“Many elderly care institutions have unsatisfactory conditions, have not implemented epidemic prevention measures, and the SAR government has not fulfilled its monitoring duties. It is like watching the elderly die in vain.” p>
Writing | Yan Xiaoliu
Source | “Medical Community” Official Account
As of 0:00 on March 28, the fifth wave of the epidemic in the Hong Kong Special Administrative Region has accumulated 7,207 deaths. Of these, 56% occurred in residential care homes for the elderly or disabled.
Residential care homes for the elderly are commonly understood care institutions.
Information from the Social Welfare Department of the Special Administrative Region shows that there are 1,041 elderly care institutions in the area. Currently, at least 783 cases of infection have been reported.
If employee infections are counted, “the industry believes that residential care homes for the elderly have been ‘destroyed and no one is spared’.” Li Huiyu, member of the Commission on Elderly Affairs of the Special Administrative Region Government and operator of an elderly care facility told the media in mid-March.
The COVID-19 pandemic is a severe test for nursing homes around the world. The “Government Accountability Office”, an audit agency under the US Congress, released a report in May 2021 saying that more than 90% of nursing homes in the United States have experienced epidemics, and more than 30% of deaths came from nursing homes. The London School of Economics and Political Science in the United Kingdom surveyed the deaths of new crowns in Italy, Spain, Ireland, France, Belgium and other countries and found that 42%-57% were residents of nursing homes.
“Hong Kong 01” reported that the severe epidemic situation and high mortality rate in the elderly care institutions in the Special Administrative Region stemmed from the government’s major mistakes in handling the epidemic in the early stage.
Including “Nature” and other professional journals, the “low vaccination rate of the elderly” is regarded as an “important lesson” for the SAR to fight the epidemic. Nearly 90 percent of those who died in nursing homes were unvaccinated.
Yuan Guoyong, a consultant on epidemic prevention of the SAR government and a chair professor of infectious diseases at the Department of Microbiology, Faculty of Medicine, University of Hong Kong, gave another thought. He told the media: “The environment of many elderly care institutions is not ideal, they have not implemented epidemic prevention measures, and the SAR government has not fulfilled its monitoring duties. It is like watching 5,000 people lose their lives in vain.”
Ivy, 26, lost her grandfather in this round of the epidemic. The special zone media “Duan Media” reported that in February, the elderly were infected with the mutant strain of Omicron in a nursing facility. He was taken to the hospital emergency room and waited a week for a bed. In the end, the old man died.
Ivy couldn’t quell the anger in his heart: “Why does my grandfather have to wait so long for the hospital bed? Why does the medical system seem to have not improved, is it really impossible to foresee the fifth wave of the epidemic?”
Many SAR senior care institutions are cramped and poorly ventilated, which can easily become “hotbeds of viruses”. /Hong Kong 01
Hospitalization is difficult, the white car has not arrived, the black car has arrived
According to data from the United Nations Development Programme and the World Bank, from 2013 to 2019, the Hong Kong SAR has been ranked as the world’s longest-lived region for seven consecutive years.
Phoenix Spotlight points out that this top-of-the-pyramid distinction stems from the long-term security of the two pillars. One is the medical services provided by the public hospitals in the SAR, and the other is the elderly care services provided by the elderly care institutions.
Chen Shaoyi, director of the Steady Nursing Home in the Special Economic Zone, traced the epidemic in his nursing home, saying that “the source of the outbreak is the hospital.”
According to reports such as “Hong Kong 01”, after the 2022 Chinese New Year, the fifth wave of the epidemic in the SAR will gradually get out of control. Initially, under the “dynamic clearing” policy, the SAR government required confirmed cases to be sent to the hospital. Around February 15, the occupancy rate of beds in local public hospitals reached 90%.
On February 17 and 18, thousands of people lined up and waited for a doctor in an open-air temporary waiting area such as a hospital parking lot. Many hospitals have run out of mobile beds and ambulance beds. Paramedics borrowed portable bed lifts typically used at large disaster sites. The legs of these beds are short and the top is a thin sheet of canvas.
