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https://www.newtimes.co.rw/news/covid-19-advocacy-body-calls-greater-attention-elderly

COVID-19 made itself known in Rwanda in March of this year. The government was quick to respond, by setting up preventive measures and providing food to people who had informal jobs and using media to disseminate information. But older people’s heightened risk to COVID-19 was not clear in these media campaigns. Only general messages were given to communities.
We set out to make sure older people got the information they needed to keep themselves and their families safe from the virus. My organization, NSINDAGIZA, is run solely by volunteers, so I’m thankful to Helpage International for their support in translating their guidance and advice for older people into our local language, Kinyarwanda. These tools have been vital for us, as there are so few tools available on COVID-19 and ageing.
During conversations we had with older people in the community, they revealed challenges such as: lack of means for medical services, lack of food, hygienic kits, protective equipment, and receiving limited information on COVID-19. They revealed anxieties about how they will make it through the pandemic.
For instance, one older woman, Epiphanie, told us: “I’m in the care of many orphan children who I raise. They are hungry and so am I, and I have nothing to give them. On top of that, I have a stomach illness and liver problems; I have no funds to get the proper medicine after the ones I had depleted. A family member who used to support me is currently not working due to COVID-19! How do you think we can survive this pandemic?”
Epiphanie featured in a short video we created to raise awareness of older people’s concerns. I was so happy that this video touched the hearts of some who, in turn, supported NSINDAGIZA to provide food for 26 families. Epiphanie was able to feed her orphan children and get the medical services that she needed. I’m also thankful to the Rwandan Senate for considering the information we shared with them concerning older people’s problems- They even joined us in advocating for the inclusion of older people in this COVID-19 pandemic.
In April, we organised an online conversation on COVID-19 and older people, where older people could express their views on the COVID-19 response face-to-face with the Government and other decisionmakers. As an outcome, decisionmakers started to consider tailored messaging for older people, and the Rwanda Biomedical Centre decided to include a chapter on ageing in their Community Health Workers handbook.
In May, NSINDAGIZA was supported by Helpage International and Age International to respond further to the issues that older people raised. We managed to secure wheelchairs for nine people with disabilities, and 81 families and two residential care centres received hand-washing kits, which included handwashing stations, towels, hand sanitizers and soaps. Hand-washing is one of the best ways to prevent the spread of the virus, but hand-washing in rural areas where there is no running water is almost impossible. These handwashing kits are a lifeline to older people and their families.
This has opened the floor to local leaders who used this opportunity to educate the community on the importance of hand-washing and who are committed to mobilise community health workers to keep following up on the implementation of these practices in the community.
But the battle is still ongoing. I’m still challenging civil society, donors, UN agencies and government to put older people front and centre of their COVID-19 response and in their strategies to build back better. The policy brief published by the UN Secretary General on the Impact of COVID-19 on older persons is clear enough and provides enough guidance on the inclusion of older person. It’s time for older people to get the attention they are entitled to.

Elie MUGABOWISHEMA,
President of NSINDAGIZA Organization

NSINDAGIZA Organization, promoting the rights and welfare of older people is major concerned in the increasing spread of COVID-19. While the pandemic affects all population groups, older people due to their low immune system and underlying non communicable diseases threatens the wellbeing of older persons and can result to high mortality rate among the older persons. Though no many cases of COVID-19 reported among older people, there is need to take all measures to protect them by putting more efforts, ensuring that they get adequate information about Covid-19 and how to prevent being infected. The Government, UN agencies, bilateral cooperation, private sector, development partners and CSOs support systems should consider this in all their interventions.
Despite the Government’s interventions to support the most at risk people, including older people, there still more challenges such as access to information on COVID-19 for older people, as some already live alone and depend on other people, who are currently confined. Most of information are shared through social media, Televisions, Radios and written magazines, to which older people don’t have access. The lockdown period and social distancing affect older people in different ways, including the provision of basic needs such as food, sanitary materials, etc by community members who are at the moment quarantined in their homes. The situation like this may result to mental problems, anxiety, depression, etc. There could be also those who were under life-long treatment who may not be able to get medical services as normal health services have been affected by the current preparation of the Covid-19 response.
NSINDAGIZA in collaboration with the Rwanda Leave No One Behind Network and URUMURI RW’IZABUKURU ageing platform is, following up through mobile phone by community-based volunteers, elderly support group leaders and community older people committees who are monitoring the situation of older people; support given and challenges faced. This information is shared with relevant authorities and other actors who could provide support to improve the situation. At national level, members of two platforms have also been engaging policy makers and hopefully older persons will get enough information, community health systems that is age friendly, livelihood support and other important materials to ensure wellbeing of older persons.
As member of Global Helpage Network, we are also collecting information on what is being done in other contexts worldwide and get inspired from them. It is in this spirit that we got the attached materials and messages developed on COVID-19 among older people, that we are using to spread the messages to older people through community-based volunteers and elderly committees, the materials could be used by any other actors in development and humanitarian intervention. Further, the huge gaps in ensuring equality and non-discrimination of older people is being highlighted and hence the need for policy makers to modify both humanitarian and development laws, policies and programmes to include the unique needs of older persons.
Kigali, March 30, 2020
Elie MUGABOWISHEMA,
President of NSINDAGIZA Organization

