.
As per global reports, England and Wales observed 45,899 deaths among care home residents between March 2 and May 2 and 12,526 got infected by Covid-19. Similar trends were observed in France, Spain and the United States, where only limited measures were taken.
“However, there were not many studies that reported data on the numbers of elderly residents of long-term care facilities such as nursing homes, old age homes, who might have been infected or died from confirmed or suspected coronavirus in India,” Dr Mavalankar said.
The elderly population is by far the most vulnerable group and at high risk of infection of Covid-19. It has become significant to take extra care of elderly persons at home, but this became a huge challenge in case of old-age homes, as all occupants needed special care to avoid getting infected. “Our study – via structured interviews of managers or owners of care homes- explored the situation in the states where a higher number of Covid cases were reported,” Dr Panchamia said.
Home administrators first stopped all contact with the outside world as much as possible. To stop the infection from spreading in the homes, it was ensured the staff were made to live temporarily at the old age homes, thus preventing contact with the outside world.
It was found that 100 per cent of the homes were equipped with thermometers, 95 per cent with blood pressure equipment, 70 per cent with oximeters, but only 5 per cent were equipped with oxygen cylinders. All homes had regular visits from doctors, although the frequency varied from weekly to monthly. In fact, three care homes had resident doctors for medical emergencies and well-equipped hospitals to refer to. While two homes had a difficulty reaching out to hospitals during referral and the availability of ICU beds for COVID patients, 80 per cent of the care homes had a facility of isolation and quarantine ready if any cases arose.
Only 18 per cent of the care homes faced staff shortage and higher absenteeism during and after the lockdown period, mainly because of their locational disadvantage of being far from the city and a lack of residential areas nearby. 85 per cent of the care homes were adequately funded and had no issues with resource allocation to meet the needs of residents, but in 15 per cent of the care homes, the situation was the opposite as resources were scarce to meet requirements.
“Most care home administrators brought about dietary changes and added certain physical activities to the routine of residents to keep them engaged and healthy. It was challenging for some homes, that were managed on shoe-string budgets by non-professional philanthropic organisations, to ward off the probability of infection spread among their residents. Generally, they would take their residents for short excursions to nearby areas to bring some change in their monotonous daily routines, but this could not be done due to this unprecedented pandemic. Most home administrators mentioned this situation as challenging,” the researchers said.
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