scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Background: Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for possible changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods: We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results: Increasing vaccination coverage in staff decreases total symptomatic cases in each scenario. When there is low VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, but asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents through exposure to asymptomatic but infected staff. High frequency testing is needed to reduce total symptomatic cases if the vaccine has low efficacy against infection and infectiousness, or only protects against symptoms. Conclusions: Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Abstract Background Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results Increasing vaccination coverage in staff decreases total symptomatic cases in the nursing home (among staff and residents combined) in each VE scenario. In scenarios with 50% and 90% VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, and asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents. However, this is outweighed by the reduction in symptomatic cases among staff. Higher frequency testing—more than once weekly—is needed to reduce total symptomatic cases if the vaccine has lower efficacy against infection and infectiousness, or only protects against symptoms. Conclusions Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

scholarly journals Care Deficiencies and Super-Organization of American Nursing Homes in Hospital Referral Region

2021 ◽  
Vol 8 ◽  
Author(s):  
Tyler Pittman
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Ownership ◽  
Open Data ◽  
Nursing Home Residents ◽  
The United States ◽  
Care Quality ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Open Datasets

Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in the United States through use of open data and social network analysis. Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner, and were reimbursed through Medicare or Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. The percentage of nursing homes having super-organization increased from 56.8 to 56.9% over the 2-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, being part of an ownership group with more facilities was beneficial for care quality among nursing homes with super-organization.

Tuberculosis in Long-Term Care Facilities

1990 ◽  
Vol 11 (1) ◽  
pp. 42-46 ◽  
Author(s):  
David W. Bentley
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Age Groups ◽  
Nursing Home Residents ◽  
The United States ◽  
High Risk Group ◽  
Elderly Persons ◽  
Tuberculosis Case ◽  
Term Care

Persons age 65 and over constitute the largest reservoir of Mycobacterium tuberculosis infection in the United States today. During 1987, 6,150 tuberculosis cases were reported among this high-risk group. These cases represent 27% of the total US tuberculosis morbidity, although this age group constitutes only 12% of the US population. Tuberculosis case rates in the United States are higher among the elderly (20.6 per 100,000) than among all other age groups (average 9.3 per 100,000).More Americans live in nursing homes than in any other type of residential institution; on any given day approximately 5% of all elderly persons are living in a nursing home. Elderly nursing home residents are at greater risk for tuberculosis than elderly persons living in the community. In a Centers for Disease Control (CDC)-sponsored survey of 15,379 routinely-reported tuberculosis cases from 29 states, 8% of the 4,919 cases that occurred among elderly persons occurred among residents of nursing homes. The incidence of tuberculosis among nursing home residents was 39.2 per 100,000 person years, whereas the incidence of tuberculosis among elderly persons living in the community was 21.5 per 100,000. The observed rate of tuberculosis among nursing home employees was three times the rate expected in employed adults of similar age, race and sex (CDC, unpublished data).

scholarly journals Mortality in Nursing Home Evacuations in the United States from 1995-2017

2019 ◽  
Vol 34 (s1) ◽  
pp. s2-s2
Author(s):  
Sharon Mace ◽  
Daniel Caicedo ◽  
Aishwarya Sharma
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Natural Disasters ◽  
Nursing Home Residents ◽  
The United States ◽  
Loss Of Life ◽  
External Events ◽  
Analyze Data

Introduction:There are an estimated 15,600 nursing homes with a total of 1.4 million residents in the United States. The number of residents will continue to increase due to the aging population, and the associated morbidities will make it difficult to evacuate them safely.Aim:This study is the first of its kind to provide an analysis of the number of nursing home deaths caused by external and internal events following evacuations.Methods:Information from the databases Lexis Nexis and PubMed were compiled and limited to news articles from 1995-2017. The gathered information included the reason for evacuation, injuries, deaths, and locations within the United States.Results:From 1995 to 2017, there was a total of 51 evacuations and 141 deaths in nursing homes. 27 (53%) evacuations were due to external events which resulted in a combined 121 (86%) deaths, and 24 (47%) evacuations were due to internal events which resulted in a combined 20 (14%) deaths. Hurricanes were responsible for the majority of deaths during evacuations, followed by fires and floods. The number of evacuations and deaths increased the greatest between 2005 to 2008.Discussion:External events have the greatest impact on loss of life. Internal disasters are about equal in the number of incidents, however, external events have a much greater mortality rate. Exact numbers on injuries, morbidity, and mortality are difficult to ascertain, but it appears to be related to natural disasters. In view of the increasing likelihood of natural disasters related to global warming, a drastic improvement of standard evacuation procedures of long-term nursing homes is critical to decreasing mortality of nursing home residents. There also needs to be a nationally standardized method of reporting evacuations in order to better analyze data on nursing homes.