Protecting older people during the coronavirus (Covid-19) pandemic
Covid-19 is a new disease that presents specific risks for older people.
Initial research in China based on over 44,000 cases of Covid-19, showed a mortality rate of 2.3% for the general population, rising to 8% in those aged 70-79 and nearly 15% in those 80 and over.
It has been characterised by the WHO as “a controllable pandemic” which all countries need to prepare for and respond to. This presents a challenge for low- and middle-income countries with weaker health and care systems, as well as in countries hosting populations of refugees and displaced people living in camps.
This pandemic can be suppressed but only in so far as people act in solidarity with each other and take steps to protect and care for those most at risk.
HelpAge International has six key messages for decisionmakers at global and national levels: 1. Equality and non-discrimination Older people have the right to health including access to information, care and medical services on an equal basis with everyone else. The risk of discrimination in accessing medical services is one that should be monitored for all high-risk groups, including older people.

1. Preparedness and planning Preparedness and planning should take account of the additional risks to older people. Countries are advised to act in line WHO’s global Strategic Preparedness and Response Plan which outlines how to implement public health measures to manage Covid-19.
2. Public information – reaching older people Regular communications with the public and at-risk populations is one of the most important steps to help prevent infections, save lives and minimise adverse outcomes. Information must be provided in multiple formats and local languages to address the barriers which older people often face, related to literacy, language and disability.
3. Access and support Specific measures to support older people must be implemented during an outbreak. These include access to alcohol-based hand rubs where there is poor access to water; access to social support and essential supplies for older people in quarantine or selfisolating; and a proportionate and non-discriminatory approach to restrictions on freedom of movement. Communities must work together to ensure everyone’s wellbeing during the response.
4. Conflict and displacement settings Contingency planning by governments and humanitarian agencies must address the high risks faced by older refugees and displaced people and provide for access to health treatment and care, including access to national health systems and hospitals, regardless of legal status.
5. Development and humanitarian funding Older people are frequently overlooked in development and humanitarian strategy development and funding. In the context of Covid-19 and the risk posed to older people, they must be explicitly identified and considered in funding applications and decisions at all levels and in all settings.

This document provides guidance and advice for care homes about coronavirus, or COVID-19. While older people in care homes are particularly vulnerable to COVID-19, there are steps that can be taken to reduce their risk, and to ensure they are well cared for and supported. Care home staff must also be looked after and must be equipped with information to protect themselves as well as those in their care. The document includes information on personal behaviour, action to take inside the care home, interaction with the outside environment, management responsibilities, governance, and what to do if someone has COVID-19.

These guidelines have been informed by experience in China, Korea and Japan.

Personal behaviour

• Staff, older residents and all visitors to care homes, including independent contractors should take precautions to protect themselves and those in their care from contracting COVID-19. These precautions include: 1. Washing hands with soap and water for at least 20 seconds 2. Using alcohol-based hand rub 3. Sneezing or coughing into a tissue, and discarding it immediately, or into an elbow, and then washing hands 4. Keeping at least one metre (3 feet) from each other wherever possible • Care home staff looking after older residents who are unwell should wear masks. They should wash their hands after putting on their mask, if they touch
Guidelines for care homes for older people in the context of Coronavirus (COVID-19)
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Published by HelpAge International in March 2020 PO Box 70156, London WC1A 9GB www.helpage.org Registered charity no. 288180
their mask while wearing it and after they have taken their mask off and throw it away • Care home staff should remind and help older people to take these precautions

