The VA’s Long-Term Care Strike Team Supporting Florida’s Nursing Homes Workforce

Abstract In coordination with the Florida Department of Health, the VA Sunshine Healthcare Network (VISN 8) established Long-Term Care Strike Teams to provide services to the LTC facilities most affected by the COVID-19 pandemic across the state of Florida. Between April 2020 through September 2020, the Strike Teams provided direct patient care to community residents, infection control/ prevention education, and patient/staff COVID-19 swabbing. We encountered facilities with large numbers of staff infected with COVID-19 and agency staff that were refusing to come to “COVID-infected” facilities. Remaining staff, including the administrators, were under much psychological distress. However, our experience supporting the long-term care facilities also had a major impact on our own perceptions of nursing home care. The bravery, dedication, and caring that we witnessed reinforced that the health care workers in long-term care facilities are true heroes.

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The vulnerability of nursing home residents to the Covid-19 pandemic

International Journal of Care Coordination ◽

10.1177/2053434520958860 ◽

2020 ◽

Vol 23 (2-3) ◽

pp. 57-60 ◽

Cited By ~ 1

Author(s):

Edward H Wagner

Keyword(s):

Nursing Home ◽

Long Term Care ◽

Nursing Home Residents ◽

Nursing Assistants ◽

Nursing Home Care ◽

Term Care ◽

Staff Members ◽

Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

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Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints?

International Psychogeriatrics ◽

10.1017/s1041610216000028 ◽

2016 ◽

Vol 28 (6) ◽

pp. 983-994 ◽

Cited By ~ 2

Author(s):

Bernadette M. Willemse ◽

Jan de Jonge ◽

Dieneke Smit ◽

Wouter Dasselaar ◽

Marja F. I. A. Depla ◽

...

Keyword(s):

Work Environment ◽

Psychotropic Drugs ◽

Long Term Care ◽

Longitudinal Research ◽

Nursing Home Care ◽

Physical Restraints ◽

Term Care ◽

People With Dementia ◽

Care Facilities

ABSTRACTBackground:Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints.Methods:Data were derived from the first wave (2008–2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ).Results:Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints.Conclusions:Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making – especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.

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Importance of Employee Vaccination against Influenza in Preventing Cases in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/661916 ◽

2011 ◽

Vol 32 (10) ◽

pp. 990-997 ◽

Cited By ~ 18

Author(s):

Aaron M. Wendelboe ◽

Catherine Avery ◽

Bernardo Andrade ◽

Joan Baumbach ◽

Michael G. Landen

Keyword(s):

New Mexico ◽

Vaccination Coverage ◽

Long Term Care ◽

Direct Care ◽

Term Care ◽

Department Of Health ◽

Laboratory Confirmation ◽

Care Facilities ◽

Influenza Outbreaks

Objective.Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation.Methods.The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds.Results.Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]).Conclusions.High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.

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Suicide attempts and completions in Veterans Affairs nursing home care units and long-term care facilities: a review of root-cause analysis reports

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4357 ◽

2015 ◽

Vol 31 (5) ◽

pp. 518-525 ◽

Cited By ~ 7

Author(s):

Peter D. Mills ◽

Bradley I. Gallimore ◽

B. Vince Watts ◽

Robin R. Hemphill

Keyword(s):

Nursing Home ◽

Long Term Care ◽

Suicide Attempts ◽

Veterans Affairs ◽

Nursing Home Care ◽

Term Care ◽

Cause Analysis ◽

Root Cause ◽

Care Facilities

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Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of Long-Term Care Facilities (VIVALDI study)

10.1101/2021.03.26.21254391 ◽

2021 ◽

Author(s):

Madhumita Shrotri ◽

Maria Krutikov ◽

Tom Palmer ◽

Rebecca Giddings ◽

Borscha Azmi ◽

...