scholarly journals Facility Characteristics and Quality Deficiencies of Florida Nursing Homes With COVID-19 Cases and Deaths

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 945-945
Author(s):  
Xiaochuan Wang ◽  
Courtney Wilson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Nursing Home Residents ◽  
The United States ◽  
Future Research ◽  
Staffing Level ◽  
Policy And Practice ◽  
Staff Shortage ◽  
Facility Size

Abstract The Coronavirus disease 2019 (COVID-19) has been disproportionately affecting nursing homes throughout the United States, resulting elevated risk for COVID-19 morbidity and mortality to nursing home residents. Given the high percentage of aging population, large number of nursing homes, and staggering surge of COVID-19 cases in Florida, it’s critical to understand factors that may affect Florida nursing homes’ vulnerability to the COVID-19 pandemic. Using Nursing Home COVID-19 Dataset as of July 26, 2020 obtained through Centers for Medicare and Medicaid Services (CMS), and Provider Info Dataset and Health Deficiencies Dataset available through CMS Nursing Home Compare data, we constructed a database of Florida nursing facilities with confirmed COVID-19 cases and deaths, with corresponding facility characteristics and quality deficiencies. We examined the facility characteristics (e.g. facility size, ownership state, chain affiliation, staffing level) and quality deficiencies (e.g. infection control deficiencies) of Florida nursing homes with and without publicly reported COVID-19 cases and deaths. Results indicated that, as of July 26, 2020, 73.3% and 40.8% of Florida nursing homes had resident COVID-19 cases and death, respectively (N=701). Findings also suggested that Florida nursing homes of large facility size, chain affiliated, and for profit, were significantly more likely to have documented resident COVID-19 cases (p<.05). Larger facility size (120 beds or more), staff shortage, and having prior infection control deficiency citation, were significantly related to the odds of having resident COVID-19 deaths (p<.05). Policy and practice implications and future research directions will be addressed to better protect the at-risk nursing home residents.

Variability of total phenytoin serum concentrations within elderly nursing home residents

Neurology ◽  
2003 ◽  
Vol 60 (4) ◽  
pp. 555-559 ◽  
Author(s):  
A. Birnbaum ◽  
N. A. Hardie ◽  
I. E. Leppik ◽  
J. M. Conway ◽  
S. E. Bowers ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The United States ◽  
Serum Concentrations ◽  
Minimum Concentration ◽  
Elderly Nursing Home Resident ◽  
The Mean

Background: Approximately 6% of all elderly nursing home residents receive phenytoin. Phenytoin concentrations are often measured to guide therapy.Objective: To evaluate the intraresident variability among multiple measurements of total phenytoin serum concentrations in nursing home residents.Methods: This was an observational study of 56 elderly (≥65 years) nursing home residents from 32 nursing homes who had at least 3 phenytoin concentrations measured while on the same dose of phenytoin for at least 4 weeks and who were not taking any interfering concomitant medications. These were a subset of 387 elderly nursing home residents from 112 nursing homes across the United States who had total phenytoin concentration measurements between June 1998 and December 2000.Results: The mean age was 80.1 years (range, 65 to 100 years) and 58.9% were women. The mean daily dose of phenytoin per resident was 4.9 ± 1.5 mg/kg. Total phenytoin concentrations within an elderly nursing home resident varied as much as two- to threefold, even though there was no change in dose. The person with the smallest variability had a minimum concentration of 10.0 μg/mL and a maximum of 10.4 μg/mL. The person with the largest variability had a minimum concentration of 9.7 μg/mL and a maximum of 28.8 μg/mL.Conclusions: There is considerable variability in the total phenytoin concentrations in the elderly nursing home resident and measurement of a single total phenytoin concentration should not be used to guide treatment.

Long-Term Care

2019 ◽  
pp. 606-614
Author(s):  
Joan Carpenter ◽  
Mary Ersek
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Developed Countries ◽  
The United States ◽  
Nursing Home Population ◽  
Care Services ◽  
Challenges And Opportunities ◽  
Palliative Care Services

This chapter examines palliative care across residential care settings with a focus on nursing homes. It reviews the environment of nursing homes, describes the residents who live there, and provides details about the interdisciplinary team providers who care for the residents. It also discusses the challenges and opportunities for delivering palliative care services to nursing home residents with life-limiting illness. Quality end-of-life care in nursing homes is important because more than 1.4 million Americans live in nursing homes, and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. Of those nursing home residents over 65 years of age, 80% are 75 years or older. Despite the efforts to keep frail elders in the community, the nursing home population is expected to increase as the numbers of older persons in the United States and other developed countries increase. The chapter concludes with a description of models for delivering palliative care in nursing homes.

