Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk

Dosa, David; Jump, Robin L.P.; LaPlante, Kerry L.; Gravenstein, Stefan

doi:10.1016/j.jamda.2020.03.004

Cited by 78 publications

(90 citation statements)

References 5 publications

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“…Signi cant care needs and cognitive impairment makes the task of contact precautions and social isolation extremely di cult. (3)(4)(5) Underlying multi-morbidity, medical complexity, cognitive changes, and longstanding systemic issues resulting from chronic under-funding (e.g. for sta ng, for addressing structural challenges such as the lack of private rooms) increase the risk of morbidity, loss of functional independence and mortality during a disease outbreak, such as in uenza.…”

Section: Introductionmentioning

confidence: 99%

“…for sta ng, for addressing structural challenges such as the lack of private rooms) increase the risk of morbidity, loss of functional independence and mortality during a disease outbreak, such as in uenza. (3,(6)(7)(8) Epidemiologic studies of the outbreak in King County, Washington reports a CFR in LTC of 33.7%. (9) However, in Ontario, Ministry of Health and Long-term care (MOHLTC) statistics from June 1, 2020 have con rmed 1,652 deaths in LTC residents; this represents 72% of all COVID-19 related deaths in Ontario.…”

Section: Introductionmentioning

confidence: 99%

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A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

Siu

Kristof

Elston

et al. 2020

Preprint

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Background The COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes. Methods An online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the LTC clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent’s LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent’s LTC home was also assessed. Results The overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home. Conclusions This study highlights the communication to and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

Siu

Kristof

Elston

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Ensure that AL residents are involved in discussion related to COVID-19, and that social distancing does not translate to social disengagement For residents with dementia, be mindful of the effects of social distancing and remain especially vigilant to medical signs of possible COVID-19 Be proactive in instilling infection control practices in AL Consider the capacity of each AL community to promote social engagement and provide infection control, and their need for outside assistance Keep medical care providers informed about the status of their patients, and also of the capacity of the given AL community to provide care; make telehealth available, if possible Be mindful of whether the direct care workforce has the knowledge and skills to provide the care necessary in times of crisis; provide resources to enhance those skills if necessary Engage in continuous communication with family members, conveying the practices in place to prevent and combat COVID-19, and helping them remain meaningfully involved in resident oversight and well-being These recommendations are best situated alongside practical guidelines for long-term care in general as presented in a recent JAMDA editorial: reduce morbidity and mortality among those infected; minimize transmission; ensure protection of health care workers; maintain health care system functioning; and, as especially relevant for AL, maintain communication with residents and family members. 28 The CDC recognizes AL communities as a component of the long-term care system, 29 and along with nursing homes, they are a critical provider of residential long-term care to our nation's older adults. There has never been a better time for AL communities to develop infection control programs as recommended in CDC guidelines.…”

Section: Summary: Assisted Living Should Not Be Ignored In Covid-19 Rmentioning

confidence: 99%

The Need to Include Assisted Living in Responding to the COVID-19 Pandemic

Zimmerman

Sloane

Katz

et al. 2020

Journal of the American Medical Directors Association

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The risk of complications and death from COVID-19 is markedly skewed toward older adults. The US Centers for Disease Control and Prevention (CDC) recently wrote, "Given their congregate nature and residents served (eg, older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness." 1 However, in the United States and many other countries, nursing homes are not the only congregate setting that serves older adults with underlying chronic medical conditions. More so, they have been a shrinking component of the residential long-term care system, with some of the largest growth having been in assisted living (AL). AL communities provide supportive care, at least 2 meals a day, and 24hour supervision to individuals who need daily supportive care, but not daily nursing care. 2,3 Recent estimates are that there are 30,200 licensed AL communities across the United States, providing care to more than 835,000 residents 4 dwhich constitutes almost 40% of persons who receive residential long-term care in this country. More than half of the AL residents are "old-old" or "oldest-old": 53% are aged 85 or older, compared with 42% in nursing homes and 47% receiving hospice. 4 More so, many have the chronic underlying conditions implicated in COVID-19: 34% have heart disease, 17% have diabetes, and 15% have lung disease (chronic obstructive pulmonary disease and allied conditions), and more than a quarter have between 4 and 10 chronic health conditions. 5 Thus, the AL population is at high risk for being affected by COVID-19 and suffering serious outcomes.Importantly, AL communities are not the same as nursing homes. In fact, there are several distinct components of AL that make this a unique setting and one not to be ignored in relation to planning and response. This editorial summarizes key differences and their related implications for care.

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“…Built environment issues are of considerable importance in long-term care settings where older residents live in close quarters and often have high levels of impairment and chronic illness, all of which can lead to a greater infection rates and mortality. 8 , 9 , 10 In addition to physical health issues, the built environment of long-term care exacerbates psychosocial and mental health challenges of COVID-19 as a result of quarantine, constrained social interaction, restricted visits from family and friends, the cancellation of shared activities, or the wearing of personal protective equipment by staff. 11 , 12 These interventions are particularly difficult for people with a cognitive impairment or a person that walks with purpose, formerly termed “wandering.” 4 …”

Section: The Built Environment Of Nursing Homes and Covid-19mentioning

confidence: 99%

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

Anderson

Grey

Kennelly

et al. 2020

Journal of the American Medical Directors Association

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Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

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Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk

Cited by 78 publications

References 5 publications

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

The Need to Include Assisted Living in Responding to the COVID-19 Pandemic

Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience

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