As the COVID-19 pandemic played out in 2020, nursing homes, veterans’ care, and other long-term facilities for the elderly became critical points of outbreak. Infection spread and the death toll rose among healthcare’s most vulnerable population. Seniors and the infirm were not the only victims either; nursing home staff and medical professionals were among the essential workers who were, and continue to be, at the highest risk for infection.
- To date, the coronavirus has killed more than 184,000 residents and staff of nursing homes and other long-term care facilities, according to the AARP.
- More than 1 in 5 reported deaths from COVID-19 were residents of or linked to nursing homes, according to the Wall Street Journal.
These statistics have made it clear that nursing facilities were unprepared for a pandemic and not properly equipped or staffed to handle this type of infectious outbreak. Advocates for the elderly and their families are now pushing for reforms to ensure this type of emergency can be managed better in the future.
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Why Was COVID So Deadly in Nursing Home Facilities?
There were a number of factors that contributed to the high rates of infection, hospitalization, and death in long-term care facilities during the pandemic. In general, infection rates tend to be high among the geriatric population which has weaker immune defenses, chronic diseases, and various underlying conditions.
Nursing home facilities were already cited as a weak link in healthcare before the COVID outbreak, with low compliance for hand washing hygiene, user of personal protective equipment, and isolating patients that are ill. Then, many nursing homes were overwhelmed by the flood of cases and lacked the amount of testing kits and PPE needed to help keep staff safe. In some facilities, personnel were forced to reuse or share masks and gowns.
Residents share living spaces and are in close-quarters. Plus, interaction between staff and patients is unavoidable in this type of facility. Nursing homes are often understaffed meaning that nurses and workers must move quickly from patient to patient, increasing the risk of spreading contagions. Staffing shortages continue to be an issue due to low wages, long hours, and hiring requirements.
What Reforms Are Needed to Safeguard the Elderly in a Pandemic?
That is the question that many advocates, politicians and families are now asking. Some states have also made headway towards improving pandemic preparedness and bolstering support of aging services.
- In New Jersey, a bill was expedited to increase salaries for direct care staff in nursing facilities and go towards purchasing PPE supplies. The state also hopes to centralize outbreak reporting, response, and prevention for infectious diseases.
- In New York, new rules will regulate how funding is allocated in nursing homes; requiring a full 70% of revenues to go towards patient care.
- California, among a few other states, has recently mandated that elderly care facilities keep a minimum stock of PPE – masks, gloves, face shields, goggles, and gowns – sufficient for at least two months.
- Pennsylvania representatives want to increase regulations and oversight for nursing homes in order to identify those that fail to comply with safety and care standards.
Advocates in multiple areas are also pushing for measures to reduce the amount of social isolation caused by pandemic visitation restrictions. This could be in the form of grants to purchase tablets and facilitate communications and virtual visits with family and friends. It may also extend to the creation of “safe rooms” designed for in-person visits.
At the federal level, many point to the need to increase Medicaid reimbursements for long-term care in an attempt to increase staffing levels and the quality of care. Nursing home industry groups are lobbying for legislation that would adjust Medicaid reimbursement rates to cover the actual costs of care, rather than the 70-80% that it currently funds.
How Assisted Living Facilities Can Improve Safety for the Aging
As more Americans are aging and the “Baby Boomer” generation approaches geriatrics, caring for this vulnerable population is more critical than ever. Care for older adults will need to expand services by unprecedented amounts in the coming decade. And, currently, there is no set plan to address the increased demand and their complex needs. We also know that Boomers will present unique challenges as the first generation to be more likely to be divorced, have few or no children, and live far from potential caretakers.
Assisted living and home care services, in contrast to nursing homes, are considered a safer option in a pandemic situation first because living spaces tend to be larger and more private. Reducing interaction between residents and the use of shared living space helps slow down the spread of infection.
Secondly, records show that smaller assisted living settings seem to provide better care. In smaller family-like environments, there is a lower patient to nurse ratio and care is usually more personalized. Patients benefit from greater amounts of socialization and signs of health issues are addressed sooner. Residential care homes simultaneously enable closer supervision and greater personal freedom for aging adults.
Thirdly, expanded home care for older adults will help address the growing demand for aging services. An estimated 1 in 8 nursing home residents have “low care” needs, meaning that they do not require complex medical attention or rehab and are better able to care for themselves. Helping “low care” patients to age in place, would ease the strain on staffing in nursing homes and free up spaces for those with more critical needs.
Finally, as a cost-effective option, assisted living communities are expected to make elderly care services more accessible. On average, costs for aging-in-place care are about half that of residential skilled nursing care facilities. This will make it possible to treat more Boomers as they get older.
Related article: Lessons Learned in the Healthcare Industry from the COVID-19 Pandemic.
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