Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis

Abstract

Background Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. Objective To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. Method We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. Results We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents’ hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents’ case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. Conclusion SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.

Impact of skilled nursing facility (SNF) 3‐day hospitalization requirement waiver during the COVID‐19 pandemic on emergency department and inpatient SNF discharges in California

“…5,6 Similarly, COVID had a major impact on SNF and other long-term care facilities that adopted efforts to reduce disease spread within their facilities such as limiting access and admissions. 7 Second, the 3-day hospitalization rule primarily applied, and thus the waiver had the most potential impact, on fee-for-service (FFS) beneficiaries of Medicare. Other alternative Medicare coverage, such as most Medical Advantage plans and Accountable Care Organizations may not have had the 3-day requirement under their agreements with CMS during the study period.…”

“…For example, during the initial months following the declaration of the public health emergency, ED census across the nation fell markedly, including in California 5,6 . Similarly, COVID had a major impact on SNF and other long‐term care facilities that adopted efforts to reduce disease spread within their facilities such as limiting access and admissions 7 …”

“… 5 , 6 Similarly, COVID had a major impact on SNF and other long‐term care facilities that adopted efforts to reduce disease spread within their facilities such as limiting access and admissions. 7 …”

Analysis of the impact of COVID-19 on Scotland’s care-homes from March 2020 to October 2021: national linked data cohort analysis

“…There is a need to better understand the indirect impact of COVID-19 on care-home residents, families and friends, and staff. For example, control measures which had some effect in reducing the risk of transmission [ 47 ] are recognised to have adverse effects on individuals and relationships [ 48–50 ]. Research is needed to understand the balance of benefits and harms of different control measures [ 51 ].…”

Vaccines in Long-Term Care Settings: A Narrative Review

“…A 1-day study in 9 geriatric hospitals in France and Switzerland in December 1987, totalling 1,919 patients, 44% aged more than 85 years and 74% being female, found a high rate of infections (18.7% in males and 15.4% in females) [8]. In a systematic review of 108 studies, Zhang showed a SARS-CoV-2 infection rate of 32.63% for residents [9]. In a prospective, longitudinal study, Aronow et al [10] investigated the major clinical cause of death among all residents aged 60 years older in a large nursing home.…”