Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Dean, Adam; Venkataramani, Atheendar S.; Kimmel, Simeon D

doi:10.1377/hlthaff.2020.01011

Cited by 63 publications

(63 citation statements)

References 28 publications

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“…However, not all nursing homes had doctors and nurses on their staff. The USA's research also showed similar result that the nursing home with health care worker represents a lower mortality rate compared with facilities without health care worker [25]. In our survey, there were no medical staff (doctors, nurses, or pharmacists) in 19.7% of the nursing homes, as nursing homes tend to strive to create a family environment rather than a medical environment [26].…”

Section: Discussionsupporting

confidence: 75%

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

Shi

Zhang

et al. 2021

Preprint

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Background: The novel coronavirus disease 2019 (COVID-19) pandemic has become a challenge for nursing homes in China. Nursing homes are particularly dangerous places regarding the spread of COVID-19 given that they house vulnerable, high-risk populations. As such, several useful guidelines for coping with COVID-19 in nursing homes have been provided. However, the actual implementation rates of such guidelines are unknown. This study aims to document the adherence of nursing homes to the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes.Methods: A cross-sectional study was conducted among 484 nursing homes in 136 cities of 28 provinces in China. A self-report questionnaire was created based on the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes (first edition). The questionnaire and the Transformational Leadership in the Public Sector Scale were sent to nursing home managers via the Wenjuanxing app online from February 7 to 29, 2020. A total of 461 responses were included in the analysis. Results: The average overall implementation rate of COVID-19 prevention and control measures was 80.0% (143.97/180). The average implementation rates for hygienic behaviour management, access management were lower, with 75.3% and 78.7% respectively. The number of medical staff, established a quarantine unit (room), leadership’s three dimensions included intellectual stimulation, individualized consideration, and idealized influence were found to affect the prevention and control implementation (p<0.05). Nursing homes that did not have hospital-nursing home cooperation, did not have medical staff, and had not established a quarantine unit (room) had low implementation rates (p<0.01). 69.8% (332/461) of nursing home managers reported they had serious resource problems, inadequate of protective supplies (72.0%) and staff shortage (47.7%) were two primary problems. Conclusion: Overall, the implementation of prevention and control measures by nursing homes are insufficient during the epidemic in China. Further education for staff, provide support to staff, supply adequate protective resources, and cooperation with hospitals are required to improve the implementation rate. It is urgent for nursing homes keep the safety of the residents and staff.

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Section: Discussionsupporting

confidence: 75%

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

Shi

Zhang

et al. 2021

Preprint

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“…4 Furthermore, many facilities suffer from understaffing, which may lead to even higher contact rates between staff and residents, and larger COVID outbreaks. 5 The ability to develop evidence-based responses to this crisis has been constrained by limited data and a shortage of research in these facilities prior to the COVID-19 pandemic. So far, infection control in many nursing homes has relied on moving infected residents into new rooms in a "COVID cohort," isolated from other residents, as recommended.…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…4 Furthermore, many facilities suffer from understaffing, which may lead to even higher contact rates between staff and residents, and larger COVID outbreaks. 5…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…So far, infection control in many nursing homes has relied on moving infected residents into new rooms in a “COVID cohort,” isolated from other residents, as recommended. 5,6 Long-term separation after recovery keeps the non-COVID cohort at or near 100% susceptible, and thus has the potential unintended effect of preventing development of institutional herd immunity that could slow outbreaks. Additionally, there is relatively little evidence about the potential of strategies that focus on staffing based on infection histories.…”

Section: Introduction/backgroundmentioning

confidence: 99%

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Frequent testing and immunity-based staffing will help mitigate outbreaks in nursing home settings

Holmdahl

Kahn

Hay

et al. 2020

Preprint

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Background: Nursing homes and other long term care facilities have been disproportionately impacted by the COVID-19 pandemic. Strategies are urgently needed to reduce transmission in these vulnerable populations. We aimed to evaluate the reduction in transmission in nursing homes achieved through contact-targeted interventions and testing and to evaluate the effectiveness of two types of screening tests conducted with varying frequency: 1) rapid antigen testing and 2) PCR testing. Methods: We developed an agent-based Susceptible-Exposed-Infectious(Asymptomatic/Symptomatic)-Recovered (SEIR) model to examine SARS-CoV-2 transmission in nursing homes. Residents and staff are modelled individually; residents are split into two cohorts based on COVID-19 diagnosis. In the resident cohorting intervention, recovered residents are moved back from the COVID (infected) cohort to the non-COVID (susceptible/uninfected) cohort. In the immunity-based staffing intervention, recovered staff, who we assume have protective immunity, are assigned to work in the non-COVID cohort, while susceptible staff work in the COVID cohort and are assumed to have high levels of protection from personal protective equipment. These interventions aim to reduce the fraction of people's contacts that are presumed susceptible (and therefore potentially infected) and replace them with recovered (immune) contacts. Results: The frequency and type of testing has a larger impact on the size of outbreaks than the cohorting and staffing interventions. The most effective testing strategies modeled are daily antigen testing of everyone and daily antigen testing of staff with weekly PCR testing for residents. Under all screening testing strategies, the immunity-based staffing intervention reduces the final size of the outbreak. The resident cohorting intervention reduces the final outbreak size under some, but not all, testing scenarios. Conclusions: Increasing the frequency of screening testing of all residents and staff, or even staff alone, in nursing homes has the potential to greatly reduce outbreaks in this vulnerable setting. Immunity-based staffing can further reduce spread at little or no additional cost and becomes particularly important when daily testing is not feasible.

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“…La relation entre le statut à but lucratif et les conséquences est complexe. Ces dernières sont influencées par plusieurs facteurs, notamment la syndicalisation des employés, le type de propriété de la chaîne et la disponibilité de l’équipement de protection individuelle (EPI) 37 – 39 . Par exemple, plusieurs rapports ont indiqué que les foyers à but lucratif offrent des salaires moindres, ont moins de personnel, engagent plus d’employés occasionnels et à temps partiel, et ont un plus grand roulement que les foyers à but non-lucratif 14 , 40 – 42 .…”

Section: Quelles éTaient Les Différences Entre Les Soins De Longue Durée En Ontario Et En Colombie-britannique Avant La Covid-19?unclassified

La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique

Liu

Maxwell

Armstrong

et al. 2021

CMAJ

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Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

Cited by 63 publications

References 28 publications

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

Frequent testing and immunity-based staffing will help mitigate outbreaks in nursing home settings

La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique

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