gms | German Medical Science

Background: During the COVID-19 pandemic it became obvious that older people are a highly vulnerable group, especially people in need of long-term care (LTC) were particularly affected. International results show that the share of all COVID-19 deaths living in LTC- facilities worldwide is on average around 50% of all deaths. Recommended measures to face the challenges of the pandemic like social distancing can only be carried out to a very limited extent for care-dependent people. Additionally, we know that reduced social contacts are particularly harmful itself for nursing home residents.

Objectives: The study aims to describe the extent to which nursing homes were affected during the first and second wave of the pandemic, the human and material resources of the homes, the organizational handling of the situation, and possible influencing factors.

Methods: More than 7,000 nursing homes were invited to participate in the online surveys with quantitative and qualitative elements. Data were obtained by a self-designed online survey in April/May 2020 and January/February 2021. Analyses were mainly carried out by means of descriptive statistics.

Results: 824 nursing homes participated in the first and 404 in the second wave of the survey. During the first wave four in five nursing homes had neither at least one confirmed case of COVID-19 among its residents and/or employees, during the second wave only one in four nursing homes. Local incidence rates are important predictors for the rate of infections in nursing homes. And although only about one percent of all persons in Germany are living in LTC-facilities, about 6–7% of all infections emerged in nursing homes and the share of all COVID-19 deaths living in nursing homes was between 48–50%.

During the first wave the lack of protective equipment was striking, later this changed to a shortage of rapid tests and vaccines. In addition to that, facilities had to cope with additional corona-related care needs, additional expenditures of time due to hygiene measures and reduced staff availability. Mostly nursing homes tried to solve the issue of increased work load and staff shortage with an internal staff management. Contacts between residents and relatives have been banned to a great extent during the first wave, later on this changed to incidence-dependent visiting concepts.

Discussion: As about half of all COVID-19 deceased people live in nursing homes, the support of nursing homes in their attempt to restrict the pandemic still requires highest attention. Strategies for protecting nursing home residents can only be successful if the pandemic is overcome in the whole population. Nursing homes need support for the provision and external financing of protective equipment and for facing additional tasks. Otherwise, one results of the pandemic will be a dramatically worsening of the shortage of nursing staff.

Implications for practice: Strategies for nursing homes to face the pandemic must contain three pillars: vaccination of all residents and personnel, rapid testing for all non-vaccinated visitors, obeying strict hygiene rules.

Appeal to politicians: The provision of uniform guidelines for action facing pandemic challenges throughout Germany is urgently needed.