Invest in the overlooked and unsung: Build sustainable people-centred long-term care in the wake of COVID-19

Statement to the press by Dr Hans Henri P. Kluge, WHO Regional Director for Europe

COPENHAGEN, Denmark – Over these past three months, since the first cases were reported, the WHO Regional Office for Europe has worked around the clock to support countries prepare and respond to COVID-19. As part of this support, we have sent teams into countries to offer on-the-ground support and guidance. One such country was Spain. Yesterday, I received a report from our second mission to the country that indicates an encouraging decline in new COVID-19 cases. Greater testing availability, intensive care unit capacity, and preventive distancing measures have resulted in Spain being able to carefully ease restrictions.

Every signal that the virus is being controlled, managed, mitigated is a good signal. However, my message today remains one of caution.

Complacency could be our worst enemy at this time. We cannot permit ourselves to believe we are secure and safe. Any steps to ease social and physical distancing measures must be carefully considered and gradually undertaken. The public must understand the inherent risks as governments, understandably, try to release the steam building up in societies and pressing our respective economies.

This is not an ‘exit’: there is no fast track to the new normal. The question is not whether there will be a second wave. The question is whether we will take into account the biggest lesson so far, namely to work between waves to strengthen readiness and surge for worst-case scenarios. Any return to the new normal needs to be based on a risk assessment needs to happen gradually and taking into account the WHO European Transition Framework presented to the ministers of health last Friday.

Almost 50 percent of the global burden of COVID-19 cases – over 1.2 million – are in the European Region. Sadly, over 110,000 people have lost their lives. Since I last reported to you seven days ago, new cases have increased by over a quarter and deaths by a third.

Countries in the Eastern part of the Region (The Russian Federation, Turkey, Ukraine, Uzbekistan and Belarus) have seen increases in the rate of new cases over the past week. Last week our teams were in Belarus and next week we will send missions to Tajikistan and Turkmenistan.

Make no mistake, we remain in very turbulent water and will do so for some time.

Of the 10 countries across the globe who have reported the highest number of new cases in the past 24 hours, six are in the European Region.
I call on all countries to keep a firm grip on the strategies that we know work to halt this virus – identifying, isolating, testing, tracing contacts, and quarantining – whilst constantly monitoring the effectiveness of the measures in place.

COVID-19 in long-term care facilities

Let me turn now to the deeply concerning picture that has been emerging of COVID-19 in long-term care facilities in the European Region and globally in recent weeks.

According to estimates from countries in the European Region, up to half of those who have died from COVID-19 were residents in long-term care facilities. This is an unimaginable human tragedy.  To the many who are experiencing this loss, my thoughts are with you.

All those dying in homes from COVID-19 have the right to be attended to and to receive end-of-life care, including symptom relief with adequate medication, surrounded by their loved ones.

People who are suffering from physical and/ or mental disability, often at higher ages are particularly vulnerable to this virus. Their advanced age, underlying health conditions, cognitive challenges in understanding and following health and hygiene advice due to intellectual disability or dementia, for example, are all factors that put them at greater risk.

Many today are prevented from receiving visits from family and friends, no longer getting the emotional and physical support that such visits provide. Sometimes residents face the threat of abuse and neglect.

And yet equally troubling – the way that such care facilities operate, how residents receive care – is providing pathways for the virus to spread. The role of the public sector leaving no one behind cannot be overestimated.

Even among very old people who are frail and live with multiple chronic conditions – many have a good chance of recovery if they are well-cared for.

This pandemic has shone a spotlight on the overlooked and undervalued corners of our society. Across the European Region, long-term care has often been notoriously neglected. But it should not be this way. Looking to the future, transitioning to a new normal, we have a clear investment case for setting up integrated, person-centered long-term care systems in each country.

We have inherited the European rights, values, and opportunities that define us from the generations that came before – so we must care for them. It is our duty to leave no-one behind. We must step up.

So what must we do?

1. Empower care workers.
2. Change how long-term care facilities operate.
3. Build systems that prioritize people’s needs.

On my first point:

The dedicated, compassionate people working in long-term care facilities who are so often overstretched, underpaid and unprotected – are the unsung heroes of this pandemic.

We must do all we can to ensure that those workers have PPE and other essential supplies to protect themselves and those they care for; to provide appropriate remuneration for the long hours and difficult work they have, and make sure they have the appropriate training to carry out their work. Here, WHO has online training resources and guidance to assist.

We must change the environment in which they deliver care, offering suitable levels of resources and staffing.

Secondly:

There is an immediate and urgent need to rethink and adjust how long-term care facilities operate today and in the months to come. This means striking a balance between the requirements of residents and their families, and ensuring that services are run safely and staff are protected and well supported.

• Establish comprehensive plans to prevent and control infections;
• Prioritize testing of any suspected cases among long-term care facility residents and staff;
• Provide PPE, training and essential medical supplies and equipment to care homes;
• Isolate all cases, set up separate wards or spaces for residents with COVID-19 even before the first cases occur, and make sure residents can be referred to and safely discharged from hospital.

These measures will help cut the spread of the virus and allow for the managed opening once again of such homes to families and visitors.

And my third point: From now on, quality, resourced, strong, and sustainable long term care systems that prioritize people’s needs and dignity must be our gold standard. Commitment from the highest levels of government, across every section of our society, is needed. Coordination and continuity between health and social services, as well as across information systems, must be fortified. We must bring together physicians, nurses, pharmacists, social and other health care professionals, care workers, and above all, care home residents themselves, in decision-making and care provision.

We have much to learn from each other. Let us share relevant experiences in whole-of-society, and community approaches to care. WHO stands ready to support countries to establish integrated, person-centered long-term care systems.

In conclusion, let me repeat my appeal. Together, across sectors and society, we must act:

1. Now to ensure that the services in long-term care facilities are safe and supportive;
2. In the weeks and months ahead so staff are trained and empowered to provide safe, effective care; and
3. Long-term so that every person living in care systems has a voice, and is valued.