Residents of long-term care facilities, including assisted living communities, nursing homes, and planned retirement neighborhoods, have been hard hit by the Covid-19 pandemic. As a demographic with an increased risk of severe symptoms and ongoing respiratory complications, these individuals are some of the most vulnerable. An at-risk population in close quarters, unable to fully quarantine or socially distance, is almost a guarantee for a high degree of mortality. Unfortunately, this is exactly what happened in long-term care facilities across the country.
The High-Risk Characteristics of Long Term Care Residents
The majority of long-term care residents are elderly, aged 65 and older. Many have several comorbid health conditions that make them especially vulnerable to respiratory diseases, including influenza and other SARS types of viruses. Many have diabetes or heart disease, making it harder to fight off infections. Influenza-type viruses are the most common cause of viral pneumonia, which can be deadly for immune-compromised individuals. Progression to severe disease can be rapid in older seniors with multiple comorbidities.
For individuals with fragile health, the need for intensive care from Covid complications is higher than that of the general population. Unfortunately, while equipped to provide 24-7 health care, many nursing homes are not equipped with the ventilators, intensive care equipment, and additional staff to provide the intensive care that the severely ill require.
The Impact of Coronavirus on Nursing Homes
Close quarters tend to quicken the spread of airborne viruses, and the nursing home/long-term care home operation model prior to the Covid outbreak made it challenging to control the spread of the virus. Shared private quarters, common gathering spaces for dining and activities, and rotating staff, some of whom worked at other health care facilities, too, all contributed to an environment that made it hard to control the spread of a highly contagious, novel virus.
In addition to close living quarters, the supply of personal protective equipment and source control for many nursing homes was in incredibly short supply. Many nursing homes found themselves with continual supply shortages.
Several other factors contribute to the rapid spread of Covid in assisted living homes. Lack of knowledge and conflicting information at the start of the pandemic created an environment of constantly changing protocols, and lack of experience, standard best practices, and knowledge about handling a pandemic outbreak made things confusing for many caregivers. Many caregivers in these facilities may have largely been asymptomatic and unwittingly carried the disease into the building, while others worked in more than one facility, thus creating larger contamination zones.
The pandemic highlighted the need for increased nursing home safety and infection control and the need to be a public health focus. With the outsized impact of the pandemic on residents and staff, there’s an immediate need to take a closer look at the relationship between infection control and the physical environment of the facility and the quality of life offered to residents. Community directors should balance both staff and resident safety against those considerations.
Room occupancy may be one of the most significant issues for nursing home reform. Many homes operate on a dual occupancy model for patient care rooms, with private rooms priced at a premium. With each resident in a private room, the chances for transmission are reduced, and it’s easier for those who have been exposed or who are ill to isolate safely.
Testing Plans to Reduce the Impact of Covid
Creating a testing plan for residents, staff, and visitors, re-training all staff members, and consistently adhering to this plan is one of the most essential things that nursing homes can do to reduce the impact of Covid and its spread through the facility. The CDC outlines a step-by-step plan for this, which each facility can use to create its own Best Practices.
- Anyone who exhibits even mild coronavirus symptoms should take a viral test as soon as possible
- Residents in close contact with someone who has a SARS-CoV-2 infection, even those who are asymptomatic, should receive two viral tests, one immediately after the suspected exposure and a second 5-7 days later, if the first test was negative
- Unvaccinated health care professionals working in nursing homes should remain subject to expanded screening testing, although vaccinated individuals may not be required to do so
Residents should be evaluated daily as part of their morning routine. Care workers are recommended to take the following steps:
- Ask residents daily if they feel signs of a respiratory infection or symptoms consistent with Covid
- Test daily for fever (temperature ≥100.0°F) and, if possible, check oxygen saturation of each individual
- Actively monitor all residents throughout the day, especially those who are classified as in the highest risk category or those who may have been exposed to someone with SARS-CoV-2
Testing and consistent monitoring can reduce the spread of influenza diseases. In addition, educate residents about the signs and symptoms of Covid and how it’s transmitted, plus ways to reduce the risk of getting sick. When possible, residents should also be informed of the community’s policies for quarantining and limited access should an outbreak of Covid occur.
Recommendations for Ongoing Infection Prevention in Long Term Care Communities
Facilities with 100 or more residents should have a full-time infection prevention and control manager responsible for maintaining an infection control program, as per the Centers For Disease Control. This individual is in charge of training all staff on the protocols for resident testing and the response if someone tests positive for Covid or another contagion.
They also ensure that the facility has access to supplies needed for personal protection and for cleaning and disinfecting common spaces and the community. An infection control department can also work with the state for emergency response for a Covid outbreak. For example, some states may activate the National Guard to assist with sanitation and disinfection of the entire facility and train staff on the proper way to wear and dispose of personal protective gear.
While comprehensive nursing home reform may take years, there are many steps that individual communities can take to protect the health of fragile residents and staff. Daily checks for fever and other Covid symptoms should be mandatory. Each community should keep a stock of rapid tests to diagnose ill patients and enact their emergency responses protocols quickly.