Although a nursing home industry analysis predicts future growth typically over the next five years, implementing safety precautions now can help stop the spread of Covid-19 and ensure resident safety in the short and long term.
Policies Enacted Today Will Help Ready Facilities For Future Crises.
Skilled nursing facilities are facing hard times with the onset of the COVID-19 pandemic. With a newly encountered disease, as new information becomes available, health guidelines can change at a rapid pace.
Nursing home industry analysis demonstrates that the elderly population is more vulnerable to COVID-19
According to the Centers for Disease Control and Prevention (CDC), the risk of severe illness from contracting COVID-19 increases with age. The CDC defines severe illness as any of the following:
- The need for hospitalization.
- The need for a ventilator to breathe.
- Admittance to an intensive care unit.
- Possible death.
A nursing home industry analysis shows that eight out of ten deaths related to COVID-19 have occurred in adults aged 65 and older. The highest risk is among those over 85. Older adults with underlying medical conditions are at an even higher risk. Beyond advanced age, certain types of conditions can make COVID-19 more severe, such as diabetes, cancer, hypertension, heart issues, and lung disease.
Nursing homes emerged as COVID-19 hot spots
Older adults and those with underlying conditions are urged to avoid interaction with others as much as possible. However, this becomes difficult in assisted living and skilled nursing facility settings, with many people living close together and multiple caregivers coming and going.
According to the Center for Infectious Disease Research and Policy (CIDRAP), COVID-19 cases are dropping throughout the U.S., but still rising in nursing homes. The American Health Care Association (AHCA) has reported almost an 80% increase in nursing home cases over the summer.
Nursing home challenges include:
- Lack of personal protective equipment (PPE). A continued shortage of PPE continues, including the need for N95 masks.
- Slow turnaround time for test results. In an AHCA survey conducted in June, 87% of nursing homes reported a waiting time of two days or longer to get results. Further, 25% reported that results took five days or more to receive.
- Community spread. When local communities are experiencing a spike in cases, it becomes a matter of time before the disease reaches long term care facilities.
- Risk of contamination from staff. Staff members who work at more than one site can increase the risk of contamination.
- The contagious nature of COVID-19. Residents must come in close contact with nurses, doctors, aides, and other staff directly and frequently. The care they provide is essential and cannot be suspended like visits to the facility from family members and other guests.
Government help
The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) have been overseeing relief efforts for skilled nursing facilities during the pandemic.
These relief efforts include an additional $5 billion to Medicare-certified long term care facilities and state veterans’ homes, on top of the $4.9 billion previously provided for additional costs and PPE.
The funding is for the following purposes:
- Improving infection control and hiring experts to implement infection control programs.
- Hiring additional staff.
- Testing residents and staff for COVID-19.
- Encouraging and helping residents to connect virtually with families and loved ones who may not be allowed to visit in person.
Without adequate testing, the asymptomatic spread of the virus is hard to control. To combat this problem, the federal government has announced its plan to send point-of-care COVID-19 testing kits to every nursing home in the U.S. Every resident and staff member will be able to get tested once a week for four weeks. After that point, the testing kits will be available for purchase at about $25 each.
How to maintain quality care in nursing homes
These steps are critical to keeping the standard of care high in skilled nursing facilities, assisted living communities, and nursing homes:
- Implement frequent testing. Controlling the spread of the disease before it begins is the key to keeping residents and staff safe and healthy. Frequent COVID-19 testing is working in areas where it has been implemented. The state of Pennsylvania mandated the testing of all staff and residents in nursing homes. Many mild and asymptomatic cases were identified. Without testing, they would have most likely gone unnoticed, only to spread to others. But by identifying the positive cases, nursing homes in Pennsylvania were able to isolate the positive individuals and mitigate the spread of the virus. The federal government’s point-of-care test kits will be essential to resident and staff safety.
