No abstract

Objectives: Little is known about how the COVID-19 pandemic has affected rehabilitation care in postacute and long-term care. As part of a process to assess research priorities, we surveyed professionals in these settings to assess the impact of the pandemic and related research needs. Design:Qualitative analysis of open-ended survey results. Setting and Participants: 30 clinical and administrative staff working in post-acute and long-term care. Methods: From June 24 through July 10, 2020, we used professional connections to disseminate an electronic survey to a convenience sample of clinical and administrative staff. We conducted an inductive thematic analysis of the data. Results: We identified 4 themes, related to (1) rapid changes in care delivery, (2) negative impact on patients' motivation and physical function, (3) new access barriers and increased costs, and (4) uncertainty about sustaining changes in delivery and payment. Rapid changes: Respondents described how infection control policies and practices shifted rehabilitation from group sessions and communal gyms to the bedside and telehealth. Negative impact: Respondents felt that patients' isolation, particularly in residential care settings, affected their motivation for rehabilitation and their physical function. Access and costs: Respondents expressed concerns about increased costs (eg, for personal protective equipment) and decreased patient volume, as well as access issues. Uncertainty: At the same time, respondents described how telehealth and Medicare waivers enabled new ways to connect with patients and wondered whether waivers would be extended after the public health emergency. Conclusions and Implications: Survey results highlight rapid changes to rehabilitation in post-acute and long-term care during the height of the COVID-19 pandemic. Because staff vaccine coverage remains low and patients vulnerable in residential care settings, changes such as infection precautions are likely to persist. Future research should evaluate the impact on care, outcomes, and costs.

The COVID-19 pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. To document these healthcare professionals’ experiences during the pandemic, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff from May 11 through June 4, 2020. Four investigators identified themes from qualitative responses for 152 nursing home staff respondents from 32 states. Key themes included: constraints on personal protective equipment (PPE) and testing; burdensome regulations and guidance; concern for self, family, and residents; workforce burnout; organizational communication and teamwork; and public lack of recognition. Respondents described ongoing constraints on testing, and reliance on crisis standards for extended use and reuse of PPE. Administrators discussed implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed empathy and concern for their residents. They described burnout due to increased workloads and the emotional burden of caring for residents facing isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. These challenges added significant burden to an already strained workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long-term.