Models of Adaptation of Long-­Term Care Institutions to the COVID‑19 Pandemic

Abstract

The spread of the COVID‑19 pandemic became a threat to institutional care facilities in view of the high risks for the elderly with comorbidities and the high density of accommodation. This paper is devoted to identifying adaptation models of institutional care facilities to the challenges of coronavirus, which includes the need to comply with social distancing measures, unplanned expenses, the failure of the local healthcare system, the transformation of the lifestyle and work schedule of employees, and the isolation of the patients and their psychological difficulties. For this, 25 semi-structured interviews were collected with heads of private and public institutions in 12 subjects of Russia and 5 with representatives of regional authorities and NGOs. We analyze the transformation of the institution’s activities from the perspective of the crisis management theory. Adaptation models are built on the basis of three main characteristics that describe the actions of institutions, namely the degree of agency, control and management of the organization, and problem-­solving tools. At the intersection of the respective axes, five adaptation models were identified, namely 'Everyone for himself,' 'According to the instruction,' 'Entrepreneur,' 'Leader,' and 'Personnel.' The resulting models emphasize the high role of proactive attitude and transformative action in overcoming the challenges of the pandemic. The development of the transforming agency theory in our work is associated with the identification of three types of agency, i. e. mediated, individual, and collective, depending on who is the initiator of the action and control (an external agent or structure, an individual agent (leader) or a team, respectively). Understanding the mechanisms for restructuring activities during forced adaptation to the pandemic can become a basis for building the social structure of such organizations in the context of the transformation of the current social services system, which started in Russia in 2018.