scholarly journals “Doing the Impossible with the Inadequate”: COVID-19 Response in U.S. Assisted Living Settings

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 930-931
Author(s):  
Sarah Dys ◽  
Jaclyn Winfree ◽  
Paula Carder ◽  
Kaylin Dugle ◽  
Sheryl Zimmerman ◽  
...  
Keyword(s):  
Public Health ◽  
Social Isolation ◽  
Assisted Living ◽  
Long Term Care ◽  
The United States ◽  
Dementia Care ◽  
Unintended Consequences ◽  
Trade Association ◽  
Term Care

Abstract The COVID-19 pandemic has disproportionately affected long-term care operators, staff, residents and their families; although much attention has been given to nursing homes, largely lost in the discourse are assisted living, residential care, and dementia care (AL) communities. As part of a broader, ongoing study assessing states’ AL regulations regarding medical and mental health care for residents with Alzheimer’s and related dementias (ADRD), stakeholders across the United States were recruited in July and August 2020 for semi-structured interviews to provide their perspectives on AL policies and practices specific to COVID-19 response. Stakeholders (n=32) consisted of state healthcare and trade association representatives, clinical practitioners, operators, researchers, and dementia care experts experienced in AL-related operational, healthcare, and regulatory affairs. Using thematic analysis, we describe several emerging topics regarding the opportunities, challenges, and innovations of responding to COVID-19 within the unique context of AL. States’ public health responses to COVID-19 lacked an understanding of the broader long-term care system, especially AL’s scope and purpose, workforce, capacity to implement infection control practices and policies, and unintended consequences of social isolation for older adults, specifically residents living in dementia care units. Despite these challenges, stakeholders described opportunities to expand telehealth infrastructure, communication and collaboration across states and among operators, and several innovations to mitigate the effects of social isolation. It is imperative for policymakers to understand the nuances of the AL context and design regulations and public health responses grounded in a whole-person perspective and in partnership with operators during, and beyond, pandemic circumstances.

Improving the Fate of Nursing Homes During the COVID-19 Pandemic: The Need for Policy

2021 ◽  
pp. e1-e3
Author(s):  
R. Tamara Konetzka
Keyword(s):  
Public Health ◽  
United States ◽  
New York ◽  
Nursing Homes ◽  
Long Term Care ◽  
New York Times ◽  
The United States ◽  
Term Care ◽  
Care Facilities

Approximately 40% of all COVID-19 deaths in the United States have been linked to long-term care facilities.1 Early in the pandemic, as the scope of the problem became apparent, the nursing home sector generated significant media attention and public alarm. A New York Times article in mid-April referred to nursing homes as “death pits”2 because of the seemingly uncontrollable spread of the virus through these facilities. This devastation continued during subsequent surges,3 but there is a role for policy to change this trajectory. (Am J Public Health. Published online ahead of print January 28, 2021: e1–e3. https://doi.org/10.2105/AJPH.2020.306107 )

Forensic Issues in Long-Term Care Psychiatry

2017 ◽  
Author(s):  
Marshall B. Kapp
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Psychiatric Treatment ◽  
Health Assessment ◽  
The United States ◽  
Assisted Living Facilities ◽  
Nursing Facilities ◽  
Care Providers ◽  
Term Care

This chapter focuses on medical-legal issues that may arise in the context of identifying psychiatric needs and providing psychiatric care for older persons in long-term care institutional settings, specifically residents of nursing facilities and assisted living facilities. Following general observations about the present regulatory climate in the United States governing nursing facilities and assisted living facilities, the chapter explores mental health assessment requirements for residents of those venues. Key legal responsibilities and restrictions regarding the psychiatric treatment of those residents are then discussed, as well as several areas of concern about potential exposure to litigation and liability on the part of long-term care providers. Finally, some of the most salient future legal and policy challenges confronting those who plan, fund, provide, and evaluate long-term care institutional psychiatric services are noted.

