<scp>COVID</scp>‐19 in Nursing Homes: Calming the Perfect Storm

Ouslander, Joseph G.; Grabowski, David C.

doi:10.1111/jgs.16784

Cited by 265 publications

(276 citation statements)

References 57 publications

(103 reference statements)

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“…Furthermore, in June of 2020, CMS has refocused the nursing home survey process on infection control (https://www.cms. gov/files/document/qso-20-31-all.pdf), which, although criticized as being inadequate, 20 is still superior to general absence of infection control regulations and requirements in ALs. 9,26 And although the federal government has allocated over $10 billion to specifically assist nursing homes with the pandemic, including support for testing, PPE, and staff shortages, 27,28 federal assistance to ALs has been limited to those communities serving Medicaid-eligible residents (i.e., about 16% of AL communities), 29 even though ALs and nursing homes care for similar populations and share many of the same pandemicrelated challenges.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…IPC training requires additional resources but, if successful, the benefits should include less absenteeism among staff (from illness or quarantine), which has been a major contributor to high COVID-19 attack and fatality rates among RACF residents. 17 In the long term, improved prevention and control of infection in RACFs should contribute to reducing the impacts of seasonal influenza and antimicrobial resistance, 18,19 which are important causes of avoidable hospitalisation and cost in aged care.…”

Section: Embedding Infection Prevention and Control Practices Into Ramentioning

confidence: 99%

COVID ‐19 in a Sydney nursing home: a case study and lessons learnt

Gilbert

2020

Medical Journal of Australia

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Perspectives COVID-19 in a Sydney nursing home: a case study and lessons learnt Lessons learnt from COVID-19 outbreaks in residential aged care facilities could limit future impacts I nfectious disease outbreaks are a hazard of communal living in places such as military barracks, boarding schools, prisons and residential care homes. The risks are exacerbated when residents are vulnerable because of advanced age, comorbidities and frailty, or there are too few or inadequately trained staff. The home-like setting of modern residential aged care facilities (RACFs), and the overcrowding and limited staffing that are features of many, are not conducive to prevention or control of infectious diseases. 1-3 Early in the coronavirus disease 2019 (COVID-19) pandemic it was clear that age would be a risk factor. 4,5 Internationally, age-stratified case fatality rates (CFRs) have been an estimated three times higher in people aged over 60 years (4.5%) than in those aged under 60 years (1.4%). 6 In Australia, the overall CFR from COVID-19 is about 3%. 7 The majority of deaths have occurred in people over 70 years of age. At 14 September 2020, there were 1995 COVID-19 cases among residents of government-subsidised RACFs, of whom 604 (30%) died. This is in contrast to a CFR of 8.5% (7/82) among recipients of government-subsidised domiciliary aged care services. Residents of RACFs represent 74% (602/816) of all COVID-19 deaths in Australia to date. 7 Comorbidities associated with an increased risk of severe COVID-19, including diabetes, chronic kidney and cardiovascular disease, are more common among RACF residents. 8 Transmission of COVID-19 can spread silently within an RACF from someone with asymptomatic or presymptomatic infection, or atypical symptoms. 9-11 Outbreaks in RACFs, with high attack rates and CFRs, have been reported in many countries. 9,10,12-14

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“…Over 100,000 deaths from the novel coronavirus infectious disease 2019 pandemic have been reported among residents of long-term care settings, 1 but official counts may underestimate the total mortality. 2 Asymptomatic infected nursing home staff are known to transmit the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to residents. 3 Staff themselves are vulnerable to adverse outcomes, with nearly 800 deaths nationwide attributable to SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Willingness of Long‐Term Care Staff to Receive a COVID‐19 Vaccine: A Single State Survey

Unroe

Evans

Weaver

et al. 2021

J American Geriatrics Society

126

155

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Objectives To plan for coronavirus infectious disease 2019 (COVID‐19) vaccine distribution, the Indiana Department of Health surveyed nursing home and assisted living facility staff. Design Cross‐sectional analysis of an anonymous survey sent via text message link to personal cell phones and emails. Setting and Participants Nursing home and assisted living facility staff in Indiana. Measures Staff characteristics including age, gender, race, ethnicity, role in the facility, experience in long‐term care, and geographic location of facility were self‐reported along with prior infection and willingness to receive an approved vaccine as soon as it is available. Responses were weighted to represent staff statewide. Weighted frequencies and logit regression estimated characteristics associated with vaccine willingness. Results There were 8,243 responses to the survey. For nursing home staff (survey delivered via 23,232 working phone numbers), there was a 33% response rate). There were 2,372 (29%) in nurse aide or similar roles and 1,602 nurses providing direct clinical care (19%). Overall, 45% of respondents indicated they would receive an approved COVID‐19 vaccine as soon as available. Of those unwilling to take the vaccine when first available, 44% would consider in the future. Concerns about side effects was the primary reason for vaccine hesitancy (70%). Characteristics associated with increased willingness were age over 60, male, and white race (P < .0001). No statistically significant differences were observed among staff self‐reporting prior SARS‐CoV‐2 infection. Conclusions and Implications The willingness to receive the COVID‐19 vaccine immediately or in the future may be as high as 69%, but varies among subgroups of nursing home staff which has implications for distribution. Educating staff on the vaccine may be critical for increasing uptake. Widespread vaccination holds the promise of protection against serious illness and death and a return of visitors and activities that support improved quality of life. This promise will not be realized without strong uptake of the vaccines.

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COVID‐19 in Nursing Homes: Calming the Perfect Storm

Cited by 265 publications

References 57 publications

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

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

COVID ‐19 in a Sydney nursing home: a case study and lessons learnt

Willingness of Long‐Term Care Staff to Receive a COVID‐19 Vaccine: A Single State Survey

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