Five Key Takeaways to Inform State COVID-19 Responses in Long-Term Care Settings

Five Key Takeaways to Inform State COVID-19 Responses in Long-Term Care Settings

Dec 08, 2020
Patricia Rowan
Asian nurse taking care of mature male patient sitting on wheelchair in hospital

One of the earliest hot spots of the COVID-19 pandemic was in a Washington State nursing home, and to this day, the virus disproportionately affects residents of long-term care facilities nationwide. Since the beginning of the year, the United States has recorded 100,000 deaths among residents and staff of long-term care facilities.

Mathematica recently convened a panel of experts from across the country to share the latest evidence about COVID-19’s effect on nursing home residents. The panel also discussed how state governments and long-term care facilities can translate that evidence into action to mitigate the impact of the pandemic in nursing homes and assisted living facilities.

The conversation covered topics ranging from testing to vaccines, to personal protective equipment (PPE) and combatting social isolation. Here are five takeaways that states and facilities should consider as they combat the pandemic in long-term care facilities.

  • The lack of a coordinated, federal response in nursing homes created a patchwork of different experiences across states. Panelists shared their experiences in Florida, Ohio, California, and Texas, and Mathematica highlighted our recent work in Connecticut. States have taken different approaches to addressing challenges related to supplying PPE, testing residents and staff, handling staffing shortages, and creating resident cohorts—that is, grouping residents based on their risk of infection or whether they have tested positive for COVID-19 during an outbreak. Although this led to some innovative policy solutions that hold promise, it also led to significant variation in state responses and repercussions for facilities, residents, and staff.
  • Adequate testing remains a challenge for residents and staff. Panelists generally thought that facilities are not testing residents and staff frequently enough to identify asymptomatic cases. They encouraged more frequent testing to ensure that facilities can respond quickly when residents or staff receive positive results. States must ensure adequate testing supplies are available, and facilities must implement testing strategies that will support complete, accurate, and timely results.
  • The pandemic amplified the need to stabilize and strengthen the long-term care workforce. Research has consistently demonstrated the importance of staffing, particularly nurse staffing, in assuring and improving the quality of care provided in nursing homes. Mathematica’s recent work for the Assistant Secretary for Planning and Evaluation (ASPE) found that the pandemic has exacerbated staffing and workforce challenges that existed in the long-term care industry well before COVID-19. Nursing homes with more staff per resident per day have had fewer COVID-19 cases and deaths. Nine of the 27 recommendations from the Coronavirus Commission on Safety and Quality in Nursing Homes (sponsored by the Centers for Medicare & Medicaid Services) were related to strengthening the long-term care workforce.
  • Combatting social isolation as winter begins is critically important. State regulators and long-term care facilities must work together to ensure that residents and their family members can safely visit one another. Some states, including Minnesota, have created innovative designations for essential caregivers that allow visitors who receive regular testing and training to have increased visitation within the facility.
  • Leaders charged with distributing vaccines need to consider those at the highest risk within the high-risk elderly group. Panelists discussed the importance of prioritizing the long-term care population for vaccine distribution, while ensuring that residents can make an informed choice about whether they get vaccinated. Panelists recommended that states prioritize nursing homes with the highest-risk residents (facilities whose residents are age 85 or older, facilities with more male residents, and facilities serving primarily Black and Hispanic residents) in their vaccine distribution plans. A CDC advisory committee recently voted almost unanimously to recommend that residents and staff in nursing homes be the highest priority group for eventual vaccine distribution.

Panelists emphasized the importance of ensuring that policymakers and state regulators receive input from the long-term care industry, nursing home residents and their family members, and the long-term care workforce when making policy decisions. While we wait for a vaccine, policymakers must continue to do everything possible to protect the physical and mental health of long-term care residents and staff until the pandemic abates.

Watch a recording of the event here.

About the Author

Patricia Rowan

Patricia Rowan

Researcher
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