Ethical Considerations in the Conduct of Electronic Surveillance Research

2006 ◽  
Vol 34 (3) ◽  
pp. 611-619 ◽  
Author(s):  
Ashok J. Bharucha ◽  
Alex John London ◽  
David Barnard ◽  
Howard Wactlar ◽  
Mary Amanda Dew ◽  
...  
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
The United States ◽  
Assisted Living Facilities ◽  
Ethical Considerations ◽  
Term Care ◽  
Baby Boomer Generation ◽  
Demographic Shifts

Nearly 2.5 million Americans currently reside in nursing homes and assisted living facilities in the United States, accounting for approximately five percent of persons sixty-five and older. The aging of the “Baby Boomer” generation is expected to lead to an exponential growth in the need for some form of long-term care (LTC) for this segment of the population within the next twenty-five years. In light of these sobering demographic shifts, there is an urgency to address the profound concerns that exist about the quality-of-care (QoC) and quality-of-life (QoL) of this frailest segment of our population.

scholarly journals 1207. Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County’s Response, California 2020-2021

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S694-S694
Author(s):  
Raymond Y Chinn ◽  
Sayone Thihalolipavan ◽  
Jennifer Wheeler ◽  
Grace Kang ◽  
John D Malone ◽  
...  
Keyword(s):  
Public Health ◽  
Long Term Care ◽  
Health Department ◽  
The United States ◽  
Infection Prevention And Control ◽  
Public Health Department ◽  
Term Care ◽  
Care Facilities ◽  
Outbreak Investigations

Abstract Background The coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States. Methods We report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI); the Medical Operations Center (MOC); Testing, Tracing, and Treatment (T3); and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing; the HPSTF team collected data and issued questionnaires; the MOC responded to staffing and PPE requests; and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings. Table 1. Sectors and Function of Response Teams to COVID-19 Results From March 2020 through May 2021, there were 504 outbreaks in LTCFs; the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms; laboratory services were outsourced during peak testing requests (Figure 2); “strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested; total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled (Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues. Figure 1. Number of Outbreaks and Number of Outbreak Investigations Figure 2. Number of Tests Performed by the Public Health Laboratory and the Number of Visits by “Strike Teams” Figure 3. Personal Protective Equipment Fulfillment during COVID-19 Pandemic Conclusion The management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases. Disclosures All Authors: No reported disclosures

scholarly journals Social Isolation in Long-Term Care Facilities Related to COVID-19: Effect on Resident Anxiety and Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 579-579
Author(s):  
Nazmus Sakib ◽  
Joseph June ◽  
Lindsay Peterson
Keyword(s):  
Risk Factor ◽  
Nursing Home ◽  
Family Support ◽  
Social Isolation ◽  
Assisted Living ◽  
Long Term Care ◽  
Virus Spread ◽  
Term Care ◽  
Care Facilities

Abstract Loneliness is a common problem in long-term care. It has been associated with a higher risk of depression, aggressive behaviors, and anxiety and may be a risk factor for cognitive decline. Loneliness can exacerbate social isolation. The COVID-19 emergency brought on measures in Florida, beginning in March 2020, to separate nursing home (NH) and assisted living community (ALC) residents from each other and family members to limit virus spread. This study examines results of a survey with Florida NH (N=59) and ALC (N=117) administrators concerning effects of these measures. Scaled (1-5, lowest to highest) data indicate that resident anxiety was higher in NHs (M=3.40) than ALCs (M=3.17). Care disruptions related to limited resident-to-resident contact also were worse in NHs (M=3.74) than in ALCs (M=3.21), while care disruptions related to loss of family support were higher among ALCs (M=3.19) than in NHs (M=2.86). Implications of these findings will be discussed.

scholarly journals Work of Art, Art of Work: Artistic Literacy and Quality in Long-Term Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 92-92
Author(s):  
Katie Aubrecht
Keyword(s):  
Mental Health ◽  
Long Term Care ◽  
The United States ◽  
Care Quality ◽  
Dementia Care ◽  
Structured Interviews ◽  
Work Of Art ◽  
Term Care ◽  
The Arts

