key: cord-0925144-ny2mw99z
authors: Bilal, Atif; Saeed, Muhammad Ali; Yousafzai, Taimur
title: Elderly Care in the Time of Coronavirus: Perceptions and Experiences of Care Home Staff in Pakistan
date: 2020-08-03
journal: Int J Geriatr Psychiatry
DOI: 10.1002/gps.5386
sha: 9c943f0fb6c2d321ea79e12af2480802729ac62c
doc_id: 925144
cord_uid: ny2mw99z

OBJECTIVE: The highly contagious and deadly, coronavirus disease 2019 (COVID‐19) has caused significant disruption in the small care sector of Pakistan. This study accordingly explores the perceptions and experiences of staff providing direct caregiving services to the elderly residents at three care homes during the time of the coronavirus pandemic in Karachi, Pakistan. DESIGN: Using a qualitative approach, 27 digitally‐recorded, semi‐structured, face‐to‐face interviews were performed with current and former caregiving staff members. The data was analyzed through qualitative content analysis. RESULTS: Analysis highlights various kinds of challenges that were faced by the caregivers and their families during the pandemic. The main theme class identified from the data was “living in anxiety and fear.” The work‐related decisions made by caregivers at that time were mainly influenced by their familial demands and responsibilities. CONCLUSION: Caregivers were at risk of catching the lethal virus through inhalation of or physical contact with infectious particles, but despite that most of them continued to render elderly care services. This study’s findings could be used by government leaders and care home administrations when making coronavirus containment policies, designing economic relief packages, and formulating caregiving training programs in Pakistan or other countries in the world. This article is protected by copyright. All rights reserved.

Elderly Care in the Time of Coronavirus supervisors, administrators and support staff of care homes were excluded from participation in this study because they mostly work at their offices or designated places where physical contact with residents is at minimum. In total, 27 caregivers were recruited for this study from three care homes; nine from each. The socio-demographic characteristics of recruited caregivers are presented in table 1.

Semi-structured, face-to-face interviews were conducted with the recruited caregivers that all began with an open question. caregivers talked candidly and reflected over the topics, and probing questions were added whenever required to get more details and acquire deeper understanding about the issues they face. Theme saturation was noticed after 21 interviews but despite that, six more were performed to confirm saturation. The digitally recorded interviews roughly lasted between 30 to 75 minutes and were conducted during the third and fourth week of April, 2020. Data was collected and analyzed in parallel which paved the way for additional interviews with subjects.

The transcribed data was initially examined in a line-by-line manner. Codes were first identified, and were then organized and combined into a main class of themes, other classes and sub-classes. The characteristics and scope of each class were identified until saturation in themes was confirmed. Similarly, the classes and sub-classes were combined till a structure demonstrating the conceptual arrangement or framework of linkages among the main class, Elderly Care in the Time of Coronavirus that is critical for maintaining caregivers' peace of mind. Researchers like Chang et al. (1998) concur that spiritual coping indirectly lowers caregivers' psychological distress through improvement in the quality of the caregiver-care receiver relationship.

This study differs from past works in a way that the factors that influenced caregivers' experiences and perceptions, and above all, their decision to stay home or render care during COVID-19 were based on their emotional connections with family, coworkers, elderly residents and the community. The decision also rested upon caregivers' value system especially as regards spirituality and professionalism. As a distinctive aspect, the present study's findings draw attention to the spiritual/religious side of the experiences of caregivers. They indicate how descriptive, behavioral and internalized dimensions of the faith factor affect caregivers' decision to continue their job. Past research on caregivers' attitudes, perceptions or work experiences during outbreaks or crisis has overlooked this spiritual angle. Choi et al. (2008) advocate that religious support from congregations and personal spirituality influence the decision-making regarding elderly caregiving. This study's over all findings are congruent with current news regarding the upheaval in elderly housing facilities.

A shortcoming of this research is the inadequate representation of male caregivers' perspective as the sample was female-dominant. Also, sample was recruited from care homes of a severely coronavirus-hit city (i.e. Karachi) only, thereby overlooking the experiences of care workers in other parts of Pakistan. The study's focus was limited to staff providing close, one-on-one care to the elderly in assisted-living facilities. It did not explore the happenings in care homes This article is protected by copyright. All rights reserved.

Elderly Care in the Time of Coronavirus in time of the COVID-19 upheaval from the viewpoint of their kitchen, cleaning or maintenance staff.

Government leaders and care home administrations could use the suggestions this study offers to amend work policies in order to accommodate caregivers' family concerns in times of crisis.

They could do so by providing (if needed) special housing, financial compensation, education, and public or written appreciation of caregivers' family members. Schools that offer geriatric care courses could include this study in their curricula to better educate and train students as regards caregiving during deadly virus outbreaks. The study stresses on the need that not only caregivers, but their families also should be included in compensation and protection policies and plans, and given access to materials for personal protection. Besides, spiritual dimensions, ethical considerations, and psychological or emotional implications of coronavirus caregiving should be addressed. In simple terms, caregivers should not be pressurized to work, periodic psychological counseling and debriefing should be arranged for them, and multi-faith prayer rooms should be provided where they can practice their faith and draw comfort from it.

The unparalleled and unprecedented COVID-19 crisis caused great devastation in Pakistan, and particularly deteriorated the structure of its small caregiving sector that was based on respect, consideration and compassion. The role of caregivers in looking after the marginalized and vulnerable elderly living in long-term care homes cannot be overstated. They constantly lived in anxiety and fear when the virus was rampaging across the country and turning care This article is protected by copyright. All rights reserved.

Elderly Care in the Time of Coronavirus homes into funeral homes. Their family was the foremost reason behind whatever work decisions they made in that time. The novel virus changed the very nature of the relationships and interactions caregivers had with coworkers and elderly residents. Supply of protective gear and training gave caregivers confidence that they can serve and be safe at the same time. When making coronavirus containment policies or designing economic relief packages, government ministries and care home administration should not overlook the mental and physical trauma faced by the care workers and their family. This study's findings could also be used in planning, or making work and educational policies regarding future virus outbreaks in Pakistan or other parts of the world. Accepted Article This article is protected by copyright. All rights reserved.

Nursing homes are ground zero for COVID-19 pandemic

The role of religion/spirituality in coping with caregiving for disabled elders

Caregiver's spirituality and its influence on maintaining the elderly and disabled in a home environment

Nursing and the Novel Coronavirus: Risks and Responsibilities in a Global Outbreak