Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned

Abstract

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

“…However, resource constraints and organizational obstacles present significant barriers to the person-centered approach that is often required, and recommended as best practice ( 9 , 59 , 60 ). Other studies have reported similar experiences across licensed and unlicensed care staff, where organizational and systemic barriers deprioritize implementation of nonpharmaceutical interventions ( 23 , 28 , 61 , 62 ).…”

“…This study has limitations worth considering for future research efforts. Long-term care settings, including AL/RC, have been disproportionately impacted by both resident morbidity and mortality and staffing shortage burdens as a direct result of COVID-19 ( 61 , 62 ). In addition to this trauma, pandemic-related restrictions limited recruitment and data collection efforts adversely affecting our ability to build the trust and relationships necessary with frontline care staff and administrators to gain buy-in for this study.…”

Lessons Learned from the COVID-19 Pandemic in Nursing Homes: A Systematic Review

“…Together, the studies included 7379 residents and 2598 staff members, spread over 99 care homes. Two studies had no participants (staff or residents) [ 15 , 16 ] and a third study interviewed experts in the field [ 17 ]. The sample size varied widely between studies, with the regional studies of Luzón et al [ 18 ] and Vijh et al [ 14 ] having the largest numbers of participants.…”

“…Three practices were the most widespread in the framework of the operational processes: systematic polymerase chain reaction (PCR) testing of residents and professionals with symptoms of COVID as a mechanism for detecting positive cases and controlling infection [ 14 , 16 , 17 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 ]; the use of personal protective equipment (PPE) by facility personnel and masks by residents [ 14 , 15 , 16 , 17 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 ]; and restriction of outings and external visits [ 14 , 15 , 17 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Other practices commonly used included: case monitoring for the outbreak and contact tracing of COVID-19-positive individuals [ 14 , 15 , 19 , 20 , 21 , 23 , 25 , 26 , 27 ], cohort segmentation by identifying and monitoring transition zones regarding cleaning between contaminated area and other areas [ 14 , 16 , 18 ,…”

Caregivers’ Concerns About Assisted Living Residents’ Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study

“…Caregivers in a Dutch study ( n = 1,997, April to May 2020; Wammes et al, 2020 ) reported concerns about residents’ increased loneliness (76%), sadness (66%), and decreased quality of life (62%). These high rates of caregiver concerns about resident mental health in both, AL and nursing home settings, point to the need to develop public health measures that (a) better balance residents’ mental health needs with safety concerns and (b) ensure continued inclusion of caregivers in resident care ( Dys et al, 2021 ; Hindmarch et al, 2021 ; Mitchell et al, 2021 ; Nash et al, 2021 ; Parmar et al, 2021 ; Prins et al, 2021 ; Wammes et al, 2020 ).…”