The Impact of the COVID-19 Pandemic on the Conditions of Elderly Nursing Homes

This study focused on the forms of social care provided by nursing homes for the elderly during the COVID-19 pandemic, mainly as the elderly were more vulnerable to this virus, with a high number of fatalities recorded among them. This vulnerability is due mainly to their weakened immunity due to aging. The study also aimed to highlight the various types of care provided in nursing homes, including healthcare, psychological support, social assistance, and even spiritual care, which are tailored to meet the needs and specificities of this group. The study emphasised the need to further develop and enhance these forms of care, especially during the COVID-19 pandemic, when the virus spread rapidly and cases surged within nursing homes.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

• 1.    Problem of the Study

• 2.    Importance of the Study:

• 3.    Objectives of the Study:

Ageing is a stage in human development accompanied by biological, psychological, and social characteristics. Given the significant increase in the number of elderly individuals, which represents the most prominent demographic shift, caring for elderly individuals has become a current topic that demands the attention of all societal systems and institutions. This shift presents new challenges regarding the volume and nature of services that need to be provided to this group.

Elderly care centres are among the social care institutions that aim to provide various types of care to meet the requirements and needs of the ageing process. This stage is marked by physical, emotional, social, and economic limitations that reduce self-reliance, requiring the provision of integrated care, particularly during the COVID-19 pandemic. The pandemic posed significant challenges for these centres, which had to take on significant responsibility in ensuring the care and protection of the elderly by implementing precautionary measures to prevent virus transmission, especially since this group is at increased risk of contracting COVID-19 and suffering from severe complications due to their weakened immune system and the prevalence of chronic diseases.

Reports from around the world have confirmed the discovery of large numbers of cases and deaths among the elderly in nursing homes. For example, Hans Kluge, a representative of the World Health Organisation in Europe, stated in a press release on April 23, 2020, that nearly half of the COVID-19 deaths in Europe came from nursing homes. This led us to explore the conditions of the elderly individuals within these centres during the pandemic and the impact they had on their psychological, health, and social well-being.

To explore this issue, we began with the following central question for the study:

This study highlights, in part, the problems and needs associated with the ageing process and the role of healthcare, psychological, and social care in meeting these needs and ensuring their fulfilment. On the other hand, this study attempts to draw attention to the suffering experienced by the elderly during the COVID-19 pandemic in nursing homes, which exposed weaknesses and shortcomings. This calls for rethinking their conditions and implementing tangible measures to develop effective and just systems that ensure their rights.

• •    To clarify the problems associated with ageing and to explain the various care mechanisms suitable for alleviating them.

• •    To examine the repercussions of the COVID-19 pandemic for services provided by elderly care centers.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

• •    To explore the impact of the COVID-19 pandemic on the health, psychological, and social conditions of elderly individuals within nursing homes.

4-Study Terminology4-1. Concept of the Elderly:

In Arabic, the term "مسن" refers to an elderly man who has aged or grown old. The term " سن الرجل" refers to the ageing of a man, and the Arabic language uses synonymous terms such as "الشيخ" to refer to an elderly person, particularly someone whose age is evident through physical signs such as greying hair. Some people use this term for those over fifty, and "ھرم" (senility) is used for someone ancient. All these terms refer to advanced age (Ibn Manzur: 2005, p. 250)1.

In terms of terminology, there are various opinions on the concept of ageing, which differ according to discipline, society, and eras. However, they all agree that old age represents the final stage in human development, during which both physical and cognitive functions start to deteriorate more noticeably than in earlier stages of life (Akoun, Ansart: 1999, p. 563)2.

4-2. Concept of Elderly Care Institutions:

Elderly care institutions are social centres that provide comprehensive care for elderly individuals. These institutions house older adults who live their later years alongside other elderly residents, offering them food, clothing, entertainment, and medical treatment. They provide various services, including healthcare, psychological, and social services, that meet their needs (Ruqban 2008, 24)3. The Algerian legislature defines them in Articles 4, 5, and 7 as public institutions with an administrative character, enjoying legal personality and financial independence. They are under the supervision of the minister responsible for national solidarity and are designed to house elderly individuals in complex social situations (Official Journal: Executive Decree 12--13)4.

