Lessons Learned from the COVID-19 Pandemic in Nursing Homes: A Systematic Review

Abstract

Nursing homes are one of the hardest-hit environments in terms of mortality from COVID-19. Given the reactive management of the pandemic, it is necessary to reflect on, and answer, the question as to which good practices (interventions) were implemented in care homes (population) to improve management and care quality (outcomes). This systematic review aimed to identify and describe good practices adopted in care homes during the COVID-19 pandemic or other recent epidemics. We conducted searches in Embase, PubMed, ScienceDirect, ProQuest Central, and Scopus over the period 1-30 November, 2021, using the descriptors "nursing homes", "long-term care", "long-term care facilities" and "COVID-19"; and the keywords "learnings", "lessons", "positive learnings", "positive lessons", "SARS", "MERS", "COVID-19" and "pandemic". We identified 15 papers describing 14 best practices and 26 specific actions taken for COVID-19 management in long-term care facilities. Following the IDEF methodology, the practices were classified into strategic processes (staff training, communication with the national health system, person-centered care, and protocols), operational processes (cohorts, diagnostic testing, case monitoring, personal protective equipment, staff reinforcement, restriction of visits, social distancing, and alternative means for communication with families) and support processes (provision of equipment and hygiene reinforcement). Fifty percent of practices were likely to be maintained beyond the outbreak to improve the operation and quality of the long-term care facilities. This review summarizes the most common measures adopted to manage the COVID-19 pandemic in the context of increased vulnerability and highlights the deficiencies that must be addressed.

Keywords: COVID-19; long-term care; nursing homes; pandemic; residential facilities.

Figure 1

PRISMA 2020 flow diagram.

Figure 2

Good practices according to the IDEF model.

Figure 3

Frequency of good practices according to their categories. Comm.: Communication; Eqpt.: Equipment; HCWs: healthcare workers; JGSS: Japan Geriatrics Society Subcommittee; NHS: national health system; PPE: Personal protective equipment; w/: with. * Practices maintain beyond the pandemic. Those practices not marked with an asterisk apply only during the pandemic. Refs. [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].