Support of nursing homes in infection management varies by US State Departments of Health

Empowering a person-centered long-term care workforce

Currently there is a crisis in the long-term care workforce, as many workers experience poor pay, a lack of training, burnout, low quality working conditions, and physical strain, which is leading to a workforce shortage. To address this, the Alzheimer's Association Dementia Care Provider Roundtable (AADCPR) convened a panel of direct care workers to discuss and provide direction on their view of the current state of the workforce. From this panel, five touchpoints for hiring and retaining direct care workers were highlighted: high quality jobs; recruitment and reputation management; onboarding; retention; and training and career advancement. In addition, the DCPR put together a set of standards to follow to meet these needs, which includes promoting staff dementia education opportunities, creating recommendations around peer mentoring programs specific to dementia care, and increasing inclusion of direct care workers in decision-making and plans of care. HIGHLIGHTS: Presents the current state of workforce in long-term care. Provides five touchpoints that long-term and home and community-based services should implement for hiring and retaining direct care workers. Recommends a set of standards to follow to meet the needs of the workforce within long-term care.

The Burden of COVID-19 Mortality Due to Referrals From Skilled Nursing Facilities in a Small Community Hospital

BACKGROUND

Amidst the COVID-19 pandemic, nursing home residents have seen a significant increase in hospitalizations. However, there is a lack of published data on the healthcare provided to these individuals in community hospitals. This knowledge gap hinders our understanding and evaluation of the quality and outcomes of care received by nursing home residents when they are hospitalized for COVID-19 or other medical conditions. Furthermore, insufficient data is used to compare the clinical outcomes of COVID-19-related admissions from nursing facilities between small community hospitals and tertiary care facilities. It is essential to conduct further research to identify potential disparities, which may indicate an unequal burden of nursing facility referrals to less-resourced hospitals.

OBJECTIVE

We examined the characteristics of COVID-19-related deaths in a community hospital during the first surge of COVID-19 and calculated the proportion of patients who expired and were transferred from nearby nursing facilities.

METHOD

We performed a retrospective review of all cases of COVID-19 admitted to a 160-bed community hospital in Connecticut from January 1, 2020, to August 1, 2020. One hundred seventy-seven patients with COVID-19 who were admitted to our hospital were included in this study. Seventy patients (70/177, 39.54%) were transferred from nearby nursing facilities. The primary objective of this study was to examine the clinical characteristics of COVID-19-related deaths in our community hospital during the first surge of COVID-19. We also calculated the proportion of patients who expired and were transferred from nearby nursing facilities.

RESULTS

Although the mortality rate in our community hospital was 15.23% (27/177), the majority of those who died were from nursing facilities (85.18%, 23/27). In contrast, mortality among the patients admitted from the community was 3.7% (4/107). The patients transferred from a nursing facility had 12.6 times higher odds of 30-day inpatient mortality or referral to hospice (95% CI, 4.1-38.5; p<0.001).

CONCLUSION

The majority of COVID-19 deaths in our community hospital were due to nursing facility referrals. We hypothesize that this high mortality may reflect healthcare inequality due to the unequal burden of nursing facility referrals to less-resourced hospitals.

Modeling shield immunity to reduce COVID-19 transmission in long-term care facilities

PURPOSE

Nursing homes and long-term care facilities have experienced severe outbreaks and elevated mortality rates of COVID-19. When available, vaccination at-scale has helped drive a rapid reduction in severe cases. However, vaccination coverage remains incomplete among residents and staff, such that additional mitigation and prevention strategies are needed to reduce the ongoing risk of transmission. One such strategy is that of "shield immunity", in which immune individuals modulate their contact rates and shield uninfected individuals from potentially risky interactions.

METHODS

Here, we adapt shield immunity principles to a network context, by using computational models to evaluate how restructured interactions between staff and residents affect SARS-CoV-2 epidemic dynamics.

RESULTS

First, we identify a mitigation rewiring strategy that reassigns immune healthcare workers to infected residents, significantly reducing outbreak sizes given weekly testing and rewiring (48% reduction in the outbreak size). Second, we identify a preventative prewiring strategy in which susceptible healthcare workers are assigned to immunized residents. This preventative strategy reduces the risk and size of an outbreak via the inadvertent introduction of an infectious healthcare worker in a partially immunized population (44% reduction in the epidemic size). These mitigation levels derived from network-based interventions are similar to those derived from isolating infectious healthcare workers.

CONCLUSIONS

This modeling-based assessment of shield immunity provides further support for leveraging infection and immune status in network-based interventions to control and prevent the spread of COVID-19.

Prevention is Key to Reducing the Spread of COVID-19 in Long-Term Care Facilities

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has greatly affected the older people who live in long-term care facilities (LTCFs). Older people and those with underlying chronic conditions in LTCFs have experienced disproportionately high morbidity and mortality. COVID-19 vaccines plus a booster shot provide strong protection against severe illness, hospitalizations, and deaths, but new COVID-19 variants, such as Omicron, have a remarkable ability to evade immunity from vaccines, past infection, or both. Prevention is key to reducing the spread of COVID-19 in LTCFs. This study aims to investigate a prevention approach for protecting residents and staff from COVID-19. This paper first presents a case study of massive coronavirus outbreaks at a big nursing home facility and demonstrates how the facility incorrectly responded to COVID-19. It further investigates prevention measures, such as improving vaccination, early detection, isolation and intervention to prevent the spread of COVID-19. It concludes by discussing the implications of the study and directions of future research.

Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach

Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes.

Mental Health in Residential Healthcare Workers During the COVID-19 Pandemic: The Moderating Role of Selfobject Needs

The COVID-19 outbreak has affected healthcare across all levels. Older adults and those with chronic illness are at greatest risk for infection complications and mortality, which presents significant psychological distress for residential healthcare workers. The concept of selfobject needs, consisting of Mirroring, Idealizing, and Twinship, may be relevant in explaining psychological distress. This study seeks to enhance our understanding of the needs of healthcare workers responsible for elderly patients and evaluate the role of psychosocial support through selfobject needs to mitigate the effects of trauma during the pandemic. Participants (N = 103) employed in residential healthcare facilities in the metropolitan Detroit, MI (USA) region completed an online survey during the peak initial infection. Assessments included standardized measures of trauma-related symptoms, depression, anxiety, and general distress symptoms, as well as a validated measure of selfobject needs. Residential healthcare workers reported mental health symptoms across domains, including clinical elevations in symptoms of trauma, depression, and anxiety. Selfobject needs and mental health outcomes were positively correlated, indicating that greater unmet relational need was associated with greater severity of symptoms. Greater trauma symptom severity as a proxy index of current experience during the pandemic predicted high depressive symptoms, and greater Mirroring need worsened the effect. These results suggest that interventions targeting selfobject needs, specifically Mirroring, may be effective at mitigating acute mental health symptoms among healthcare workers during a distressing event.