scholarly journals Modeling the impact of vaccination strategies for nursing homes in the context of increased SARS-CoV-2 community transmission and variants

2021 ◽  
Author(s):  
Inga Holmdahl ◽  
Rebecca Kahn ◽  
Kara Jacobs Slifka ◽  
Kathleen Dooling ◽  
Rachel B Slayton
Keyword(s):  
Nursing Homes ◽  
Vaccination Coverage ◽  
The United States ◽  
Agent Based ◽  
Booster Vaccine ◽  
Vaccination Strategies ◽  
Primary Series ◽  
Community Transmission ◽  
The Impact ◽  
To Receive

Nursing homes (NH) were among the first settings to receive COVID-19 vaccines in the United States, but staff vaccination coverage remains low at an average of 64%. Using an agent-based model, we examined the impact of community prevalence, the Delta variant, staff vaccination coverage, and boosters for residents on outbreak dynamics in nursing homes. We found that increased staff primary series coverage and high booster vaccine effectiveness (VE) in residents leads to fewer infections and that the cumulative incidence is highly dependent on community transmission. Despite high VE, high community transmission resulted in continued symptomatic infections in NHs.

scholarly journals Covid-19 Swept Nursing Homes in the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 939-939
Author(s):  
Lei Yu
Keyword(s):  
United States ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
The United States ◽  
Demographic Information ◽  
Nursing Home Administrators ◽  
Final Data ◽  
The Relationship ◽  
Demographic Features

Abstract Nursing Homes experienced a colossal loss impacted by the Covid-19 pandemic in the United States. This study applied Covid-19 Nursing Home Dataset (updated on 08/16/2020) released by Data.CMS.gov to explore possible factors behind the death s at nursing homes. The results indicated 2.55 residents died per week at a nursing home averagely. Besides, the absence of nursing staff, aides, clinical physicians, PPE supplies contributes to more deaths at nursing homes. Lastly, the number of positive COVID-19 cases of nursing home staff positively associate with the number of total deaths of residents（R=0.65). These findings provide more pieces of evidence for nursing home administrators and policymakers to make adjustments to help nursing home residents better cope with challenges caused by the pandemic; however, this dataset is not the final data for the pandmic is not over. Also, the dataset covers few demographic information (gender, race, ethinicty and so on) ; therefore, researchers could explore the relationship between the demographic features and COVID-19 deaths at nursing homes.

Nursing home evacuations due to disasters in the United States over 22.5 years from 1995 to 2017

2021 ◽  
Vol 16 (2) ◽  
pp. 105-121
Author(s):  
Aishwarya Sharma, DO ◽  
Sharon E. Mace, MD, FACEP, FAAP
Keyword(s):  
United States ◽  
New York ◽  
Nursing Home ◽  
Nursing Homes ◽  
Natural Disasters ◽  
Nursing Home Residents ◽  
The United States ◽  
Total N ◽  
Nursing Home Administrators ◽  
Ice Storms

A large and growing segment of the United States population resides in nursing homes. Many nursing home residents have multiple comorbidities, are unable to perform activities of daily living, and need assistance for their daily functioning. They are some of the most fragile and vulnerable members of the population. Disasters are increasing in frequency and severity. This makes it likely that disasters will strike nursing homes and affect their residents. The purpose of this study was to evaluate the characteristics of disasters in the United States that resulted in nursing home evacuations. There were 51 reported nursing home evacuations due to a disaster over 22.5 years between 1995 and 2017. Natural disasters were responsible for the majority of evacuations (58.8 percent) followed by man-made unintentional disasters (37.3 percent) and man-made intentional (arson) (3.9 percent). The single most common reason for evacuation was hurricanes (23.5 percent, N = 12) and internal fires (23.5 percent, N = 12). Water-related disasters accounted for nearly three-fourths of the natural disasters (hurricanes 40 percent, N = 12; floods, 33.3 percent, N = 10; total 73.3 percent, N = 22), then snow/ice storms (13.3 percent, N = 4). Of man-made disasters, over two-thirds (66.7 percent) were due to internal fires (internal fires, n = 12, 57.1 percent and arson n = 2, 9.5 percent; total N = 14, 66.7 percent). The highest number of evacuations occurred in Texas, Louisiana, Missouri, New York, and Pennsylvania. This knowledge should enable nursing home administrators, disaster planners, public health officials, and others to improve preparedness for disasters that lead to nursing home evacuations.

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