Crises in care for older adults Implementation and evaluation of intermediate care and SARS-CoV-2 infection prevention

This thesis focuses on two crises in care for older adults. First, the rising health care expenses and how governments shift residential care to community care. On top of this crisis, the COVID-19 pandemic hit and older adults were at high risk of disease and death.

The first part of this thesis evaluates short-term residential care (STRC). STRC was implemented in 2015 and is bed-based care for simple medical problems with the aim to discharge older adults to home. No guidelines and no targeted patient groups were provided. STRC has a wide-ranging patient population, and is also organized differently across the country. Older adults are not only admitted for reablement, but most of the time as a response to crisis. These findings indicate that STRC should be organized differently, and guidelines for reablement and observation should be developed. Also, we discuss alternative funding for STRC to prevent the accumulation of waiting lists and better treatment possibilities. Last, advance care planning is important to prevent crisis admissions to STRC.

The second part of this thesis evaluates infectious disease prevention and control (IPC) for older adults in nursing homes and in the community. Implementing weekly testing of residents and staff of nursing homes with a COVID-19 outbreak was an effective strategy for early identification of SARS-Cov-2 cases, resulting in mitigation of the outbreak in four case studies. A national implementation study showed barriers and facilitators for this serial testing and IPC measures in general. Last, this thesis focused on the psychological impact of the lock-down measures of older adults living in the community.