4-3. Concept of the Novel Coronavirus (COVID-19):

COVID-19 is a coronavirus that affects the respiratory system, causing various diseases, such as the common cold, flu, and Middle East respiratory syndrome (MERS-CoV). When observed under a microscope, it has a crown-like shape; hence, the Latin name "corona," meaning "crown." The novel coronavirus (SARS-CoV-2) is a new strain of these viruses, and the newly established virus classification committee, along with the World Health Organisation, named it COVID-19, with "19" referring to the year 2019 (Malikawi, 2020)5. The first reported case of COVID-19 occurred on February 27, 2020, with 82,623 confirmed cases and 2,858 deaths across 46 countries. The overall death rate for COVID-19 patients was estimated at 3.46% on the basis ofdata published by the China Centers for Disease Control and Prevention (China CDC) (Yixuan Wang, Yuyi Wang, Yan Chen, Qingsong, 2020)6.

• 5-    Problems and Requirements of the Elderly Stage:

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

During the elderly stage, individuals face challenges that their abilities and resources are often insufficient to address effectively. These challenges result from a range of physical, functional, psychological, or social changes, leading to a state of weakness and reliance on others.

Consequently, the elderly stage presents society with a reality that requires specific needs to be met through the provision of comprehensive and integrated care that aligns with the physical, mental, and emotional conditions of elderly individuals. This care aims to help them cope with the issues arising from ageing.

The following outlines the main problems that may accompany the elderly stage, along with the corresponding care mechanisms that can be provided in this context:

5-1- Health Problems of the Elderly and Care Requirements

Most research in the life sciences agrees that biologically, ageing represents a typical pattern of physical decline in structure and function that occurs with advancing age. Hall's book, published in 1922, is considered the true beginning of biological studies focused on elderly individuals, examining the effects of time on biological changes in humans (Al-Sayed: 357)7.

These changes affect all physiological, organic, motor, circulatory, digestive, urinary, reproductive, neurological, and cognitive systems. This has led to the emergence of numerous health issues, often referred to as age-related diseases. The most common of these diseases are as follows: arthritis and muscle disorders; heart diseases; circulatory diseases; blood pressure issues; nerve injuries; lateral sclerosis; facial paralysis; digestive system disorders; diabetes; skin diseases; sensory impairments; memory loss; and urinary and reproductive system diseases (prostate enlargement in men and uterine infections in women), among others (Fahmy 1999, 102--107)8.

Although this stage of life is characterised by general weakness and a decline in biological capabilities, this does not mean a total and uniform decline in abilities among all elderly individuals to the same degree. The situation differs from one older adult to another, as these changes are linked to various factors, such as the older adult's previous lifestyle and their social, educational, and cultural conditions, without neglecting the role and impact of genetic factors.

On this basis, the changes and weaknesses that result in many health problems require special care that focuses on these aspects and is based on two main components:

• •    Preventive Aspect: This involves raising awareness about the requirements of ageing, knowing healthy foods and harmful substances, and understanding the importance and necessity of physical activity to avoid certain diseases. Suitable activities for this stage include walking, training healthy and proper habits, educating elderly people about their health conditions, and providing sufficient information about their status.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

• •    The therapeutic aspects include taking care of the physical health and fitness of the elderly by providing specific services such as health insurance; performing regular medical checkups for early disease detection; providing medications and their free availability, especially those related to chronic diseases; organising physical therapy programs; arranging home visits by doctors; offering free health care institutions; providing hospitalisation services for specific surgeries; and supplying various medical devices, such as hearing aids, glasses, wheelchairs, and prosthetic devices.

Health care also requires attention to ageing-related diseases, and various studies that contribute to alleviating their effects on individuals and societies are needed. These studies explore the relationship between certain types of food and ageing, the effect of emotions on accelerating ageing, the impact of sleep, physical exertion, etc. This can be achieved by establishing research centres that study ageing and related issues.

5-2 Psychological problems of the elderly and care requirements:

The biological changes that occur in elderly individuals affect their psychological, mental, and social aspects. Ageing is a state of decline that affects older adults’ ability to adapt psychologically and socially, which reduces their ability to cope with life pressures and leads to unmet needs (Abd Al-Aziz 1999, 64)9.

The psychological changes that occur in elderly individuals vary depending on their environment and their experiences throughout their lives. Typical changes in elderly individuals include mental abilities, which decline as they age. Manifestations of this decline include deterioration in reasoning; numerical, verbal, and perceptual abilities; or what is commonly referred to as cognitive impairments.

