Nursing Homes: Scared and Alone in Coronavirus Fight

In the COVID-19 fight, let’s not overlook our most vulnerable populations and those who care for them.

By Maria Colaberdino, RN, BSN, clinical principal, government programs, Medecision

As the coronavirus pandemic has unfolded, we’ve seen constant news about our frontline healthcare heroes in hospitals and other settings, along with images of them receiving much-deserved applause and recognition. Sadly, one group has been largely overlooked: workers in nursing homes and other long-term care facilities.

These sites have been ravaged by COVID-19. The New York Times reports that more than one-third of U.S. coronavirus deaths have been nursing home residents or workers. In New York state alone, more than 5,400 pandemic deaths have been in long-term care facilities. In other states, the toll has been much lower, but some have seen high percentages of their coronavirus deaths coming in long-term care facilities, despite detailed COVID-19 preparation strategies from the Centers for Disease Control and Prevention (CDC).

Most Vulnerable Populations

Several factors contribute to the vulnerability of these populations:

• Pre-existing conditions. Many residents are frail and elderly or have special needs and comorbidities. Weakened immune systems and other health conditions―especially of the lungs and heart―increase their risk.
• Close proximity and confinement. Residents often share rooms and common spaces, and staff go from one patient to the next to distribute medications, take temperatures and provide other care. In addition, residents typically remain indoors, lacking exposure to fresh air. Studies have shown that indoor ventilation and airflow can contribute to the spread of the virus.
• Lack of handwashing capabilities. While healthcare workers can easily wash their hands between patient visits, patients may touch a railing, a table or another patient and then touch their face, increasing their risk of exposure to the virus.
• Diminished mental states. Patients with dementia or other memory impairment likely do not have the wherewithal to keep a mask in place or avoid touching their face. They also may unknowingly touch a utensil or other item that a fellow resident has been using.
• Longer incubation period. In the early stages of the virus, a patient can be a carrier yet display no symptoms. The median incubation period is estimated at five to six days, according to the World Health Organization (WHO).
• Ventilation and airflow. The CDC posted a research letter showing that a coronavirus outbreak in late January and early February at a restaurant in Guangzhou, China, was most likely due to the air conditioning system, which moved virus droplets from table to table. Such a spread could occur in a healthcare facility.

Healthcare Workers at Risk

The staff face their own risks, including:

• Insufficient personal protective equipment (PPE). Many hospitals have the resources to obtain proper protective gear, while nursing homes may have more difficulty getting these crucial supplies.
• Staffing issues. Hospitals, with elective surgery and procedure units closed, can reallocate staff to support patients. In nursing homes, there is likely no extra staff to cover when workers get sick, which adds to the burden on their colleagues and limits their ability to care for patients. It is a vicious circle: The workers who are able to come in become stressed, overworked, run-down and more susceptible to the virus.
• Inadequate testing. This remains an issue for the population at large, and particularly for the people in these hotbeds of coronavirus growth.

What Is Being Done (And What Should Be Done)

The Centers for Medicare and Medicaid Services (CMS) released guidance on May 18, saying nursing homes should not relax restrictions until all residents and staff have received test results showing they do not have COVID-19. In addition, they should continue to restrict visitors until later phases of reopening in their respective states.

But much more needs to be done. For one, we need to learn from our mistakes. In Minnesota, where hospitals were allowed to discharge COVID-infected patients to nursing homes, there have been 600 COVID-related nursing home deaths―81% of all coronavirus deaths in Minnesota. In Pennsylvania, 67% of all COVID-related deaths have occurred in long-term care facilities.

Helpful measures would include more responsive testing, identifying those who have been exposed and using contact tracing to isolate all who have been in contact with an infected person. Protocols for these types of settings should factor in other facilities with similar confined or proximal residents, such as in prisons, and how patients are discharged from hospitals to long-term care facilities.

How the Public Can Help

It is important that we show our concern and appreciation for the brave professionals who work in these potential coronavirus hotbeds, as well as the patients entrusted to their care. Here are some ways to do that:

• Collect supplies. Call a local facility and ask about specific needs the community can address. Our church organized a collection of supplies for a facility needing masks, cleaning supplies, hand soap and sanitizer.
• Organize a car parade. Social isolation can cause many residents to feel depressed or anxious. It can do residents good to look out their window and see decorated cars go by bearing signs that let them know others care about their well-being.
• Deliver goodies. Homemade cards, lunch, cookies or other treats can spread cheer. (Check with your local nursing home or long-term care facility to inquire about any restrictions for homemade food. Prepackaged treats may be preferred.)
• Contact elected officials. It never hurts to make those in charge aware of your concerns.

The little things add up in this battle, which affects everyone. Let’s all do our part!