Crisis of "nursing care collapse" with new corona? What is happening at the facilities for the elderly

Crisis of "nursing care collapse" with new corona? What is happening at the facility for the elderly at 20:51 on May 8th?

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By the end of April, at least 550 or so people were infected with the new coronavirus in nursing homes and other elderly facilities, and 60%, or 10% of them, died, according to interviews with local governments nationwide. . In Europe and the United States, most of the fatalities are resident in facilities for the elderly, and experts point out that "the number of infected and dead people in Japan may increase."

Elderly facilities related 15% of domestic deaths

In Europe and the United States, where the new coronavirus infection became more serious, many of the people who died were resident in facilities for the elderly. NHK We covered the infection situation of.

As a result, at the nursing homes for the elderly, nursing homes for the elderly, and institutionalized elderly facilities such as paid nursing homes and group homes, at least 380 users and 170 employees, including 170 people, were infected. It was found that 60% of them, 10% of them, died.

In addition, about 190 people, including users and staff, were infected with day-service outpatient facilities and short-term admission facilities such as short stays, of which 6 users died, as well as visiting care establishments. A total of over 30 people were infected with only users and staff.

Furthermore, in Aichi Prefecture, two clusters related to day services have occurred, and a total of more than 90 people have been confirmed to be infected, including users, staff, users' families and contacts, and 20 of these have been confirmed. Is dead.

All together, at least 86 fatalities related to elderly facilities account for approximately 15% of all confirmed and fatal cases in the country.

Elderly facilities where infections continue to spread

Infections have continued to spread among users and staff at the facilities for the elderly in various places since May.

▽ Outbreak of a nursing care facility for the elderly in Sapporo　
. A total of 30 new users and staff were revealed to be infected.

▽
Infection of 12 people including two paid nursing home users and staff in Kyoto city　was confirmed.

▽ Outbreak of a nursing home for the elderly in Ichikawa City, Chiba Prefecture　
. Three new infections, including users and staff, were revealed.
(1 week for 7 days each)

Some facilities are closed due to the outbreak of infected persons.
At a nursing facility in Furushima-cho, Fukushima Prefecture, on May 3, a 90-year-old woman who was using the day service was confirmed to be infected, so we took measures to suspend work until the 14th and performed disinfection work.

Why is it difficult to disinfect? What is unique situation

An organization that is disinfecting elderly people's facilities infected with the new coronavirus released a video of the disinfection work done at the group home where elderly people with dementia live, and some of the residents are in the room I witnessed the difficulties peculiar to senior citizens' facilities, where they had to work while staying at the facility.

"Coronavirus Disinfection Center", an organization made up of 24 companies nationwide that handles disinfection work, is a group home for elderly people with dementia in Chitose City, Hokkaido on April 13 with permission from the client. The video of the performed disinfection work has been posted on the video posting site on the Internet.

The group home, located in a three-story building, was infected by a total of 10 residents and staff members on the first floor, of which one resident died.

According to the center, non-infected residents stayed in the room because there was no place to evacuate.

Therefore, first perform the disinfection work on the first floor where the infected person came out, then move the occupants on the second floor to the disinfected first floor and disinfect the second floor. I had to move forward.

The disinfection work is carried out in a three-stage system in which hypochlorous agents, alcohol preparations, and antibacterial agents are sprayed and wiped off. It means that everything that is present has been carefully disinfected.

Fuji Kasuga, Secretariat of the Coronavirus Disinfection Center, said, “The representative of the group home management company was very urgent when he called me to disinfect, and said,“ Please help ”. In the case of elderly facilities, residents and staff feel uneasy as the only option is to leave uninfected residents in the area. Especially, the staff seemed to be very exhausted. " It was

Europeans Nearly half of the dead live in nursing homes

In Europe and the United States, where the infection with the new coronavirus became more serious than in Japan, the majority of those who died were residents of elderly facilities.

In the United States, which has the highest number of infected and dead people, Johns Hopkins University's report has killed more than 73,000 people so far.

According to a private foundation that summarizes the deaths in elderly facilities, more than 10,000 people have died in the elderly public institutions in the 23 publicly available states alone.
About half of these are concentrated in New York, where the number of deaths is highest, and it is estimated that by the fourth of this month, nearly 5,000 had died in an elderly facility.

The situation is the same in Europe, where in the United Kingdom there are more than 30,000 deaths and the number of people who have died next to the United States. In the United Kingdom, people who died in places other than hospitals, such as elderly facilities, which were not included in the statistics because it was difficult to count initially, As a result of including it, the death toll increased by more than 4,400.

In France, infected people have been confirmed in nearly half of the 7,000 elderly facilities, and approximately 40% of the more than 25,000 deaths, or more than 9600, have died in the elderly facilities. Even in Germany, at least 2500 of the more than 7,000 people died in welfare facilities for the elderly and others.