In addition, this stage is characterised by changes in interest and needs, with some individuals experiencing fear and anxiety. The chronic diseases they suffer from, their retirement, the loss of some friends, and their failure to achieve personal and social adjustment properly contribute to these feelings. Moreover, the elderly often lose their life partner, leading them to feel isolated and lacking support or assistance. The limitation of financial resources results in insecurity and a change in social status. Ageing is accompanied by psychological dynamics characterised by reduced functional capacity, which is often accompanied by regression, agitation, and defensive mechanisms (Ismail 1999, 33)10.

The aging process is also associated with depression, headaches, insomnia, emotional rigidity, and self-centeredness. Among the most common psychological conditions that affect the elderly are paranoia and dementia, including symptoms such as forgetfulness, distraction, and Alzheimer's disease.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

On the basis of the aforementioned changes and associated psychological problems, it is evident that the elderly require psychological care that addresses their various needs, such as the need for attention, status, dignity, and psychological security. This can be achieved through interventions that modify elderly people’s negative thoughts and attitudes, strengthen their relationships with society by increasing visits, engaging them in recreational and cultural activities, and encouraging them to participate in tasks they can manage. This helps keep them connected with the outside world, fostering a sense of belonging and importance while alleviating boredom and emptiness, ultimately reducing the risks of stress, anxiety, and other psychological disorders.

In addition to providing psychological guidance and counselling for the elderly and their families about managing their emotions and understanding the various psychological changes associated with ageing, it is essential to help them comprehend their behaviours and organise their lives and free time effectively.

To provide proper psychological care for elderly individuals, specialised centres should be established for those who have experienced memory loss, suffer from complex psychological conditions, or face difficulties in carrying out certain activities. These centres should be equipped with trained social workers and psychologists to handle these cases.

5-3-Social issues of the elderly and care requirements :

The ageing process is characterised by a decline in social activity, with social relationships becoming increasingly limited and restricted to the immediate family. The isolation of older adults intensifies with the death of a spouse, the marriage and independence of children, or as a result of illness, retirement, and frailty. These factors can push older adults into a state of emptiness, loneliness, loss of contact, and feelings of marginalisation, fear, anxiety, and social alienation (Al-Tahan 1982, 402)11.

Additionally, old age is characterised by reduced social flexibility. Elderly people tend to resist change and cling to old ways of life, hindering their acceptance and adaptation to the new lifestyle and the demands of ageing.

Therefore, addressing or alleviating these issues requires providing various social programs that integrate the elderly into society, helping them adapt and regain their proper place. This can be done by training them to take on new roles that fit their new situation and fill their time. Social care also involves strengthening social relationships for the elderly with their family, relatives, and various social organisations and improving society's perception of elderly individuals. Breaking a routine can be achieved by establishing clubs near residences equipped with recreational activities that offer opportunities for friendships and that benefit from various activities and programs. Care also involves training elderly people to participate and volunteer in different institutions, using

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

their experiences, and encouraging their involvement in social life, which helps them feel valued and important.

In addition, social care for the elderly population includes providing daycare centres that offer health, nutritional, educational, and recreational care. It also includes providing services to support elderly individuals living alone by offering home services or alternative families to accommodate them.

Social care for the elderly also involves providing dedicated facilities in public spaces, such as seating and unique walkways, facilitating transportation, and offering audiovisual media programs that cater to their interests. These programs aim to raise awareness about their problems and needs and to educate society about them.

• 6-    Role of elderly care centers in providing services to the elderly

Elderly care centres are social institutions specialising in caring for elderly individuals of both genders. These centres may be governmental, private, or semigovernmental. This institutional system emerged as a natural result of the end of the traditional role of the family in caring for its elderly and dependent members, as the family was unable to meet their specific needs. Thus, the shift toward fulfilling these needs within care institutions became necessary. These centres aim to focus on the individual, collective, and societal needs of elderly individuals, providing activities and programmes that address their physical, mental, and environmental conditions. They assist them in planning for their lives while offering support to help them remain as active as possible in light of community resources and family relationships.

The following points should be considered in elderly care institutions (Barakat 2009, 1415)12:

• •    The size of the institution should be small. The smaller the institution is, the higher the level of service. Medium-sized institutions may be acceptable if necessary, but large institutions should be avoided entirely.

• •    The institution should have an appropriate courtyard, sitting areas, and shelters, with as much space as possible planted with greenery.

• •    The location should be in a healthy, quiet area, far from noise, with easy transportation access, and close to populated neighbourhoods.