- Follow CMS guidelines. The CMS has released Nursing Home Reopening Guidance for State and Local Officials. These guidelines provide steps for determining when and whether it is safe to relax restrictions on visitation and group activities. Nursing homes must be aware of current situations in their facilities and keep them in mind while following state and local guidelines. It may be necessary to reenact restrictions if health and safety become threatened by outbreaks.
- Designate an expert. The CDC recommends that nursing homes assign an individual or a team as the manager of the facility’s infection control program. This is a full-time role in facilities that house over 100 residents. An online training program created by the CDC is available.
- Wear face masks. If they can tolerate it, residents need to wear cloth face coverings or masks whenever they leave their room. Face masks are preferred over cloth face coverings for employees as they protect against splashes of infectious materials. When visitors are permitted into nursing homes, they will need to wear cloth face coverings at all times during their visit.
- Disaster plans need to be revised for COVID-19. Disaster preparedness plans are essential for skilled nursing facilities. These need to be reimagined based on the new requirements of the pandemic.
Social and emotional needs of residents:
Social isolation to mitigate the spread has affected everyone around the globe, but nursing home residents are already at an increased risk of loneliness. When nursing homes need to close to visitors to isolate residents, unfortunately, the result is separation from their family support system.
The American Psychological Association (APA) suggests several tips for improving the mental health of nursing home residents during this difficult time.
Tips to combat loneliness and isolation:
- Encourage family members to send residents cards, inexpensive gifts or family photos. This gives residents a connection to their loved ones while providing variety.
- Help residents regularly contact family members through video chats and phone calls.
- Provide telehealth visits with social workers. Therapists can assist residents who are struggling with stress or depression while maintaining the need for social isolation. The CMS has approved coverage for phone services, which is helpful for residents who may be unable or unwilling to communicate via video.
Care Providers May Need Emotional Help, Too.
It’s not just the residents who are experiencing added stress. Nursing home staff are stretched to their limits with the increasing demands brought on by the pandemic. Psychologists can assist staff with stress management techniques and methods for self-care. Employees will be better at meeting the needs of residents when their own needs are met as well.
Nursing home industry analysis also identifies what to avoid:
We’ve looked at what is necessary to continue to provide high-quality care throughout the pandemic. Let’s take a look at some practices to avoid.
To protect vulnerable residents:
- Do not let staff report to work if they are sick or show any symptoms of COVID-19.
- Do not allow visitors with any symptoms in the building. Temperature checks can be implemented before allowing guests in the facility.
- Avoid large group gatherings. Resident activities may need to be rethought with social distancing and smaller groups in mind.
- Do not ignore the mental health of residents and staff. As discussed above, this is a stressful time for all. Measures need to be taken to improve the emotional state of residents and the staff who care for them.
- Do not neglect the current local conditions. As mentioned previously, when areas experience a spike in cases, nursing homes are at higher risk. Administrators should stay vigilant about the incidence of community spread in their local areas.
Nursing home industry analysis
Nursing homes provide more than just medical care for the elderly. They also supply emotional and psychological benefits for residents who are no longer able to live at home. And more than that, many facilities assist patients with recovery until they are strong enough to go home, or help them gain the strength they need before a procedure.
These types of needs for the U.S. population are only going to increase in the near future. The assisted living and nursing home industry is expected to grow at a compound overall growth rate of 5% over the next five years.
According to the World Health Organization (WHO), sedentary lifestyles are a leading cause of death worldwide, and one in four adults is not sufficiently active. Unfortunately, this shows no signs of reversing as more Americans than ever are sedentary for most of the day.
Also, America’s aging population is increasing. By 2030, all Baby Boomers will be over the age of 65, and one in five Americans will have reached retirement age. By 2034, older people will outnumber children for the first time in history.
A nursing home industry analysis shows that the increasingly aging population, combined with unhealthy sedentary lifestyles, has the potential to create even more of a demand for nursing home services in the future. The COVID-19 crisis, as dramatic as it is, will not be the last crisis nursing homes and senior care services will have to deal with.