“The nursing home usually doesn’t move.” Nurse A Hui (pseudonym) told “Duan Media” that because the bed was too short, he and his colleagues had to kneel on the ground, Elderly care.
On March 1, 96-year-old Mr. Wang was initially diagnosed in a nursing home and sent to the emergency room of Caritas Hospital. Her daughter accompanied her father and waited all night in the open air before being admitted to the hospital.
“No one helped. I just asked the doctor if I could go in for care. The doctor said, you can come in whatever you want, whatever you like.” Ms. Wang told “Phoenix Focus”, the doctor No safeguards were provided when it was granted entry.
Image sourced from “Phoenix Focus”
Ms. Wang (pseudonym) works in Yuen Long Kidd (Taheng) Nursing Home. There is a mother-in-law in her 90s who has lived there for more than ten years. One morning, my mother-in-law’s quick antigen test showed “two bars”.
“She soon became short of breath and refused to eat. The situation took a sudden turnstraight down. “Miss Wang immediately called the emergency number. The recording of the call repeatedly told her “please wait”. After 45 minutes, the call was finally answered.
“Calling an ambulance is like winning a lottery,” Ms. Wang told Duan Media.
“Phoenix Focus” believes that under the epidemic, the run on public medical institutions stemmed from years of stagnation. “Every year when the flu season is high, emergency departments and infectious disease departments in public medical institutions are frequently in emergency. There is a serious shortage of medical rescue personnel, vehicles, and hospital beds.”
D.C. government data shows that at the end of 2021, the attrition rates of doctors and nurses in the D.C. will be 6.7% and 7.7%, respectively. By early March this year, there were 1,600-1,800 daily ambulance calls. During the same period, about one-third of the ambulance staff fell ill with the disease, or were classified as close contacts and quarantined, resulting in a serious shortage of manpower.
Picture from AP
The risk of severe illness and death increases significantly for every minute of delay in hospital delivery for the elderly.
Studies on early hospitalized patients show that 40% of those severely ill from COVID-19 suffer from cardiovascular and cerebrovascular diseases, such as stroke. Ollie Vardani, an associate professor of medicine at the University of Minnesota, explained that such people are more likely to develop complications once they are infected.
The 2019 data from the Census and Statistics Department of the Special Administrative Region Government shows that 78.1% of people aged 65 and over in the District have chronic diseases, including high blood pressure (51.5%), diabetes (23.4%) and Hyperlipidemia (26.1%). “People are already on the edge of the cliff. The new crown has pushed harder.” “Duan Media” wrote.
Li Hui said that under the fifth wave of the epidemic, it often takes more than 10 hours to call an ambulance. An elderly person passed away while waiting, and “the black box car (funeral car) was faster than the white car (ambulance) to pick up the elderly”.
The Chief Executive Officer of the Hospital Authority of the Special Administrative Region, Gao Basheng, said that in the face of the shortage of medical resources, how to divert the confirmed patients and whether the hospital should accept all the confirmed patients is the crux of the problem.
Separate in situ, for one, for all
In addition to distressing patients, nurse A Hui is angry with the nursing home.
“The medical system has collapsed, and a large number of elderly people have to send it. Some elderly people have no symptoms, and they are suffering when they are sent. Why should they send it?” “.
According to the guidelines issued by the Social Welfare Department of the Special Administrative Region earlier, if the elderly are found to be suspected of being infected or have a positive rapid test, they should immediately notify the Center for Health Protection, and arrange to send them to the hospital according to the instructions.
At nearly 23:00 on February 17th, the Social Welfare Department of the Special Administrative Region issued the guidelines for “in-situ quarantine/isolation”, saying that it would try to send the elderly suspected of being diagnosed to a quarantine center or hospital However, because these two places have received a large number of people, some elderly people need to stay in “situ isolation”, waiting for quarantine or treatment.
This principle clarifies the criteria for hospital admission: it is necessary to first determine with the Hospital Authority whether it can be admitted to the hospital, and if not, it should remain in the nursing facility for continued care.