Abstract This paper shares results from a thematic analysis (Braun & Clarke, 2006) of semi-structured interviews with a purposive snowball sample of 15 leaders in dementia arts education and praxis from Canada, the United States and United Kingdom. Interviews were conducted as part of a multi-phased collaborative, interdisciplinary arts-informed research project that aimed to operationalize quality mental health and dementia care in long-term care (LTC) from a relational perspective, with a focus on LTC staff literacy. Artistic literacy that is cultivated through creative arts-making and public exhibiting was described by participants as crucial to supporting and promoting quality within long-term care. Quality was imagined as a work of art and operationalized in terms of artist competencies, capacities and conditions. Artists included LTC staff, residents and their family and friends. Our analysis identified five themes related to artistic literacy: space-making, validation, fostering community, means of engagement, vulnerability and resilience. Drawing on cultural sociology (Bourdieu, 1993, 1984) and aging studies theory (Basting, 2018), we consider and discuss the role of the arts in disrupting unexamined assumptions about quality in LTC and advancing innovation in LTC staff mental health and dementia care.

scholarly journals 872. Burden of Influenza Outbreaks in Long-Term Care Facilities in Philadelphia, 2012-2020

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S474-S474
Author(s):  
Kurt M Kunz ◽  
Dana Perella ◽  
Tiina Peritz ◽  
Kristen Feemster ◽  
Susan E Coffin ◽  
...  
Keyword(s):  
Public Health ◽  
Long Term Care ◽  
Antiviral Treatment ◽  
Care Facility ◽  
The United States ◽  
Control Measures ◽  
Term Care ◽  
Health Measures ◽  
Influenza Outbreaks

Abstract Background In the United States, influenza and other acute respiratory viruses contribute to a high burden of disease in long-term care facility (LTCF) residents. We aim to characterize the disease patterns and inter-seasonal variation of influenza virus outbreaks in LTCFs and identify institutional, environmental, and public health interventions associated with differences in outbreak outcomes and characteristics. Methods We conducted a retrospective, longitudinal study of influenza outbreaks in LTCFs reported to the Philadelphia Department of Public Health (PDPH) over eight consecutive seasons (November 2012 through March 2020). Characteristics of individual outbreaks, facilities, and infection control measures were reported in the PDPH Influenza Outbreak database, while quality measures and other facility-level data were extracted from the CMS Nursing Home Compare (NHC) database. Cases of influenza-like illness (ILI) in residents and staff were reported. Results 131 influenza outbreaks were reported among 56 facilities, leading to 1196 cases of ILI, 227 influenza-related hospitalizations and 20 deaths. The median number of facility residents affected per outbreak was 4 (range, 0-52), and the resident attack rate was 3.0% (IQR, 1.6-7.4). Facility staff were affected in 56 (43%) of outbreaks. A greater number of facility beds was associated with sites reporting 3 or more outbreaks compared to those that did not (180 vs 133 beds, p=0.019). Public health measures were associated with lower total attack rates for surveillance (1.9% vs 4.3%, p=0.0015), education (1.9% vs 5.1%, p=0.0004), visitation restrictions (1.8% vs 3.1%, p=0.049), and vaccination policies of staff and/or residents (1.6% vs 2.7%, p=0.047). Smaller outbreaks were associated with the implementation of droplet precautions (3 vs 6, p=0.0071), antiviral treatment and prophylaxis (3 vs 6, p=0.024), and admission restrictions (4 vs 7, p=0.015). Conclusion Larger facility size was associated with an increased frequency of outbreaks. Public health measures may reduce the size and severity of influenza outbreaks in LTCFs. These results emphasize the importance of ensuring consistent utilization of recommended infection prevention strategies. Disclosures All Authors: No reported disclosures

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