The Need to Include Assisted Living in Responding to the COVID-19 Pandemic

Abstract

The risk of complications and death from COVID-19 is markedly skewed toward older adults. The US Centers for Disease Control and Prevention (CDC) recently wrote, "Given their congregate nature and residents served (eg, older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness." 1 However, in the United States and many other countries, nursing homes are not the only congregate setting that serves older adults with underlying chronic medical conditions. More so, they have been a shrinking component of the residential long-term care system, with some of the largest growth having been in assisted living (AL). AL communities provide supportive care, at least 2 meals a day, and 24hour supervision to individuals who need daily supportive care, but not daily nursing care. 2,3 Recent estimates are that there are 30,200 licensed AL communities across the United States, providing care to more than 835,000 residents 4 dwhich constitutes almost 40% of persons who receive residential long-term care in this country. More than half of the AL residents are "old-old" or "oldest-old": 53% are aged 85 or older, compared with 42% in nursing homes and 47% receiving hospice. 4 More so, many have the chronic underlying conditions implicated in COVID-19: 34% have heart disease, 17% have diabetes, and 15% have lung disease (chronic obstructive pulmonary disease and allied conditions), and more than a quarter have between 4 and 10 chronic health conditions. 5 Thus, the AL population is at high risk for being affected by COVID-19 and suffering serious outcomes.Importantly, AL communities are not the same as nursing homes. In fact, there are several distinct components of AL that make this a unique setting and one not to be ignored in relation to planning and response. This editorial summarizes key differences and their related implications for care.

Correlations between COVID-19 and burden of dementia: An ecological study and review of literature

“…The rate of dementia in hospitalized cases COVID-19 varied from 6.8% [11] to 13.1% [12]. A higher rate of COVID-19 among patients with dementia might be partially explained by problems with appropriate safeguard, self-quarantine procedures, less adherence to social distancing, and living in long-term care facilities [28].…”

#MoreThanAVisitor: Families as “Essential” Care Partners During COVID-19

“…Nursing homes receive more attention than assisted living when it comes to COVID-19, including critiques of restrictive visiting policies. Yet, as Zimmerman and colleagues (2020) note, assisted living residents resemble nursing home populations with high rates of chronic disease and multiple comorbidities, including conditions that heighten COVID-19 risk (see also Kistler et al, 2016 ). Dementia rates also are high and most residents are advanced in age ( Caffrey et al, 2012 ; Zimmerman et al, 2020 ).…”

“…Considering families “visitors” in policy goes beyond inaccurate portrayal of their roles and should be challenged. Research underscores the need to keep family informed and involved in residents’ lives to the greatest extent possible ( Zimmerman et al, 2020 ). In the absence of a vaccine, cure, or treatment and, in preparation for future public health emergencies, researchers, policy makers, and practitioners must conceptualize family members as #MoreThanAVisitor.…”

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

“…Further, nursing homes often lack adequate healthcare resources or infrastructure needed to curb the impact of COVID-19. For example, numerous studies have indicated a lack of investment in training programs for nursing home staff, in addition to high turnover rates [33,34], that management teams are often ineffective [35,36], and that the nursing home infrastructure is often too outdated [32,[37][38][39].…”