“Unless the Hospital Authority approves, the elderly who test positive must stay in the elderly care institutions.” Chen Zhiyu, chairman of the District Elderly Service Association, said that this is a huge impact on the elderly care industry. Regardless of psychology or equipment, many institutions are not ready.
The Social Welfare Department also stated in the above guidelines that masks, rapid testing equipment and protective equipment will be provided to nursing home staff and the elderly. Special allowances will also be provided for institutions to purchase anti-epidemic materials.
“The SAR government has previously organized mandatory testing for all employees, which is only for employees. The rapid test kits distributed on February 15 are only for employees’ daily self-testing.” Oriental Daily reported.
“You call people to fight, but you don’t have any weapons — I’ll give you 20,000 yuan and 10 bullets. If you go to the battlefield like this, you will definitely be shot to death.” Chen Shaoyi told “Duan Media” “, HK$20,000 is a special allowance. But taking her nursing home as an example, the total monthly expenditure on epidemic prevention materials is about 40,000 Hong Kong dollars.
Nurse Xie, a registered nurse in the elderly service industry, used a screen in the nursing home to divide the home into two and set it as “isolation area” and “non-isolation area”. Once the elderly are found to have cold symptoms, they will be arranged to the “quarantine area” first.
Nurse Xie told “Phoenix Focus”: “It will soon be out of control. There are infections everywhere, from 10 to 20. In the end, all the elderly in the hospital were diagnosed .”
Chen Shaoyi’s home for the elderly is closed with black garbage bags and used as an isolation ward. /port media
In addition to being unable to be admitted to the hospital, the elderly who were diagnosed were also “discharged early”.
At the beginning of February, the Hospital Authority of the Hong Kong Special Administrative Region updated the guidelines for discharge, stating that the patient had 2 nucleic acid test samples separated by 24 hours were negative, or 3 nucleic acid samples separated by 24 hours had a Ct value of >33, that is Can be discharged.
The Ct value is the “cycle threshold”. Liu Jiaxian, Chief Administrative Manager (Quality and Standards) of the Hospital Authority of the Special Administrative Region, said that if the Ct value is increased to >33, the probability of the sample carrying the virus is very small.
After more than 10 days, the discharge criteria were adjusted again. 2 nucleic acid samples separated by 24 hours have Ct values > 30, can be discharged.
During the same period, the Hospital Authority of the Special Administrative Region responded to a question from Ta Kung Pao, saying that if the patient is clinically assessed and deemed to be in stable condition, he will be sent back to the nursing home for further treatment when the hardware conditions permit. recovery. Since then, some elderly care institutions have received phone calls one after another, saying that their licenses may be revoked if they refuse to accept the elderly sent back by the hospital.
According to the “Notice on Printing and Distributing the Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 9)” issued by the National Health and Medical Commission on March 15, it is clear that the nucleic acid detection Ct value of infected persons in the convalescent period is ≥35 , meet the criteria for discharge or release from isolation.
“Duan Media” quoted a front-line nurse as saying: “The boundaries of discharge are getting looser and looser, and I understand the concerns of nursing homes.”
“We have an old man who has a high fever. We told the emergency department of the hospital, there is no way, you really have to accept it.” An anonymous nurse told “Phoenix Focus”, “the doctor said There’s nothing they can do, they don’t have a bed. Or, give us another one.”
In other words, the nursing home accepts an elderly person with mild or late infection in exchange for a hospital accepting a severely ill person.
“We really had nothing to do, so we exchanged with the hospital.” The nurse sighed, “I have been a nurse for so many years, but I have never heard of an exchange.”
On February 24, the SAR government reopened Hall 2 of the Asia-Expo (referred to as Asia-Expo) as a “fangcang shelter hospital” to receive confirmed elderly people from elderly care and other institutions. So far, a total of 1,018 isolation and quarantine beds have been opened. By 9 am the next day, half of the beds were full.
“The news we got has always been that there is no place, don’t think about coming to Beijing. You should be isolated in the same place.” Nurse Xie said.