Inside the care home

• Care home staff should not go to work if they have symptoms, including a fever, a cough or shortness of breath. This applies to all staff members, from care providers who have direct contact with older residents, to clerical workers, transfer staff and volunteers • If possible, staff should measure the older residents’ body temperature every morning and evening • Door handles, handrails, tables, chairs and other surfaces should be cleaned with disinfectant regularly • Staff should regularly empty garbage bins in which tissues are disposed • Care home staff should be aware of older people’s mental health and wellbeing. Affectionate personal communication can relieve anxiety • Older residents and staff should be well nourished • Warm temperatures should be maintained in the care home, and spaces should be regularly ventilated • Staff should try to maintain older residents’ normal schedule and daily routine • If possible, care home staff should organise or facilitate regular online contact between older residents and their family members and friends (i.e. via Skype, WhatsApp, WeChat). This will help to relieve stress and isolation • Staff with symptoms who cannot work should not face any employment-related disadvantages or penalties such as reduced wages or loss of their job

Interaction with the outside environment

• Decisions on whether visitors should be allowed to attend care homes should be based on advice from government or other relevant authorities. Visits should be discouraged where possible • All visitors should consider any potential contact they may have had with infected people before making a decision to visit. If they think this contact may have occurred, they should not visit a care home • People should not visit a care home if they have symptoms, including a fever, cough or shortness of breath • Care home staff should ask all visitors if they have symptoms before allowing them to enter the home • All visitors should take basic precautions when visiting. This includes hand washing, sneezing or coughing into a tissue or elbow, maintaining one metre
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Published by HelpAge International in March 2020 PO Box 70156, London WC1A 9GB www.helpage.org Registered charity no. 288180
distance from residents and avoiding personal contact • In a widespread outbreak or high-risk situation, visits should be limited to emergency needs only, for example, for medical professionals if a resident is ill • Delivery of goods should be restricted to a single entrance. If a contractor or vendor needs to enter the care home, staff should ask if they have symptoms such as fever, a cough or shortness of breath. If any of these symptoms are present, they should not be allowed to enter the care home

Management responsibilities

• Care homes should establish links with their nearest health facility providing COVID-19 testing and care • Care homes should discuss with the health authority and their nearest facility, what they should do if a resident has symptoms • Care home managers should regularly refresh basic health education for staff. This should include knowledge of the virus and training in basic precautions. Posters and leaflets should be used as reminders • Care home managers should prepare and manage prevention and control items such as thermometers, masks, gloves, soap, alcohol-based hand rub, tissues and paper towels • The psychosocial support needs and wellbeing of staff should be supported through regular communication

Governance

• Care home staff should maintain close contact with related institutions and local administrations or health authorities. They should respond promptly to changes in their local situation or advice provided • Care home staff should keep families regularly informed of the situation, including prevention arrangements. This can be done through telephone calls, text messages and emails

If someone is suspected of being infected

• If an older resident or a member of staff feels unwell and has symptoms, they should be isolated from other residents, in a separate room. Symptoms include a fever of 37.5°or above, a cough or shortness of breath • Care home staff should immediately contact relevant health authorities or facilities and follow their instructions • Anyone isolated because of suspected COVID-19 infection should wear a mask
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Published by HelpAge International in March 2020 PO Box 70156, London WC1A 9GB www.helpage.org Registered charity no. 288180
• Any staff looking after someone suspected to have COVID-19 should wear a mask • The room where someone is isolated should be in a relatively separate, wellventilated area. It should have a door that can be closed and an independent toilet if possible • If health authorities require an older person to go to a designated facility for testing or treatment, care home staff should follow their instructions immediately. Public transport should not be used. The older person and accompanying staff should wear a mask • An isolated older resident should be given quality care and should be provided with support to maintain their mental health and wellbeing • Any older residents who have come into contact with someone known or suspected to have COVID-19 should be isolated from other residents • After an older resident or staff member with symptoms has been transferred to a health institution, care home staff should thoroughly clean and disinfect any areas the person has been in • Staff should be divided – as much as possible – between those providing care for older residents suspected to have COVID-19 or who have been in contact with those who have COVID-19, and those providing care for other older residents • Older people whose symptoms have ended and who return to the facility should be observed in a separate room for 14 days

Please remember: COVID-19 is a serious illness, but there are things we can all do to protect ourselves and others. Taking sensible precautions is important but there is no need to panic.