495. Evaluation of Antigen Testing for Detection of COVID-19 Vaccine Breakthrough Cases in Long-Term Care

Abstract Background Long-term care facilities (LTCFs) are at high risk for severe COVID-19 outbreaks due to their congregate nature and vulnerable population. Oregon Health Authority (OHA) deployed point-of-care antigen (Ag) tests to promptly identify COVID-19 cases in LTCFs. However, their performance in identifying vaccine breakthrough cases has not been evaluated. Methods During 2/25/21–5/25/21, OHA supported testing of residents and staff for two outbreaks at a single LTCF. Paired nasal swabs were collected and tested for SARS-CoV-2 by CDC Influenza SARS-CoV-2 Multiplex PCR Assay (molecular test) and Abbott BinaxNOW COVID-19 Ag Card (Ag test) twice weekly during the outbreaks. Participants were considered fully vaccinated if ≥ 14 days had passed since completion of a vaccine series; all others were deemed unvaccinated. A vaccine breakthrough case was defined as a positive Ag or molecular test from a fully vaccinated person’s specimen. Performance characteristics of the Ag test were assessed, with molecular test as the reference standard. Cycle threshold (Ct) values were compared by one-sided independent t-tests. Results 94 unvaccinated residents and staff provided 563 paired samples; SARS-CoV-2 was detected in 21 (12 by Ag and molecular test, 6 by molecular test only, 3 by Ag test only), yielding Ag test sensitivity of 66.7% (95% CI: 43.8–83.7%) and specificity of 99.4% (95% CI: 98.4–99.8%). Mean Ct values were higher for specimens positive by PCR but negative by Ag than those positive by both (30.0 vs. 20.7, P < .01). 81 vaccinated persons provided 925 paired samples; SARS-CoV-2 was detected in 5 (1 by Ag and molecular test, 4 by molecular test only), yielding Ag test sensitivity of 20% (95% CI: 3.6–62.5%) and specificity of 100% (95% CI: 99.6–100%). Mean Ct values for specimens from vaccinated cases were higher than those from unvaccinated cases (30.2 vs. 23.8, P < .05). The lone Ag-positive breakthrough case had a Ct of 20; all others had Ct > 29. Conclusion Ag test performance and reduced sensitivity on specimens with high Ct values found in this population are consistent with published data. Molecular testing maximizes identification of vaccine breakthrough cases. More studies are needed to estimate the proportion of breakthrough cases missed by Ag testing and their risk of transmitting the virus in LTCFs. Disclosures All Authors: No reported disclosures

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Will the Conversion from Sanatorium Medical Facilities into New Facilities Progress in Japan?

Global Journal of Health Science ◽

10.5539/gjhs.v12n10p7 ◽

2020 ◽

Vol 12 (10) ◽

pp. 7

Author(s):

Yuka Mine ◽

Masayuki Yokoi ◽

Takao Tashiro

Keyword(s):

Health Services ◽

Long Term Care ◽

Care Service ◽

Published Data ◽

Term Care ◽

Medical Facilities ◽

Long Term Care Insurance ◽

Management Policies ◽

Geriatric Health Services

In Japan, under the Long-Term Care Insurance Act of 2018, the Integrated Facility for Medical and Long-Term Care was established as a new long-term care insurance facility into which Sanatorium Medical Facilities could be converted, and this conversion has taken place gradually; in this study, we compared the management policies between existing Sanatorium Medical Facilities and Integrated Facilities. We also examined the management policies of Geriatric Health Services Facilities. For the management policies of individual facilities, published data on the “Long-Term Care Service Information Publication System” website were used; the study included 142 Integrated Facilities, 245 Sanatorium Medical Facilities, and 237 Geriatric Health Services Facilities. The percentage of facilities in each facility group that included specific keywords was compared. There were no significant differences in the percentage of facilities including “Return,” “Long-term,” “Management,” “Care,” and “Coordination” in their management policies between Sanatorium Medical Facilities and Integrated Facilities. Compared with Geriatric Health Services Facilities, Sanatorium Medical Facilities had a significantly lower rate of including “Return” and a significantly higher rate of including “Long-term,” “Management,” “Care,” and “Coordination.” As seen from the above, the management policies of Sanatorium Medical Facilities were similar to those of Integrated Facilities, rather than Geriatric Health Services Facilities. When Geriatric Health Services Facilities and Integrated Facilities were compared as candidates for conversion from Sanatorium Medical Facilities, it was suggested that the barrier to entry is lower for the Integrated Facilities than for Geriatric Health Services Facilities in terms of necessity of major change in management policies.