Asia-Expo’s “Makeshift Hospital”, August 2020. /SCMP
“Pigeon cage” pension, the environment has congenital defects
On March 14, the Faculty of Medicine of the University of Hong Kong released an analysis of 37 deaths under the fifth wave of the epidemic. The results showed that the average time from onset to death for elderly people in nursing homes was 8 days; for elderly people of the same age living in the community, the average time from onset to death was 10.5 days.
The Hong Kong Special Administrative Region non-profit organization “Local Research Society” wrote an article that the government blamed the high mortality rate and other problems on the low vaccination rate, but rarely mentioned the living space of the institutions.
Chen Zhiyu also made a similar statement, saying that “the biggest pain point in the outbreak of the epidemic in elderly care institutions is the problem of land space.”
On June 1, 1996, the SAR government promulgated the “Elderly Homes Regulations”, which proposed the goal of elderly care services closely bound to the community, and let the elderly live in a familiar community environment as much as possible .
“Phoenix Focus” reported that based on this original intention, for decades, there has not been a single-family nursing home in the D.C. The vast majority of elderly care institutions are located in the podium and subsidiary floors of residential buildings, or in abandoned buildings such as school buildings.
The “land is expensive” in the special zone, coupled with the change in the use of the building, has led to the existence of congenital defects in these elderly care institutions. For example, to share the elevator with the residents of the building, the lack of fresh air system, only rely on air conditioning for ventilation and windows for lighting.
Located in the Shamshui Steep of the Special Administrative Region for more than 10 years, there are more than 30 elderly people living there. There are about 10 staff members, including the dean. This is a common size for private senior care facilities in the District. Some public institutions receive government funding and have more beds, up to 100.
The nursing home rents a large room in the building, with an indoor area of about 400 square meters and more than 30 “single rooms” separated by wooden boards. Each “single room” can accommodate a single bed and a bedside table.
According to the Regulations on Residential Care Homes, the minimum per capita area of Residential Care Homes is 6.5 square meters, including shared toilets, kitchens and activity spaces. The “bedroom” area that really belongs to the elderly is as big as a table tennis table. This area requirement has not changed for 20 years.
“Most elderly care institutions have high population density, and it is difficult to have independent space. Most of them are open-plan designs, and there is no single room.” Chen Zhiyu told “Phoenix Focus” that the institutions did not have the conditions to immediately transform to deal with infection sick place.
Jun Yi (Mountain View) Home for the Elderly is located on the G/F and 2/F of Shop 21, Mountain View Shopping Centre, Tuen Mun, New Territories, Hong Kong SAR. /granyet care
Aside from space, people are also a big issue.
Consistent with China, staff in elderly care institutions in Germany, Switzerland, and Singapore are required to undergo regular nucleic acid testing, and staff who care for the elderly on a daily basis are subject to “closed-loop management.” Those who interface with external supply chains are required to undergo frequent and close medical observation and regular testing.
Hong Kong SAR elderly care institutions have a variety of jobs, and some employees need to work across hospitals and districts, and they mostly rely on public transportation to commute to and from get off work. It was not until March 9 that the Chief Executive of the SAR, Carrie Lam, announced that “closed-loop management” would be provided for elderly care institutions that have not yet experienced any infection, and special vehicles will be provided to transport staff to and from get off work.
In contrast, on March 13, after Beijing reported single-digit local cases for seven consecutive days, it announced that all elderly care institutions would be fully closed.
“I have contacted many senior care institutions and generally do not want to participate in closed-loop management. To this day, there is noThere are not many institutions that have been recruited. There are individual institutions located in village houses that have not been infected, but they also do not want to participate because employees also have to take care of their families. If they must attend, they would rather resign. “Li Hui said on a radio show.
Frequent human community movement increases the risk of transmission.
Miss M (anonymous), a registered nurse in the elderly care service industry, told “Phoenix Focus” that the source of infection in many elderly care institutions came from the community. “Most of the staff are infected first. They feed and bathe the elderly. One or two colleagues have an accident, and the spread spreads, and then the situation in the entire institution is very serious.”
