Alice Ashwell PhD, Dementia Connections, on behalf of STRiDE South Africa
STRiDE (Strengthening Responses to Dementia in Developing Countries) is an international research programme investigating the status of dementia care in seven developing countries. In South Africa key partners include the University of Cape Town and Alzheimer’s South Africa.
With the outbreak of the Covid-19 pandemic, STRiDE decided to investigate how long-term care facilities in South Africa that care for people with dementia were coping. The initial report is available online at https://ltccovid.org/2020/07/13/the-impact-of-covid-19-on-long-term-care-facilities-in-south-africa-with-a-specific-focus-on-dementia-care/.
This article provides brief feedback from the initial survey, which took place at a time when relatively few care homes had experienced infections.
STRiDE is tracking the impact of the Covid-19 lockdown as it unfolds and is currently inviting care homes to participate in the second phase of the survey.
Should you wish to share your experiences and insights, please contact Dr Alice Ashwell [firstname.lastname@example.org | 0827207444] for a copy of the short questionnaire.
The response of South Africa’s long-term care sector to Covid-19 has been nothing short of heroic. Having heard terrible stories of infections and deaths suffered by a number of elder care facilities in Europe and the United States, many care homes in South Africa responded by going into voluntary lockdown weeks before the official announcement by the President.
With guidelines from government departments being delayed and often inadequate, elder care organisations and homes compiled and shared their own policies and procedures, put numerous infection control measures in place, and courageously embarked upon the most challenging and uncertain period the sector has ever experienced.
In the case of care homes that are part of larger organisations, managers gave credit to their head offices for providing valuable policy, educational, administrative and moral support. For managers of independent homes, responding to the crisis has been a considerable, and often lonely, challenge.
What has been hard to bear is the fact that, despite older people being the most vulnerable to SARS-CoV-2, the government has not prioritised the elder care sector for support. Homes have been unable to access emergency funding, little personal protective equipment (PPE) has been provided, testing delays have contributed to uncertainty, and many have felt abandoned in their time of greatest need.
Most care facilities run on very tight budgets at the best of times. Covid-19 has caused a perfect financial storm, which is devastating the sector. The Disaster Management Act prevents care homes from admitting new residents during lockdown, so as residents pass away (or in some cases are removed by families who cannot bear to be separated from them for months), rooms remain empty and homes lose significant revenue on which they depend. Some family members who support residents financially have lost their jobs and can no longer afford to pay levies, and some local businesses that provide in-kind support have also closed. Finally, Covid-related costs like infection control (including PPE, cleaning materials and services, staff accommodation), appointing relief staff, and adapting facilities to accommodate staff and isolate residents are considerable – and none of these costs were budgeted for.
While a few care homes are relatively well off and have managed to take these additional expenses in their stride, others have had to retrench staff members and now face a very uncertain future. As one manager responded: “We are in dire need of food, as we have spent money beyond our budget without funding.”
In the face of all this, it is astonishing that four months after lockdown was announced, some care homes that have responded to the second STRiDE questionnaire have still not recorded any SARS-CoV-2 infections. Sadly, however, there are no guarantees, and there have been outbreaks and deaths even in homes where the strictest protocols have been adhered to. In the worst-affected homes, the pressure on the few staff who have not been infected has been immense.
I do not work in a care home. Looking in from the outside I can only say that I am humbled by the commitment, care, flexibility and resilience of those who continue to care for vulnerable elders at this time. The stories that care home managers have shared in their responses to the survey are inspiring. I would like to share just a few of them here …
- One of the most devastating aspects of the lockdown is the fact that no visitors are allowed into care homes. This has been a struggle for residents and their loved ones alike. The question is, how do we balance the need to limit infections with the need for human contact? All the care homes that responded to the survey have created a number of opportunities for telephonic and online communication between residents, loved ones and management. Some have also found ways to enable limited face-to-face contact, setting aside a meeting room, making space available in the garden, or enabling contact through the fence or windows of the home. Managers have described how they have increased the level of nursing care to compensate for the lack of visitors. One described how they made Mothers’ Day special with presents, videos and special meals, while another mentioned a concert that the staff had put on for the residents.
- Research has shown that loving physical touch (especially hugging) decreases stress hormones and increases levels of oxytocin and endorphins. This helps us to feel safe and soothed, reduces depression, lowers high blood pressure, and strengthens our immune systems. It is not possible to care for residents with dementia or those who are physically frail from a distance. One manager explained that they had turned the need for assistance with hand washing into an opportunity for carers to provide intentional tender loving care. Another stated: “Residents living with dementia need lots of hugs and touching and it would be cruel to isolate them for such a long time if not necessary. We know that it is a risk but are taking as many precautions as we can to ensure a safe environment for our residents.” These precautions included regular sanitising of surfaces and washing of hands.
- Despite the many additional tasks that Covid-19 has required of care home staff, and the fact that volunteers and service providers have been unable to assist, some have worked hard to keep residents entertained and engaged. Activities have included time in the garden, sitting in the sun on the veranda every day, having lunch together outdoors, prayer meetings, watching movies and family videos, exercise, games and colouring-in.
- In addition to extensive efforts at infection control, care homes have also provided ongoing education and training opportunities for staff and residents to help them understand and respond to Covid-19, address their fears, and improve their health. Managers have emphasised the importance of regular, open communication with staff members, residents and families.
- When asked what has helped them to keep going, care home managers have given credit to the dedication and teamwork of staff members, the support of family and community members, networking and sharing with colleagues in other care homes, and their faith which has kept them strong.
They say that you should never waste a good disaster! Covid-19 has highlighted a number of weaknesses in the elder care system in South Africa that were previously apparent, but which now urgently need to be addressed.
The full STRiDE report includes a list of ‘Calls to Action’, which we hope may stimulate discussion and action. Primary among these is the need for the government to give greater priority to older persons. Perhaps the Covid-19 crisis will prove to be a catalyst for positive developments within the elder care sector in South Africa.