Nursing Homes and COVID-19: A Crisis on Top of a Crisis

Abstract

The COVID-19 pandemic has caused a staggering number of deaths and a great deal of suffering in U.S. nursing homes. The spread of the virus across the country introduced a new emergency to a long-term care sector that had already been in a state of crisis for multiple decades. Nursing homes have been underfunded and understaffed for years, often delivering inadequate care to their vulnerable residents, and they are financed and regulated separately from the rest of the U.S. health care system. During the pandemic, policy responses at both the federal and state levels were often slow and inadequate, partly due to a frayed infrastructure that is the result of years of inattention from policy-makers. We review the state of nursing home care in the United States and the impacts of the pandemic, and we argue that a package of broader policy and delivery reforms should be implemented to improve the care of older adults that could help to prevent future tragedy.

The Massachusetts COVID‐19 initiative provides evidence for a practical, multi‐faceted, participatory implementation process

“…The increased propensity to infection and spread in nursing homes has been attributed in part to residents' vulnerabilities, including their advanced age, co‐morbidity, functional loss, and residence in communal living 3 . Low preparedness also challenged nursing homes and included shortages of personal protective equipment (PPE), lack of infection control policies, and limited staff skilled in infection control 3–9 . Compounding the problem was reduced staffing levels as the pandemic aggravated common, baseline situations of high staff turnover, low staffing numbers, and low registered nurse levels 3,8–11 .…”

“… 3 Low preparedness also challenged nursing homes and included shortages of personal protective equipment (PPE), lack of infection control policies, and limited staff skilled in infection control. 3 , 4 , 5 , 6 , 7 , 8 , 9 Compounding the problem was reduced staffing levels as the pandemic aggravated common, baseline situations of high staff turnover, low staffing numbers, and low registered nurse levels. 3 , 8 , 9 , 10 , 11 In the current issue of JAGS, Lipsitz and colleagues report on a state‐wide initiative to address these challenges and improve COVID‐19 infection control in nursing homes (NHs) in Massachusetts (MA), a state designated as a hot spot in spring 2020.…”

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak

“…The scientific literature reviewed has highlighted the high incidence of the disease and associated mortality in the older adult population in the early stages of the disease, with residents in nursing homes being the most highly affected [ 36 , 74 , 75 ], as has occurred in Spain [ 76 , 77 , 78 ]. This population group, due to its own socio-demographic conditions and age-associated chronic comorbidity and functioning, was the most vulnerable to SARS-CoV-2 infection, hospitalization, and death [ 61 , 79 , 80 , 81 ], with women being the group most affected by mortality [ 82 ].…”

Skilled Nursing Facility Changes in Ownership and Short-Stay Medicare Patient Outcomes

“…Skilled nursing facilities (SNFs) were among the hardest hit places during the COVID-19 pandemic in the US, and as a result, the industry has come under significant public scrutiny . Understanding variations in patient safety and outcomes and incentivizing quality improvements in SNFs are increasingly urgent national priorities .…”