• •    The building's design should allocate a room for each resident or a small group of residents with an attached bathroom. Alternatively, three or four rooms can be grouped into a private wing with a separate bathroom.

• •    Medical care should be given special attention in these institutions, alongside other aspects of care, particularly cultural care.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

• •    Furniture should resemble the type typically found in residents' homes to ensure a homogeneous environment.

• •    Hobby activities should be tailored to elderly care institutions and given appropriate attention.

• •    It is essential to select workers for institutions that possess specific qualities, including the ability to manage their emotions, patience, and a genuine desire to provide this service.

• •    A daily program should be prepared for residents throughout the day, along with a nightly program.

• •    Residents should be allowed to visit their families, provided thatthey adhere to the scheduled times. Families should also be allowed to visit residents in the institution.

• 7    Statistics on COVID-19 Infections in Elderly Care Centres

One of the key issues affecting public opinion in many countries worldwide has been the situation of elderly individuals in care centres during the COVID-19 pandemic. This is because they are considered a high-risk group for contracting the virus, which exposes them to severe complications that can lead to death. Reports and statements confirmed that the situation was catastrophic and represented a humanitarian tragedy. The reports indicated that the death toll in nursing homes was extremely high, reaching rates of up to 80% in some high-income countries, as stated by Michael Ryan, Executive Director of the Health Emergencies Programme at the World Health Organisation (WHO), who called for a serious re-evaluation of our relationships with the elderly after this toll, which has taken a whole generation of wisdom.

Statistics also revealed that half of the deaths in Canada occurred in nursing homes. British officials also confirmed that half of the deaths in Europe took place in these facilities. Numerous reports spoke of panic and a desire for suicide due to the fear of infection and death inside elderly care centres. International evidence indicates that individuals living in care homes experience high mortality rates due to COVID-19. In Europe, the World Health Organisation reported that approximately half of the total deaths were recorded in nursing homes (Nabouya 2021, 50)13.

In the United States, statistics indicate that more than 132,000 elderly individuals residing in care centers died due to the virus by the end of February 2021. These individuals account for more than 35% of the virus-related deaths in the country. New York alone revealed that over 1700 elderly individuals died in nursing homes and elderly care facilities, with nursing home residents comprising nearly a quarter to a fifth of the official death toll for the entire state.

In the United Kingdom, a report from the Office for National Statistics revealed that, from March 2020 to January 2021, deaths due to COVID-19 in nursing homes in England and Wales accounted for 30% of the total number of virus-related deaths in these regions.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

Switzerland also recorded the deaths of approximately 25% of nursing home residents due to COVID-19. According to a survey conducted by Swiss Television (RTS), more than half of the registered deaths occurred among nursing home residents.

In Algeria, according to reports from the Ministry of Health, many cases of COVID-19 infection and death have been recorded in nursing homes. However, there are no detailed and accurate statistics on this issue.

From the aforementioned facts, it becomes clear that elderly individuals in these environments face high risks, as environments that have long suffered from a lack of resources and capabilities. However, this should not lead to these previously safe environments becoming places where the bodies of the elderly are stacked for several weeks.

The heavy death toll among the elderly in care centers has led us to reflect and question the conditions of the elderly during the pandemic: were they subjected to neglect, deprivation, mistreatment, or discrimination during the COVID-19 crisis?

• 8-    Conditions of the Elderly in Care Centres during the COVID-19 Pandemic

Elderly care centres bear significant responsibility in protecting the elderly from contracting the virus, but at the same time, they must provide the necessary healthcare and psychological support. Therefore, they must develop clear and practical plans to address these issues. The following aspects should be considered:

• •    Provision of sufficient resources: Care centres must have adequate resources, such as sanitisers, face masks, and other medical supplies, to minimise the spread of the virus.

• •    Protection Measures: Necessary protective measures should be implemented within the centres, including reducing the number of visitors; increasing sanitation; and regularly testing staff, visitors, and elderly residents.

• •    Psychological Care: Adequate psychological support must be provided to the elderly in the centres, ensuring that they have mental comfort and emotional stability through recreational and educational activities.

• •    Communication with Families: Communication between elderly residents and their families should be provided, allowing them to stay connected.

