Variability in State Regulations Pertaining to Infection Control and Pandemic Response in US Assisted Living Communities

Bucy, Taylor; Smith, Lindsey; Carder, Paula; Winfree, Jaclyn; Thomas, Kali S.

doi:10.1016/j.jamda.2020.03.021

Cited by 23 publications

(26 citation statements)

References 3 publications

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“…7 Although staffing hours per resident per day are not commonly reported by ALs, staff shortages in this care setting have been endemic and were further exacerbated during the COVID-19 pandemic. 8 Furthermore, the level of pandemic preparedness, be it due to influenza or novel coronavirus, has also been challenging in this setting. 9 To date, almost nothing is known about the impact of COVID-19 on the AL population.…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Temkin‐Greener

Guo

Mao

et al. 2020

J American Geriatrics Society

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Objective To describe variations in COVID‐19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. Design Observational study employing data on confirmed COVID‐19 cases and deaths in ALs from seven states, through May 29, 2020. Setting Information on COVID‐19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID‐19 cases/deaths. Medicare Beneficiary Summary File (MBSF) identifying AL residents was employed to develop AL characteristics. County‐level COVID‐19 lab‐confirmed cases/deaths were obtained from publicly available data. Participants We found 4,865 ALs (2,647 COVID‐19 cases and 777 deaths) in the 7 states. After excluding missing data the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). Main Outcomes and Measures Outcomes were AL‐level counts of cases and deaths. Covariates were AL characteristics and county‐level confirmed COVID‐19 cases/deaths. Multivariable 2‐part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). Results State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least 1 case, mid‐size communities had fewer cases (IRR=0.829; p=0.004), than very small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID‐19 cases (IRR=1.08; p<0.001), as did communities with higher proportions of residents with dementia, COPD and obesity. Conclusions and Relevance ALs with a higher proportion of minorities had more COVID‐19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID‐19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.

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Section: Introductionmentioning

confidence: 99%

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Temkin‐Greener

Guo

Mao

et al. 2020

J American Geriatrics Society

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“…Social isolation, loneliness, delirium, dementia management, medication administration, and effects of the coronavirus pandemic on caregivers of residents all intersect with the overall health and wellbeing of AL/RC residents ( Brooke & Jackson, 2020 ; Brown et al, 2020 ; O’Hanlon & Inouye, 2020 ). Infection control requirements in AL/RC might not be as robust as in other care settings; 31 states have AL/RC regulations for infection control ( Bucy et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

Dys

Smith

Tunalilar

et al. 2020

Gerontology and Geriatric Medicine

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As the United States population ages, a higher share of adults is likely to use long-term services and supports. This change increases physicians’ need for information about assisted living and residential care (AL/RC) settings, which provide supportive care and housing to older adults. Unlike skilled nursing facilities, states regulate AL/RC settings through varying licensure requirements enforced by state agencies, resulting in differences in the availability of medical and nursing services. Where some settings provide limited skilled nursing care, in others, residents rely on resident care coordinators, or their own physicians to oversee chronic conditions, medications, and treatments. The following narrative review describes key processes of care where physicians may interact with AL/RC operators, staff, and residents, including care planning, managing Alzheimer’s disease and related conditions, medication management, and end-of-life planning. Communication and collaboration between physicians and AL/RC operators are a crucial component of care management.

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“…Participants highlighted how policymakers at all levels did not understand the heterogeneity of the AL context, which resulted in unfortunate consequences related to infection control compliance, accessing PPE, and meeting testing and cohorting requirements for staff and residents. Before the pandemic, the AL regulations of 32 states required settings to have infection control policies and staff training, although these requirements varied in specificity ( 24 ). Only two states explicitly mentioned pandemics in their AL regulations.…”

Section: Discussionmentioning

confidence: 99%

“…Although the CDC added recommendations for AL communities to seek guidance from state and local officials, they continued to reference CMS' NH guidance as a resource for local officials ( 20 ). Some COVID-19 related federal policies and recommendations may not be feasible in practice for AL settings because, as Dobbs and colleagues described, AL settings face unique challenges in implementing federal guidance compared with NHs ( 21 ), largely due to their use of external healthcare and service providers to provide resident care ( 14 ), lower staffing levels and licensed staff availability ( 9 , 22 , 23 ), variable infection control requirements ( 24 ), and (in)ability to isolate and cohort COVID-19 positive residents ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

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

Dys

Winfree

Carder

et al. 2021

Front. Public Health

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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.

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Variability in State Regulations Pertaining to Infection Control and Pandemic Response in US Assisted Living Communities

Cited by 23 publications

References 3 publications

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

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

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