A cluster of pneumonia cases of unknown etiology was reported in Wuhan, Hubei Province, China On Tuesday 31st December 2019. On Thursday 9th January 2020, China CDC reported a novel coronavirus as the causative agent of this outbreak; coronavirus disease 2019 (COVID-19). By the end of February 2020, several countries, including numerous European countries, were experiencing sustained local transmission of coronavirus disease. Symptoms, severity, and case fatality: By Tuesday 24th March 2020, 50,569 laboratory-confirmed cases had been reported to the European Surveillance System (TESSy). Among these cases, the most commonly reported clinical symptom was fever (47%), dry or productive cough (25%), sore throat (16%), general weakness (6%) and pain (5%). The frequency of these symptoms differs notably from those reported from China and is summarised in the sixth update of ECDC’s Rapid Risk Assessment (ECDC 2020a).

‘WHO’ has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptoms a and on public health measures related to the management of their contacts (WHO 2020b). Home care and isolation of cases clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic, subclinical infection and mild illness to severe or fatal illness. It is stated  that clinical deterioration can occur rapidly, often during the second week of illness (ECDCa 2020, WHO 2020a).

Patients with a mild clinical presentation (mainly fever, cough, headache and malaise) will not initially require hospitalisation and may be safely managed in dedicated isolation facilities or at home. The majority of these cases will spontaneously recover without complications. Management of such patients should focus on prevention of transmission to others and monitoring for clinical deterioration, which should prompt hospitalization. If such patients are cared for at home, they should remain in frequent contact with their provider to closely monitor for any symptoms or signs suggestive of clinical worsening (WHO 2020b).

However, as clinical signs and symptoms may worsen with progressive dyspnoea due to lower respiratory tract disease in the second week of illness, patients treated at home should be provided with instructions if they experience difficulties breathing. Sufficient call and reception capacity, as well as hospitalisation capacity have to be established to guarantee good access. Home care could be considered for symptomatic patients no longer requiring hospitalisation, or in a case of informed refusal of hospitalisation (WHO 2020a). ECDC has proposed criteria for hospital discharge of confirmed COVID-19 cases (ECDC 2020b). Instructions should be provided for home care, PPE use, and environmental cleaning in home settings in order to limit transmission within households (WHO 2020a, WHO 2020b). Clinical criteria such as resolution of symptoms or absence of fever and laboratory evidence of SARS-CoV-2 clearance from the upper respiratory tract should be considered, but also adapted to the local context, i.e. existing capacity of the healthcare system, laboratory diagnosis resources, and the current epidemiology situation (WHO 2020a, CDC 2020).

The older adults, disabled, and chronically ill people have created the need for more direct care workers to provide personal care and the needs of this population vary widely (CDC, 2016; Kistler et al., 2017). IOM reported that there were three million direct care workers in the United States in 2006 and, the needs of direct care workers will grow 49% between 2012 and 2022, as the aging population requires more assistance in daily living activities (IOM,2008). Approximately 40% of assisted living residents have a diagnosis of Alzheimer's disease or other dementia. Typical needs include assistance with instrumental activities of daily living such as managing medications and housekeeping and with activities of daily living, including bathing, dressing, feeding, and toileting (CDC, 2016). “Home is a place of emotional and physical associations, memories and comfort” as reported by the World Health Organisation. When faced with the choice between care options in institutions or at home most older people with disabilities and other care users usually prefer to stay in the more familiar environments of their own homes and local communities. The growth of home and community-based services has contributed to the reduction of the nursing home population (Hahn, Thomas, Hyer, Andel and Meng, 2011). Another reason for this decline is the growth of the assisted living industry, which is a response to consumer demand for long-term care housing (Kaskie, Nattinger, & Potter, 2015). In addition, there is also a perception that providing services at users’ homes may also be more cost-effective than in institutions, once a comparison is made on the basis of comparable needs of residents and equivalent quality of care and the full potential of assisted-living technologies is released.

As the aged population expands, quality of care in these communities has become an increasingly important issue for policy makers (Morgan L. A. et al., 2014). The next decades will also see dramatic changes in the needs of those with noncommunicable disease as the leading cause of disability and death. a variety of people with chronic conditions may stay at home given difficulty in mobility, and dependent children with severe health problems or people with mental disorders may also require home care. According to the reports WHO European Region, it is stated that the scarcity of up-to-date and comparative information on home care in Europe is in contrast to the growing size and importance of the sector. Growing demand for care, in combination with the diminished potential for informal care is likely to result in a need to expand formal care services and increase expenditure. This combined with big pools of unemployed persons across the EU, creates some positive expectations on the recruitment opportunities within the sector. The population most affected by the COVID-19 virus is the elderly and the people with choronic diseases and disabilities. Home care for these groups is a great deal of important. Empower4Employment Project’s outputs  will support both home care providers and home care workers in the pandemics such as COVID-19.