However, reports on this matter have indicated that the COVID-19 pandemic has significantly affected the services provided in elderly care centres, impacting their psychological, social, and health conditions. Some of the main effects that can be identified include the following:

• 1.    Isolation and feelings of loneliness: Precautionary measures caused the separation of elderly residents from their families and loved ones, leading to feelings of isolation and depression. External visits were halted in most centers, and social and recreational activities previously

• 2.    Increased Anxiety and Stress: The pandemic led to an increase in fears among elderly people about contracting the virus and the possibility of it being transmitted to them. This heightened levels of anxiety and stress. Moreover, the reduction in nurses and staff in the centres resulted in lower-quality care and attention for elderly residents.

• 3.    Increased Health Risks and Infections: Pandemic has exacerbated the risk of illness and infection among elderly individuals, who generally suffer from a weakened immune system and other health issues associated with aging. The pandemic has also led to the suspension of the physical activities and rehabilitation exercises necessary for elderly care, negatively impacting overall health.

• 4.    Reduction in Services Provided: The services provided to the elderly in care centres, such as healthcare, recreational activities, and continuous training and education, were reduced due to the risk of virus transmission and lack of sufficient resources for protection. According to a recent study published in the American Journal of Infectious Diseases, many centers have reduced the medical treatments provided to elderly residents, particularly those requiring specialised medical professionals or physical therapy. This was due to concerns over virus transmission and limited financial and human resources.

• 5.    Increased costs: The COVID-19 pandemic increased the costs necessary for implementing preventive measures and health protocols, as new safety measures, including face masks, social distancing, and regular cleaning, were introduced to prevent the spread of infection within the centres. These measures increased the financial burden on care centres, affecting their financial and human resources. As a result, services were reduced, and the quality of care declined. This also affects the ability of the centres to meet the needs of elderly individuals, such as food supplies, medical care, and entertainment.

• 6.    Changes in the healthcare system: During the COVID-19 pandemic, it became difficult for elderly residents in care centres to receive necessary healthcare, as the number of medical visits and routine checkups decreased. This increase in healthcare delays elevated the risks of other health complications for elderly residents.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

organised for the elderly population were reduced or cancelled. Movement restrictions and the prohibition of gatherings further enhanced the elderly people’s sense of loneliness and isolation. According to a recent study in the UK, one-third of elderly individuals living in care centers reported feelings of loneliness and isolation during the COVID-19 pandemic.

In Algeria, nursing homes were severely impacted by the COVID-19 pandemic, with numerous infections and deaths recorded within these centres. Nursing homes in Algeria have long faced significant challenges exacerbated by the pandemic.

Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

Among the issues faced by nursing homes in Algeria are the lack of sufficient resources to meet the needs of elderly individuals, a shortage of training and qualifications for the staff working in these centres, a lack of medical and pharmaceutical care for elderly individuals, and the social isolation experienced by many residents within these facilities.

Nursing homes in Algeria were particularly affected by the partial and complete lockdowns imposed by the government to limit the spread of the virus. Family and friends were prohibited from visiting, leading to increased isolation and loneliness among elderly individuals. The services provided to the elderly individuals within these centres were also impacted by the restrictions placed on social, recreational, and training activities.

Overall, the situation of elderly individuals in nursing homes was significantly affected by the COVID-19 pandemic. Social interactions and visits were reduced, the risk of other health problems increased, and the mental and emotional well-being of the elderly in these centres decreased. To improve the situation, measures were taken, such as increasing the number of staff in nursing homes and implementing other precautionary measures to prevent the spread of the virus, such as temperature checks and quarantine procedures when infections were detected. In place of regular visits from family and friends, digital communication tools were used to maintain contact with the elderly individuals in the centres. However, personal communication remains essential, as research has shown that good social relationships enhance the mental and physical health of elderly people.

Therefore, the COVID-19 pandemic has significantly impacted the services provided by nursing homes. Addressing this issue at various levels, including increasing funding for elderly care facilities and improving the health, social, and psychological needs of the elderly within these centres, is important.

In general, the COVID-19 pandemic has posed a significant challenge for the elderly in nursing homes, and improving their conditions requires taking additional measures and providing the necessary resources to meet their health and psychological needs.

• 9- Conclusion

As the COVID-19 pandemic continues worldwide, nursing homes must implement preventive and safety measures while improving the services provided to elderly people within these centres. This is essential to ensure the necessary health and social care for the elderly while safeguarding their dignity and fundamental rights.

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Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

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Nursing Homes, Said Mehdi , Yakhlef Najet, Hamza Djahnit, Amara Boudjem” (Algeria)

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