Background/Objectives: Few studies present clinical management approaches and outcomes of coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities (SNFs). We describe outcomes of a clinical management pathway for a large COVID-19 outbreak in an urban SNF with predominantly racial minority (>90% black), medically complex, older residents.

has had an impact on nutrition at individual, community, national, and global levels. 1 COVID-19 has been associated with weight loss and also has been linked to cachexia and sarcopenia. 2 Anorexia was the most common symptom during COVID-19 infection among patients at an academic long-term chronic care facility, with 70.8% of residents developing anorexia during the illness course. 3 In addition to effects of the disease itself, there are potential unintended consequences of infection control measures. A study of residents in a nursing home without a COVID-19 outbreak in the month following implementation of restrictions on visitors and group dining designed to mitigate the spread of COVID-19 showed significant weight loss among residents. 4 We conducted a retrospective chart review assessing the outcome of a COVID-19 outbreak on resident weights in a >200-bed skilled nursing facility (SNF) in Chicago, IL. The medical charts of each resident in the facility between March 1, 2020, and May 31, 2020, were reviewed in the electronic medical record (EMR) (PointClickCare) at the SNF and the affiliated academic medical center (Epic, 2020 Epic Systems Corporation). Among the residents included in the sample (n ¼ 209), the average age was 75.3 years (SD ¼ 11.9 years); residents were predominantly Black (93.3%) and women (56.0%). Hypertension (89.5%) and cognitive impairment (67.9%) were the most common chronic conditions present, followed by cardiac disease (43.5%) and diabetes (39.2%).There was no significant difference in age, race, gender, or comorbidities between the COVID-positive (n ¼ 172) and COVID-negative groups (n ¼ 32). Prevalence testing was completed for all residents in the facility twice at 7-day intervals in addition to as-needed testing based on symptoms and exposure. 5 The results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction

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Little is known about informal caregivers' challenges in medically underserved communities. This qualitative study explores their perceptions/experiences of caregiving in a medically underserved community in Midwest United States. Two focus groups (n ¼ 12) were conducted and themes were extracted and analyzed. Theme 1 included perceived barriers/unmet needs; most prevalent of which were lack of informational resources and support groups. A second unsolicited and unanticipated theme highlighted how caregivers constructed meaning through reappraising challenges to create enriching experiences for themselves, reinforcing their evolving dyadic relationship with care-recipient. Challenging and enriching aspects of caregiving coexisted and were rooted in caregiver-care-recipient dyad. Caregivers used meaning-making as a coping strategy for challenges. Prior research corroborates caregivers' challenges and meaning-making; this study contributes by delineating how both become interrelated. Policy makers can (a) alleviate challenges by increasing informational resources and support groups and (b) provide training to optimize caregivers' meaning-making, thus enhancing their positive experiences.

investigation. Family members were a mean age of 51 years, 62% were female, 46% were the patient's spouse, and 62% were African American. The categories that evolved from the data included: illness journey: it is getting worse, hope, uncertainty, rollercoaster, guided by patient wishes, and family decision-making. Families participated with providers in a shared decision-making process. Conclusion. The investigation found that family members were closely involved with the ICU team as life-limiting decisions were made on behalf of their family member.

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