As of March 8, approximately 4,470 nursing home employees have been diagnosed with the infection. Due to the lack of manpower, some employees even returned to the “isolation area” of the institution after being infected to take care of the elderly who were also positive. “At least there are many people to help.” “Hong Kong 01” quoted a nurse as saying.
Image from “Hong Kong 01”
Severe shortages, nurses being transferred
There are also some elderly care institutions that start to “self-help” early.
On January 22, an employee of the Steady Nursing Home was diagnosed with the infection. The institution immediately purchased anti-epidemic materials and suspended visits. “Immediately close the door of the nursing home, post a notice, and do not enter or leave.”
In late February, a private elderly care facility in Kowloon found that even if the elderly were sent to the hospital, they might not come back alive. They decided to take a risk: Unless the situation is too bad, try to keep the confirmed elderly in quarantine.
“We have nurses and registered doctors who can prescribe medicine at any time. Many elderly people get better after taking medicine. Other nursing homes do not have a resident doctor and may be even more helpless.” Nurse Wang said.
Wu Yue (pseudonym) is a visiting doctor in several elderly care institutions in Yuen Long, with more than ten years of working experience.
“Visit Doctor”, also known as “Outreach Doctor”, is a medical resource provided by the Social Welfare Department of the District, and most nursing homes have applied for this service. Relevant doctors visit the door twice a month to promote the health of institutional residents and reduce medical treatment to the public health system.
According to the guidelines of the Social Welfare Department of the District, visiting doctors do not need to visit an infected institution during the epidemic. There are also vaccination teams who can “refuse to come in”.
“In mid-February, the diagnosis was confirmed in our hospital. The vaccination team that had been appointed didn’t come until it was cleared.” Nurse Xie said, “I also asked, we Are all infected, do you still need to be vaccinated? The other party replied, we need to ask the doctor about this, we don’t know.”
“But we don’t have a doctor’s phone number.” Nurse Xie emphasized that the instructions issued by the District Hospital Authority were unclear and the process was chaotic, causing the elderly in nursing homes to miss the opportunity to be vaccinated again.
Wu Yue insists on visiting the door every day, inquiring and prescribing medicines for the diagnosed elderly. He told Duan Media that without professional doctors, it would be difficult for nursing homes to judge the condition of the elderly and whether they are suitable for in-situ isolation. Some institutions do not even have registered nurses, and the situation is even more worrying.
“Senior care services are in great need of professionals, such as nurses and therapists. Due to the lack of human resource planning and promotion ladders in the industry, these talents are often lost to the medical system.” Chen Zhiyu said that when medical The system is short on manpower, and this part of the talents will also be transferred from the pension institutions. This further exacerbates the shortage of manpower in elderly care institutions.
“After the epidemic, there are many things worth re-examining. …How to enable the elderly and the elderly to live in a safe and healthy environment is worth the whole society. Let’s reflect together.” Chief Executive Carrie Lam Cheng Yuet-ngor said at a press conference on the fight against the epidemic on March 9.
Source:
1. Beijing old-age care institutions are fully closed and managed, calling on the elderly to get vaccinated as soon as possible. China News Network
3. The epidemic in Hong Kong residential care homes for the elderly is tragic, and a total of 755 residential homes have been infected. Ta Kung Pao
4. Hong Kong experts: The high mortality rate in elderly homes is a major mistake. Lianhe Zaobao
5. Investigation on outbreak in Hong Kong elderly homes. Phoenix Focus
6. Elderly Primary Health Survey Report. Hong Kong Association of Community Organizations
7. Will Omicron finally overpower China’s COVID defences?. Nature
8. Nursing Home Quality Improvement During the COVID-19 Pandemic. AHCA NCAL
9. Unprepared and lack of support, the epidemic outbreak nursing home is struggling to save itself. Terminal Media
10. Tragedy of Hong Kong Institution . Media
Source: Medicine
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