WHO = European experts at the World Health Organization said in a press conference on April 23, "By country estimates, nearly half of the people who died in Europe were living in long-term care facilities. Will be done. "

Expert "In Japan, more people may be infected or dead"

Regarding the status of infections at facilities for the elderly in Japan, Satoshi Hayasaka, an associate professor at Toyo University, who is familiar with the care and facilities of elderly people, said, "We still perceive that the mortality rate is very high at this stage, but in Europe and North Given the high proportion of residents of facilities for the elderly, there is a possibility that the number of infected and dead people will increase in Japan as well. "

In addition, regarding future measures, “There are so many measures taken in hospitals so as not to cause medical collapse, but care facilities are inevitably a secondary issue, and concrete support measures are available even if infection is spreading. The current situation is that the government and local governments have taken measures to prevent the spread of infection, such as securing a mask, antiseptic solution, and protective clothing, and the staff and residents can perform PCR tests at an early stage. It is necessary to promptly consider measures to create a backup system for staff so that the quality of nursing care will not deteriorate even if a mass infection occurs in the facility. "

He said, "We should consider a system to maintain nursing care services in the long-term life of the new coronavirus so as not to cause nursing care collapse."

What is a cluster in a health facility for the elderly Toyama

Toyama prefecture has the third highest number of people infected with the new coronavirus per 100,000 population in Japan.
The cluster that occurred in the Toyama City Health Care Facility accounts for more than a quarter of nearly 220 infected people.

At this facility, not only the residents, but also the staff of the facility were infected, and the situation was just before "collapse of care".

In Toyama Rehabilitation Home, a health facility for the elderly in Toyama City, infection was spread since the infection was first confirmed on April 17, and 58 people including residents and staff have been infected so far. Eight people have died.

The prefecture dispatched a medical team from the prefecture to provide medical treatment and prevent the spread of infection. One of them, Professor Seiji Yamashiro of the University of Toyama Hospital, responded to an NHK telephone interview.

After visiting the facility on April 23rd and 24th, Professor Yamashiro began medical treatment from 25th, confirming the health condition of the residents, and taking measures such as transporting critically ill persons.

Since the infection spread to the caregivers and nurses working at the facility, about 5 staff members were taking care of more than 40 residents, and Professor Yamashiro said, “We have a very small number of people. I was doing the last minute just before "collapse of nursing care", and it was completely destroyed when another staff member got infected. "

There are many residents who need assistance or have weakened cognitive function at the facility, but due to a serious lack of manpower, they can change clothes and wipe their bodies with only a minimum of food and water. It means that I could hardly do anything.

In order to prevent “nursing care breakdown”, Toyama City, etc. requested a counseling from a council created at a nursing home for the elderly in Toyama Prefecture. As a result, 6 people, including caregivers and nurses, have been supporting since 2nd of this month. The situation is gradually improving with the ability to cover care such as entering and wiping the body.

Appropriate measures were not taken even after a series of symptoms ...

On the other hand, at this facility, clusters were caused by the fact that appropriate measures were not taken even after a symptom of fever and other symptoms occurred among the residents, and that many inhabitants use shared rooms to spread infection. It was found through interviews with the people involved in the city that it seems to have been seen.

According to a person in charge of the city, even if symptoms such as fever occurred one after another among the residents at this facility, they did not suspect infection and did not take appropriate measures such as consulting the public health center and having a PCR test. ..

In the case of a woman in her 80s who was first confirmed to be infected at the facility, she had a fever on April 7, a screaming voice on the 10th, and a cough and a tan on the 13th. It was on the 16th day, 9 days after the fever, that the PCR test was performed at the designated medical institution where the patient's health had deteriorated and was sent to the hospital by emergency.

Residents in their 90s and above who were in the same room as a woman had a fever on April 9th, and had coughing, tantalizing and croaking symptoms on the 14th, but they were taken to a designated medical institution for inspection. I received it on the 16th.
The woman died the next day, after which she was confirmed infected.

In addition, it was also found that at this facility, many of the residents were in shared rooms and shared structures such as shared use of rooms and baths seemed to have caused clusters because of the structure that spreads infection easily.

What should the elderly facility do?

Dr. Keihiko Kano of the Koseiren Takaoka Hospital, which specializes in infectious diseases, said about the risk of spread of infection in the facility where the elderly are admitted, `` Because people are living close to each other and people are in close contact, Clusters are more likely to occur when a virus is brought in. Even if there is a trend that the infection is converging, it is still an environment that remains untouched until the very end. ”

When an infected person or suspicious person is found in the facility, move it to a private room and isolate it to limit the care staff who will respond, and eat as far as possible in a well-ventilated place when residents and staff eat. It is important to take prompt action such as.

On the other hand, it is said that there are circumstances in each facility such as human resources and structure of the facility, `` If it is difficult to have a private room, partition it with a curtain to prevent it from going out, etc. It is necessary to think about correspondence. "

In addition, as one of the necessary things to prevent clusters in the facilities where elderly people will enter in the future, "There is one reason for the occurrence of clusters, and there are some overlapping circumstances. Yes, it is necessary to learn from the cases that have occurred overseas and in Japan and review the measures. ”