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Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification

Journal of Speech Language and Hearing Research ◽

10.1044/2016_jslhr-h-15-0135 ◽

2016 ◽

Vol 59 (6) ◽

pp. 1533-1542 ◽

Cited By ~ 12

Author(s):

Tammy Hopper ◽

Susan E. Slaughter ◽

Bill Hodgetts ◽

Amberley Ostevik ◽

Carla Ickert

Keyword(s):

Hearing Loss ◽

Test Performance ◽

Speech Intelligibility ◽

Long Term Care ◽

Assessment Instrument ◽

Term Care ◽

Data Set ◽

Hearing Ability ◽

The Relationship

Purpose The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants' hearing were compared to audiological assessment results. Results Participants' speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants' average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.

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Prevalence of pressure ulcers in long-term care: a global review

Journal of Wound Care ◽

10.12968/jowc.2019.28.11.702 ◽

2019 ◽

Vol 28 (11) ◽

pp. 702-709 ◽

Cited By ~ 3

Author(s):

Denis Anthony ◽

Dalyal Alosoumi ◽

Reza Safari

Keyword(s):

Nursing Homes ◽

Long Term Care ◽

Pressure Ulcers ◽

Published Data ◽

Term Care ◽

Long Term Conditions ◽

Prevalence Data ◽

The Us ◽

The Uk

Objective: To identify and update the prevalence and incidence of pressure ulcers (PUs) in several countries, in people with long-term conditions resident in care homes or nursing homes. Methods: We followed the PRISMA guideline for systematic reviews. However, due to funding constraints we do not claim this review to be systematic but it is a narrative review informed by PRISMA. Medline, Embase and CINHAL were searched for observational studies reporting incidence or prevalence data. Data reported relevant head-to-toe examination of PUs in residence in care or nursing homes. Internal and external validity of the included studies were assessed using the checklist devised by Hoy et al. 1 Results: Inclusion criteria was met by 17 studies and included in the study. Some studies gave a full breakdown by category, some only gave overall figures, and others excluded category I PUs. However, within those constraints certain patterns are clear. Prevalence rates varied from 3.4–32.4%. Large differences in prevalence in different countries were not explained by methodological differences. While some countries, such as Germany, the Netherlands and the US had robust data, other countries, such as the UK, had none. Conclusion: PUs are a common problem in long-term care. However, there are substantial differences between countries and many countries have no published data.

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Group Vaccination Five Days before a COVID-19 Outbreak in a Long-Term Care Facility

Vaccines ◽

10.3390/vaccines9121450 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1450

Author(s):

Mathias W. Pletz ◽

Sabine Trommer ◽

Steffi Kolanos ◽

Norman Rose ◽

Veit Kinne ◽

...

Keyword(s):

Long Term Care ◽

Care Facility ◽

Published Data ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility ◽

Number Of Patients ◽

Care Facilities

Rapid vaccination may be of benefit in long-term care facilities (LTCF) that are affected by an ongoing COVID-19 outbreak. However, there are concerns regarding the safety and effectiveness of such an approach, particularly regarding the vaccination of pre-symptomatic patients. Here, we report the effectiveness of vaccination in a German LTCF hit by an outbreak that was detected 5 days after the first vaccine doses were administered. In detail, 66.7% of the unvaccinated patients experienced an unfavorable course; this proportion was much lower (33.3%) among the vaccinated patients. Even though this study is limited by a small number of patients, the observation and the comparison with related published data shows that vaccination (i) is safe and (ii) may still be of benefit when given shortly before an infection or even in pre-symptomatic LTCF-patients.

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Working With Resistance and Encouraging Buy-In to New Programs

Perspectives on Gerontology ◽

10.1044/gero16.1.18 ◽

2011 ◽

Vol 16 (1) ◽

pp. 18-21

Author(s):

Sara Joffe

Keyword(s):

Long Term Care ◽

Term Care ◽

Optimal Outcomes ◽

Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

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Feeding Dependency Issues in the Long-Term Care Environment

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd10.1.19 ◽

2001 ◽

Vol 10 (1) ◽

pp. 19-24

Author(s):

Carol Winchester ◽

Cathy Pelletier ◽

Pete Johnson

Keyword(s):

Long Term Care ◽

Term Care ◽

Care Environment

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Communication Disordered: Program Implementation in Long-Term Care

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig15.64 ◽

2016 ◽

Vol 1 (15) ◽

pp. 64-67

Author(s):

George Barnes ◽

Joseph Salemi

Keyword(s):

Program Implementation ◽

Long Term Care ◽

Family Satisfaction ◽

Regulatory Compliance ◽

Care Staff ◽

Term Care ◽

Staff Members ◽

Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

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