The project is based on two important thematic areas. One of them is home care and other one is employability as well. COVID-19 also will effect employabilities of people especially low-skilled and low-qualified ones. Job losses are mounting across Europe, intensifying pressure on governments to protect their labour markets from the backlash of the coronavirus or face the threat of protracted recessions. Reports showing almost one million Britons applying for welfare payments in the space of two weeks, a record jobless-claims surge in Spain, and Austria’s highest post-war unemployment rate, are among the worst examples so far (Stirling et al., 2020). There’s still a lot of uncertainty about how some of the businesses who are not on the front lines, the second tier, will be able to find support from governments or whether there’s just going to be a material round of layoffs and defaults at the corporate level. European countries have pledged hundreds of billions of euros to try to mitigate the economic impact of the virus and have relaxed their rules to make it easier for people to be entitled to unemployment benefits and to help businesses that support their workers. But even with promises of cash, the scale of the crisis has forced the authorities to juggle to try to meet demands for help.

While economic downturns caused by global crisis such as the current COVID-19 may promote home care workers because of increased needs of home carers in the world after pandemic.

Empowering the Employability of Low-Skilled and Low-Qualified Adults in Home Care Sector – EMPOWER4EMPLOYMENT Project (2019-1-TR01-KA204-076960) is in the same line with the guidelines developed by WHO and ECDC. EMPOWER4EMPLOYMENT Project will help the communities to meet the needs on public health measures related to the management of safe home care and which competences/skills care workers should possess to enable them to carry out their duties in sustaining continuous quality care during pandemics such as COVID-19. The relevance of E4E project and its sustainability is far more imperative now in ensuring its outputs and competences are a success.

The proposal has been developed and coordinated by Izmir Governorship,  and the consortium is composed of  Redefine - Associação Para A Investigação, Educação E Desenvolvimento (Portugal), WSBINOZ - Wyzsza Szkola Biznesu I Nauk O Zdrowiu (Poland), BIT MANAGEMENT-Bit Management Beratung GesmbH (Austria), Izmir Chamber of Commerce (Turkey), Menderes Municipality (Turkey).

To address these challenges the project consortium will create:

The SKILLS/COMPETENCES DETERMINATION HANDBOOK, defining the basic and transversial competences required for employment in the home care sector, with a focus on learner-centered training approaches, as well as appropriate validation methodology of job seekers skills.

A TRAINING CURRICULUM aimed at equipping adult trainers, career advisors, and employment agents, with the necessary material for them to be able to adequately guide and prepare job seekers for employment in the home care sector.   

A JOB-MATCHING PLATFORM which will connect job seekers and prospective employers, thus facilitating employment in the area.

Fatma SUSAM ÖZSAYIN

Project Coordinator

Izmir Governorship EU and Foreign Relations Bureau

References:

Centers for Disease Control and Prevention (CDC). Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19) 2020 [updated 25 February 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-managementpatients.html.

Centers for Disease Control and Prevention. (2016). Long-term care providers and service users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014. Retrieved from: https://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf

European Centre for Disease Prevention and Control (ECDC 2020a)Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update. Available from:    https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-update-Outbreak-of-coronavirus-disease-COVID-19.pdf

European Centre for Disease Prevention and Control (ECDC 2020b). Novel coronavirus (SARS-CoV-2): Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? : ECDC; 2020 [March 11, 2020]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf

Hahn, E. A., Thomas, K. S., Hyer, K., Andel, R., & Meng, H. (2011). Predictors of low-care prevalence in Florida nursing homes: The role of Medicaid waiver programs. The Gerontologist, 51(4), 495-503.

Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK215406/

Kaskie, B. P., Nattinger, M., & Potter, A. (2015). Policies to protect persons with dementia in assisted living: Déjà vu all over again?. The Gerontologist, 55(2), 199-209.

Kistler, C. E., Zimmerman, S., Ward, K. T., Reed, D., Golin, C., & Lewis, C. L. (2016). Health of older adults in assisted living and implications for preventive care. The Gerontologist, 57(5), 949-954.

Morgan, L. A., Rubinstein, R. L., Frankowski, A. C., Perez, R., Roth, E. G., Peeples, A. D., ... & Goldman, S. (2014). The facade of stability in assisted living. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(3), 431-441.

Stirling C., Bosley C. and Look, C. 2020 Apr 02. Europe Feels Jobs Shockwave with Shutdown Damage Spreading. Bloomberg Wire Service.

World Health Organization (WHO 2020a). Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected - Interim guidance [17 January 2020]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratoryinfection-when-novel-coronavirus-(ncov)-infection-is-suspected.

World Health Organization (WHO 2020b) Home care for patients with COVID-19 presenting with mild symptoms and management of their contactsUpdated March 17, 2020. https://www.who.int/publications-detail/home-care-for-patients-with-sus…;