To Help Long-Term Care Residents, Connecticut Should Focus on Reducing Community Spread and Addressing Psychosocial Impacts

To Help Long-Term Care Residents, Connecticut Should Focus on Reducing Community Spread and Addressing Psychosocial Impacts

Independent Study Offers Recommendations to Prevent a Potential Second Wave of COVID-19 and Future Infectious Disease Outbreaks
Oct 01, 2020
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Mathematica has released a final report assessing the COVID-19 outbreak in long-term care (LTC) facilities in Connecticut. The report recommends ways to help the state and LTC facilities prevent future infectious disease outbreaks.

The final report describes the impact of COVID-19 in Connecticut: it highlights the specific impact of the virus within the state’s LTC facilities, assesses the state and LTC industry’s preparedness and response to the COVID-19 outbreak, and compares Connecticut with other states in the region and the country. The report also identifies immediate and achievable steps the state and LTC industry can take to prepare for a second wave of COVID-19 and longer-term recommendations to prevent future infectious disease outbreaks. Mathematica’s final report builds on an interim report released earlier this summer.

Several key findings emerged:

  • Nursing homes with a greater incidence of COVID-19 in the surrounding community and those with more residents who received dialysis or cancer treatments—usually delivered off site—had more cases and deaths per licensed bed.
  • The prevalence of symptoms of depression increased by 15 percent and rates of unplanned weight loss nearly doubled right after the peak of the COVID-19 outbreak. These outcomes suggest measuring COVID-19 cases and deaths alone does not capture the full impact of the pandemic on residents’ well-being.
  • After adjusting for facilities’ characteristics, such as size and proximity to Connecticut, cases and deaths per licensed bed in Connecticut did not vary significantly from those in nearby states.

Based on the study’s findings, Mathematica made 23 short-term recommendations to mitigate a potential second wave of COVID-19 and 22 long-term recommendations to prevent future infectious disease outbreaks.

Key recommendations include:

  • Developing a framework to guide policies on the reopening of LTC facilities to visitors based on a set of criteria at the facility and community levels, rather than a one-size-fits-all statewide visitation policy
  • Considering legislation or regulations to (1) mandate a full-time infection preventionist in nursing homes and (2) increase the minimum required staffing levels in nursing homes
  • Ensuring all LTC facility staff have access to appropriate PPE and guaranteed paid sick leave

“We all play a role in protecting the vulnerable members of our community, which is why it is important for Connecticut residents to continue with good public health measures, such as mask wearing and social distancing,” said Patricia Rowan, researcher at Mathematica and the project’s director. “Our findings also suggest that COVID-19 has had negative effects on the physical and emotional well-being of long-term care residents. This might be due to restrictions in visitation and policies that limited the movement of residents in their facility, so we recommend that policymakers keep in mind those trade-offs when planning for the future.”

Mathematica’s researchers analyzed a variety of data sources to inform the final report. Facility- and resident-level data enabled them to identify characteristics that best predicted COVID-19 outcomes in nursing homes. They also used publicly reported data from the Connecticut Department of Public Health and other state agencies, as well as the state’s LTC facilities. Together, these data sources contributed to a greater understanding of the outbreak, including which facilities had the worst outbreaks. Researchers interviewed a wide range of stakeholders in the state—52 interviews with 132 people conducted from July 13 to September 10, 2020—to determine what was effective and what can and should change with better preparation and resources. Interviewees included state agency staff, facility administrators, trade association representatives, labor representatives, legislators, and family members with loved ones living in LTC facilities. The team also reviewed all relevant policy documentation and guidance provided by the state to assess Connecticut’s preparedness and response to the COVID-19 outbreak.

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Amy Berridge

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