Few people, especially those within healthcare, are unaware that the COVID-19 pandemic hit the nursing home and long-term care areas of the care continuum harder than anywhere else. The skilled nursing environment, unfortunately, became a place where COVID-19 was easily transferred between patients, residents, family members, and staff, necessitating lockdowns, the prohibition of visitors, and elimination of resident gatherings. While some measures were successful in preventing additional widespread infection and loss of life, there were inherent challenges for this care environment in the face of the pandemic. According to a recent media briefing about nursing facilities and the COVID-19 pandemic, Duke University eldercare experts emphasized that "Nursing homes will continue to be COVID-19 hotspots until state and federal officials can institute sweeping testing of asymptomatic patients and workers." Even with reduced infection rates, unvaccinated residents are still at serious risk.
This blog post continues our series based on the HealthStream article, 10 Considerations for COVID-19 and Long-Term Care, which examines specific considerations and recommendations to improve the prospects for people living in this long term care, offered by three Duke experts in the eldercare and public policy space.
Eleanor Schildwachter McConnell notes that as she read the guidance about reopening and reentry in North Carolina, she noticed that nursing homes do not appear on the agenda. While McConnell admits that nursing homes "because of the way they are staffed, are particularly challenging reservoirs" of disease, she does not think it is acceptable to postpone reopening nursing homes. It does not make sense to completely ignore the need for a plan for reopening. McConnell advocates gathering more systematic data to better answer questions about the "control of outbreaks and control of infection." Taylor suggests one option—to "implement a testing approach to allow family members to get back to the bedside of loved ones. Family members are critical parts of the delivery system even for people living in nursing homes both to provide care and support the emotional and mental well-being of the patients." Taylor cautions, "We are going to have to learn to deal as best we can with risk, and there are going to be more risks than what we've been used to living with for some period of time."
Nathan Boucher is an Assistant Research Professor in the Sanford School of Public Policy at Duke. He studies patients' and caregivers' experiences and expectations of health care delivery during advanced illness and near the end of life.
Eleanor Schildwachter McConnell is an Associate Professor at the Duke University School of Nursing. She studies factors that influence functional decline in very frail older adults. Her research has been funded by the National Institute of Nursing Research and the Department of Veterans Affairs.
Donald Taylor is a Professor of Public Policy who researches aging and comparative health systems, including Medicare, long-term care, and health policy. Taylor also directs Duke's Social Science Research Center.
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