Supplementary Material for: Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

Introduction
Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care – especially during the COVID-19 pandemic and especially in assisted living (AL) homes, were resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap.

Methods
This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the three months prior to and during waves 1 and 2 of the pandemic: socio-demographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care.

Results
Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care.

Discussion/Conclusions
Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and wellbeing. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.

引言
家庭/亲友照护者在照护有需求的老年人身心健康方面发挥着至关重要的作用——尤其是在新型冠状病毒肺炎（COVID-19）疫情期间，以及在辅助生活（Assisted Living，AL）机构中：这类机构的入住者照护需求与长期照护机构同样复杂，但可用的人力与服务资源却更为匮乏。然而，针对新冠疫情第一波、第二波流行前后，辅助生活机构入住者的照护者参与照护情况及其照护顾虑的相关研究仍较为匮乏。本研究旨在填补这一重要的研究空白。

研究方法
本项前瞻性队列研究针对加拿大西部的辅助生活机构入住者的主要照护者开展了基线与随访线上调查，研究对象为65岁及以上、且于2020年3月1日前已在该辅助生活机构居住满3个月的老年人。调查在疫情第一波、第二波流行前后的三个月内，对以下指标进行了评估：社会人口学特征、与入住者的5种探视或沟通方式、参与16项照护任务的情况、对入住者9项身心状况的顾虑、认为入住者无法获得的7项照护服务，以及照护者是否认为自己充分了解照护信息并参与了入住者的照护工作。

研究结果
基于386份照护者有效问卷回复，疫情第一波流行期间，线下探视比例大幅下降，照护者参与几乎所有照护任务的比例也同步降低。尽管第二波流行期间上述比例有所回升，但多数指标仍未恢复至疫情前水平。相应地，照护者的顾虑（疫情前已处于较高水平）在第一波流行期间大幅上升，并在第二波流行期间持续维持高位。在那些认为自己未充分了解照护信息、未参与入住者照护工作的照护者中，这类顾虑尤为突出。

讨论与结论
受限的线下探视干扰了入住者的照护工作，且与照护者对入住者健康与福祉的负面感知相关。即便在封控期间，持续推动照护者参与入住者照护工作并保持与照护者的沟通，是缓解上述问题的关键所在。