Ratings, ownership, and previous references to infection control facilities were not consistent performance indicators.
The Journal of the American Geriatrics Society (AGS) has recently published one systematic review of studies regarding the characteristics of nursing homes and assisted living communities (ALCs), and how these features determined the COVID-19 outcome for residents.
The review establishes that the strongest and most consistent prognosis for COVID-19 outcomes in nursing homes came from larger bed sizes and a location in an area with high COVID-19 rates. These results included cases and deaths, and they varied according to the race composition of the facility and the number of employees. However, the increased number of employees led to more cases but fewer deaths. Characteristics that did not have consistent correlations with outcomes included nursing homes Compare 5-star ratings, ownership, and previous infection control citations. The authors included 36 studies of nursing home and ALC attributes in their review.
“We reviewed the evidence at facility and area level factors in nursing home COVID-19 cases and deaths (not including the few studies that examined resident-level risk factors),” said Tamara Konetzka, PhD, lead author of the report. Infection control today® in a written statement. “We found that the strongest predictors of poor COVID-19 results were the size of the facilities (where larger facilities had poorer results) and the prevalence of COVID-19 at the area level. In other words, large facilities in COVID-19 were “High-risk hotspots even with the best infection control processes. Having more staff could also help something once an outbreak occurred, but staff traffic in and out of a nursing home also posed a risk of infection.”
Because older adults are often weaker, they are more susceptible to the SARS-CoV-2 virus because it is airborne and can spread asymptomatically. In nursing home and ALC situations, social distancing is difficult, if not impossible, due to the large number of residents and close to each other and their relatives.
Joseph E Gaugler, PhD, professor and Robert L. Kane, trained chairman of Long-Term Care and Aging, School of Public Health at the University of Minnesota, agrees. In a written statement to ICT®, he said: “We often do not recognize that nursing homes are not separate from their communities but part of them. Were the tragic consequences of the pandemic for this purpose really about nursing homes failing their residents and families, or was it that a inadequate public health efforts failed nursing homes?
Konetzka et al said in the report: “The results of our review have direct implications for policy and practice. The overwhelming importance of the prevalence of COVID-19 in the community in predicting long-term care cases and deaths suggests that remedial policies should not focus solely on facility actions. . ” All steps to mitigate cases and deaths must start at the state and federal level as before ICT® reported.
“Although the article by Dr. Konetzka and her colleagues in no way absolves providers of what they did or did not do during the pandemic, the unprecedented nature and massive scale of COVID-19 coupled with major shortcomings in our nation’s overall pandemic response , that nursing homes were as vulnerable as the rest of us, ”Gaugler wrote ICT®. “Unfortunately, the nursing homes in the most infected communities bore the brunt of the terrible consequences of the pandemic in addition to their capacity to control COVID-19.”
But the lack of effective strategies from the facilities themselves is not staffing. “A large literature links the level of direct nursing staffing with nursing home quality, especially in the case of registered nurse (RN) staff,” the investigators noted in the study. “Staff may have become even more important under pandemic conditions, as having sufficient staff is a prerequisite for implementing the measures now considered best practices in trying to control an outbreak. The evidence from our review supports a positive (if small / inconsistent) role played by staff in dealing with an outbreak when it first occurred. “
One aspect of the studies that was particularly helpful was to compare their overall assessments with cases and deaths in each of the facilities. “Many of the studies (n = 16) directly examined the relationship between the overall 5-star rating at the nursing home and the COVID-19 results,” the investigators reported in the review. “Across the vast majority of these studies, including all but one of the larger studies using multiple data sources, no practically meaningful or statistically significant correlation was found between the overall 5-star rating and COVID-19 results. . “
Noted limitations of the data when examining risk factors at the resident level include reduced time factors and the age of the studies. Also, “it will be important in future work to examine risk factors at the resident and staff level along with factors at the facility level,” the authors wrote in the study.
The results of the review “do not exempt long-term care providers from implementing strict infection control practices or suggest that there are no concerns about the quality of care,” the investigators noted in the report. “Rather, the evidence points to a widespread and unique challenge, especially in light of insufficient supply chains for PPE and rapid testing.”
Partly because of this report, the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) sent a letter requesting meetings with President Joseph Biden, Department of Health and Services (HHS) and Centers for Medicare and Medicaid Services (CMS) to discuss the report’s findings and how to proceed with future pandemics, according to a press release from the AHCA.