Carers manning most residential homes have varying levels of training and a concerted effort is needed to ensure adequate staffing and regular guidance and support, according to an expert in gerontology.

Anthony Scerri, lecturer at the University of Malta’s Department of Nursing in the Faculty of Health Sciences, was speaking in the wake of a surge of COVID-19 cases and deaths among the elderly in long-term care facilities during the past month.

Outbreaks in two homes, St Joseph and Casa Antonia, which have so far lost nine and four patients to COVID-19, respectively, have led to an investigation into shortcomings by the Social Care Standards Authority.

Evaluating mitigation measures that could have been – and can still be – taken to prevent further transmission of the virus and “calm the potential tsunami” of cases and even deaths in these facilities, Scerri maintained the sector has, for many years, been highly unregularised, saying the 2018 Care Worker’s Act was a way forward to standardise it.

He referred to a study conducted in the US that showed nursing homes with higher staffing levels, especially of qualified nursing staff, had lower infection and death rates.

At St Joseph Home, in Fgura, almost half the 278 residents tested positive.

Until recently, elderly COVID-related deaths accounted for a quarter of the total while in other European countries, deaths among residents in long-term care facilities ranged bet-ween 37 and 66%.

Scerri said nursing home administrators need to be well prepared and adequately supported by the health and social care authorities to develop action plans and have access to adequate resources in crisis situations such as the pandemic.

Speaking about the challenges the long-term care sector is facing, Scerri said policy directions and guidelines by international organisations for preventing transmission in these settings include regular surveillance and a comprehensive testing strategy once a case is identified.

Current evidence also shows that, in the case of a rapid response – such as systematic testing of staff and residents, social distancing, no visitors and contact tracing – the outbreak could be better controlled.

Testing of all staff and residents is especially important in these settings since some of the residents can be asymptomatic, or pre-symptomatic, Scerri said.

Moreover, staff need to be aware that residents may have atypical symptoms, such as lethargy, acute confusion, anorexia and weight loss, common in this age group.

Other effective measures include moving residents at high risk out of the facility and isolating cases by creating separate wards, he said.

In fact, COVID-free residents started to be moved out of the Fgura home only last week but relatives have also complained that confining residents to their rooms for weeks on end for isolation purposes could also have a detrimental effect on their state of health.

While it is important to identify short-term measures to mitigate these outbreaks, “the pandemic is also an opportunity to reflect on the current provision of long-term care for older people,” Scerri noted.

In Canada, it has shown that nursing home crowding – occupancy of residents per room – was related to a higher number of infections and deaths, he said.

In Malta, Scerri added, the physical environment of nursing and residential homes varied widely, with some providing adequate space and others “falling significantly short”.

Scerri hoped the publication of the Social Regulatory Standards for Residential Services for Older Persons Regulations (2020) and the subsequent guidelines would mean the physical environment of current and future residential/nursing homes would be adequately monitored and safeguarded.

“COVID-19 has also helped us reflect about the value of life, irrespective of age or vulnerabilities,” he said.

“Various reports are indicating that ageism has become more evident, especially in relation to access to healthcare services and the allocation of resources.”

Scerri highlighted the Geriatric Medicine Society of Malta’s recent recommendation that all people, including the elderly in nursing homes, should have appropriate access to specialised care according to their healthcare needs and decisions should not be solely dependent on their age.