Keyword(s):

Long Term Care ◽

Proportional Hazards ◽

Vaccine Dose ◽

Cox Proportional Hazards ◽

Protective Effects ◽

Term Care ◽

Department Of Health ◽

Health And Social Care ◽

Care Facilities

Background The effectiveness of SARS-CoV-2 vaccines in frail older adults living in Long-Term Care Facilities (LTCFs) is uncertain. We estimated protective effects of the first dose of ChAdOx1 and BNT162b2 vaccines against infection in this population. Methods Cohort study comparing vaccinated and unvaccinated LTCF residents in England, undergoing routine asymptomatic testing (8 December 2020 - 15 March 2021). We estimated the relative hazard of PCR-positive infection using Cox proportional hazards regression, adjusting for age, sex, prior infection, local SARS-CoV-2 incidence, LTCF bed capacity, and clustering by LTCF. Results Of 10,412 residents (median age 86 years) from 310 LTCFs, 9,160 were vaccinated with either ChAdOx1 (6,138; 67%) or BNT162b2 (3,022; 33%) vaccines. A total of 670,628 person days and 1,335 PCR-positive infections were included. Adjusted hazard ratios (aHRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days following the first vaccine dose to 0.44 (0.24, 0.81) at 28-34 days and 0.38 (0.19, 0.77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (aHR 0.32 [0.15-0.66] and BNT162b2 (aHR 0.35 [0.17, 0.71]) vaccines at 35-48 days. Mean PCR cycle threshold values were higher, implying lower infectivity, for infections 28 or more days post-vaccination compared with those prior to vaccination (31.3 vs 26.6, p<0.001). Interpretation The first dose of BNT162b2 and ChAdOx1 vaccines was associated with substantially reduced SARS-CoV-2 infection risk in LTCF residents from 4 weeks to at least 7 weeks. Funding UK Government Department of Health and Social Care.

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The Pandemic and Nursing Home Care

Innovation in Aging ◽

10.1093/geroni/igab046.1501 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 388-388

Author(s):

Lori Smetanka

Keyword(s):

Nursing Home ◽

Home Care ◽

Long Term Care ◽

Elder Abuse ◽

Nursing Home Care ◽

Term Care ◽

Care Facilities

Abstract This session will provide updates on how the pandemic led to horrific situations in long-term care facilities and how the pandemic influenced major federal efforts to address elder abuse, neglect, and exploitation.

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Breathing Uneasy: Fit-Tested N95 Respirator Access in Washington State Long-Term Care Facilities

Innovation in Aging ◽

10.1093/geroni/igab046.603 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 158-159

Author(s):

Carolyn Ham ◽

Mikiko Nakamura

Keyword(s):

Assisted Living ◽

Long Term Care ◽

Washington State ◽

Term Care ◽

Department Of Health ◽

Care Facilities ◽

Facility Type ◽

Fit Testing ◽

N95 Respirators

Abstract Long-term care facilities (LTCF) have been disproportionately impacted by illness and death from COVID-19. Shortages of respirators for staff, especially Particulate Filtering Facepiece Respirators (N95), have limited LTCFs ability to follow public health recommendations for preventing COVID-19 transmission. Use of N95 respirators was infrequent in Washington State (WA) LTCFs prior to May 2020. N95 respirators must be individually fit tested to provide intended protection; a fit test is a procedure that tests the seal between the N95 respirator and the wearer’s face. The WA Department of Health (WA DOH), collaborated with stakeholders to survey LTCFs in November 2020 regarding needs for fit tested respirators and analyzed responses (n=384). Responses by facility type: 8.3% nursing homes, 17.7% assisted living, 62.8% adult family home, 11.2% other. In WA, adult family homes (AFH) are licensed for six or fewer residents. 23.70% of LTCFs indicated they did not have any N95 respirators in stock at their facility; 96.7% of these were AFH. In August 2020 WA DOH surveyed AFH owners and received 110 responses; 9.76% reported having at least one staff member fit tested for respirators. Smaller facilities may experience increased burden in accessing N95 respirators and fit testing due to lack of established relationships with suppliers and small volumes being purchased. WA DOH used federal COVID funding to contract with mobile fit testing providers and prioritized AFHs for this service. Between December 1, 2020-February 28, 2021, staff at 290 LTCFs were fit tested. The project will continue throughout 2021.

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