Ready or Not: Pivoting to Video Visits with Homebound Older Adults During the COVID‐19 Pandemic

Abstract

Smaller nursing homes, as measured by average residentsʼ daily census, were less likely to report COVID-19 data (odds ratio (OR) =0.96; P < .001). Nonchain nursing homes were less likely to report data (OR = 0.74; P = .001). When comparing nursing homes with four-star quality ratings, nursing homes with three-star ratings were less likely to follow instructions and report COVID-19 data to CMS (OR = 0.75; P = .044). Measured by years of operation, newer nursing homes were less likely to report COVID-19 cases (OR = 0.99; P = .014). Nursing homes with a higher percentage of White residents and residents aged 65 years and older were less likely to be late reporters (OR = 0.996 (P = .05); and OR = 0.991 (P = .001), respectively). DISCUSSION Participation in data reporting requires particular information technology infrastructure and additional human and financial resources, 4 which may create barriers for smaller nursing homes. A recent study found that smaller nursing homes had a lower probability of having any COVID-19 cases, but after adjusting the size, they had a much higher outbreak size compared with nursing homes with more than 50 beds. 5 It is possible that smaller nursing homes had more COVID-19 cases adjusted by bed capacity. Therefore, they did not have additional resources to report to CMS. A similar trend was observed between chain-affiliated and freestanding nursing homes. Nonchain nursing homes may lack resources to conduct reporting, and they were more likely to have COVID-19 cases. 5 The finding of this study may signal a need to help small and nonchain nursing homes in receiving incentives or resources from CMS to overcome barriers in COVID-19 reporting. Nursing homes that operated longer in the market were more familiar with the requirement by the government in quality reporting, and they were more prepared with resources to comply with COVID-19 reporting. A study found that older adults (aged >65 years) faced a higher risk in getting COVID-19 and developing into critical conditions. 6 With more severe cases and higher death rates from older residents, especially those who are older than 65 years, nursing homes may pay more attention to COVID-19 reporting. We also spotted the racial disparity in reporting COVID-19 cases. Nursing homes with a higher percentage of minority populations were less likely to participate in reporting. Previous studies found that minority residents in nursing homes were more subject to coronavirus, which indicated a disproportionate impact of COVID-19 among different racial and ethnic groups. 5,7-9 Our study is consistent with previous findings, and CMS may need to focus on nursing homes with more minority residents and explore the underlying reasons for the disparity in COVID-19 reporting and residentsʼ cases and deaths. In conclusion, CMS successfully collected COVID-19 data from nursing homes with a wide geographical variation in participation. Additional support may be needed to help small and nonchain nursing homes to make sure they have sufficient resources to comply.

Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes

“…For older adults with diabetes, attending medical appointments may be difficult or impractical. In such cases, teleconsultations may be a suitable alternative [70][71][72]. Remote blood glucose monitoring linked to web-based cloud technologies allows for the transfer of continuous glucose monitoring (CGM) data directly to healthcare professionals (e.g.…”

“…intermittent CGM) [73,74]. However, the suitability of these telemedicine activities for the individual should be carefully considered, as they may not be effective in all cases [71,75].…”

Impact of the COVID‐19 pandemic on community services for homebound older adults in New York City

“…The agency has not built an online platform due to a lack of funding, expertise and staff training. The organisational unpreparedness of delivering ICT services was also documented in other health and mental health service programs for older adults (Abrashkin et al, 2020;Latus-Olaifa et al, 2019). Considering the sociodemographic characteristics of the homebound older adults in the community, their readiness to receive online services is also questionable given limited financial resources to afford devices and internet access services, hearing and vision impairments, lack of experience in utilising the internet, fears of scams and inadequate interest and confidence.…”

Home‐Based Medical Care: High‐Value Health Care During Coronavirus Disease 2019 and Beyond

“…It is essential that home care practices can pivot between virtual and in‐person care modalities in the face of an unpredictable pandemic. For example, Northwell Health, which provides home‐based primary care to approximately 2000 patients in downstate New York, was able to complete telehealth visits with 48.6% of eligible enrollees from March to May 2020, while 11.5% of patients who consented to telehealth ultimately required a face‐to‐face visit during this time frame 13 . The authors' home‐based primary care colleagues at the University of Pennsylvania adopted similar practice patterns, with telehealth utilized for the majority of visits early in the pandemic and then carefully integrated with face‐to‐face evaluation as local transmission rates fell and PPE became more widely available.…”