Infection control
Fighting infection and isolation: the small household model
Liz Fuggle, design consultant at HammondCare, explains how a ‘cottage’ model of elderly care turned out to be a key ally in the fight against infection and isolation during the COVID pandemic
In September 2020, Melinda Gates stated in an article in The Guardian that: ‘This pandemic has magnified every existing inequality in our society.’1 This inequality was already starkly
obvious to those in the aged care sector. Already vulnerable - and at risk of isolation, loneliness, and abuse - older people living in care homes were amongst the most susceptible to infection, accounting for up to 84 per cent of all COVID-19 deaths globally.2 And they were at additional risk not just
because of their old age, co-morbidities, and frailty, but because of their increased likelihood of presenting with atypical symptoms. Those with dementia were less able to communicate their symptoms – sometimes leading to late diagnoses.3, 4
A stressed and vulnerable population In the drive to protect vulnerable populations and contain infection, the subsequent dramatic lockdowns of care homes produced another type of problem; that of increased isolation. As is typical with other outbreaks such as influenza, affected residents were confined to their rooms, many without visitors, attended to by staff dressed in full protective gear. A sea of plastic cloaked the workforce (gowns, face shields, masks, gloves) – suddenly dehumanised and physically and socially distanced. Strained care staff talked about their constant fear of bringing infection into the home and of self-imposed lockdowns at weekends to protect the residents they cared for. And, unsurprisingly, levels of stress on residents increased. One study showed that residents were constantly stressed: ‘…they were worried about themselves, family members, caregivers as well as other residents. (They) slowly developed signs of fatigue, stress and paranoia throughout the lockdown period….’5
June 2022
www.thecarehomeenvironment.com For residents with dementia, being in
lockdown could be even more confusing and distressing. When access was restricted to certain areas, some residents were not able to understand or remember why, and yet were often aware of the heightened stress of staff and others around them. Many common forms of activities in care environments stopped, such as games and entertainment. Often the main form of engagement left was the television, with the ongoing exposure to media reports likely compounding fears in residents. In addition, reduced staff numbers due to sickness and waiting for tests meant more agency staff, who were less familiar with residents’ individual needs and were less able to give personalised care and support at the time that mattered most.
Segregation and pressure points Unfortunately, the advent of vaccines did not reduce the need to lockdown. The effectiveness of vaccines is lower in frail, elderly people. It is common to have influenza outbreaks in care homes, even when vaccination rates are high.6 So, the key strategies to ‘stop the spread’
continued: increased handwashing, cleaning high touch surfaces, wearing PPE, and physical distancing. It was in the attempt to physically distance that many traditional operators were challenged. Many institutional residential care buildings still have shared bedrooms, shared bathrooms, and large groups of residents living together. Most homes have communal commercial
It was in the attempt to physically distance that many traditional operators were challenged
kitchens and staff working across many different units. Some attempted to subdivide their facilities to contain outbreaks. However, this was often challenging, with certain staff (cleaners, carers, nurses) still having to cross between isolated areas. There were therefore many touchpoints, and many potential places of transmission. Residents in these types of facility were often confined to their rooms to enforce physical distancing.
A remarkable ally For Australian not-for-profit provider HammondCare, it was here that the cottage model they have championed since 1998 revealed a hidden superpower. The specialised building design turned out to be a key ally in the fight against infection and isolation. HammondCare’s typical new builds are of 60+ places and follow a ‘village’ design – where individual ‘cottages’ of 8 to a maximum of 15 bedrooms are arranged around a streetscape with public amenities. Each ‘cottage’ is a discreet household with its own ‘fresh-cook’ kitchen used by residents, with dining and living spaces and front and back gardens. The cottage design strives to be as home-like as possible, with residential detailing, carpet throughout, and residents encouraged to bring their own furniture and personal items. This small scale of household, with discrete, plentiful back-of-house storage, meant that individual cottages could be isolated with little impact on adjacent households.
In addition, HammondCare’s staffing model (which allocates specific staff to specific households to foster relationship- based care) ensured that staff could remain with the residents they knew and cared for, reducing upheaval and distress. These staff were already multi-skilled - responsible for cleaning, cooking, care provision, and
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