Coronavirus cases and deaths in long-term care (LTC) facilities continue to rise despite the strictest protocols to prevent it from entering facilities and contain it once it enters. New cases in “hot spot” states are increasing 4x the rate as LTC cases in non-hotspot states1. Many consider and label nursing homes as “ground-zero” for the spread of the virus. Across the world, nearly half of all deaths from COVID-19 have happened in care and nursing homes, even though less than 1% of the global population lives in them.
Compliance with the shifting tide of local, state, and federal health coronavirus visiting restrictions and reporting requirements is daunting. The Center for Medicare and Medicaid Services (CMS) guidance, press releases, news events, and publications continue to proliferate, yet are likely a source of overwhelm and confusion for your residents, families, staff and community members. In many communities, these stressors are further exacerbated by intense media, public scrutiny and growing public awareness of the fragile nature of needs and resources in LTC, underprepared to take on coronavirus.
Stressors on the physical, emotional, social, and spiritual health for residents, family, and care team members are growing, complex, and interdependent. Providing information for each resident and their family about coronavirus status strains existing resources and infrastructure and make facility wide communication even more difficult. LTC administration and clinical leaders face multiple challenges in establishing effective and meaningful communication practices to assure and protect health, well-being, and safety.
In the United States, more than 2 million Americans reside in LTC facilities. Nearly half (48%) of nursing home residents are living with Alzheimer’s or other dementias. These and other chronic conditions of aging make communication during a pandemic even more challenging.
Residents in nursing homes that remain locked down during the pandemic face another silent threat: social isolation. A recent 2020 National Academies of Medicine report highlights how social isolation and loneliness are serious yet underappreciated health risks. Associated with increased risk of premature mortality from all causes, isolation and loneliness are on par or even greater than factors like smoking and obesity. Social isolation and loneliness are associated with an approximately 50 percent increased risk of developing dementia. Many older adults in nursing homes with strict social isolation have increased depression, anxiety, worsening dementia, and failure to thrive.
Social isolation (the objective state of having few social relationships or infrequent social contact with others) and loneliness (a subjective feeling of being isolated) are serious yet underappreciated public health risks that affect a significant portion of the older adult population.
Approximately one-quarter (24 percent) of community-dwelling Americans aged 65 and older are considered to be socially isolated.
- National Academies of Sciences, Engineering, and Medicine 2020
As LTC leaders wrestle with decisions to continue to ban visitors and group activities to protect their residents or relax these restrictions to lessen social isolation’s mental and physical harms, the serious health implications of these decisions must be considered. These nested conditions shape the health, well-being, and sense of safety for residents, family caregivers, and staff and make communication during this pandemic all the more complicated.
LTC facilities must, now more than ever, rely on, maintain, and support the importance of the family caregiver role throughout the COVID-19 pandemic. Family caregivers are a crucial and trusted partner in the nation’s strategy to curb the spread of the COVID-19 virus and to help the people they care for to cope with the stress and anxiety of this unprecedented situation.
Residents and family members alike rely on social support to maintain their health, well-being, and safety in LTC facilities, and therefore need to stay connected. Family and other unpaid caregivers – including relatives, partners, friends, and neighbors – are the most important source of emotional and practical support for older adults with chronic, disabling, or serious health conditions. LTC leaders must address the safety issues that are amplified during these times of crisis, when cognitive and emotional overload is stretched often beyond its breaking point for residents, families, and staff.
LTC leaders are seeking transparent and easy to implement communication practices that continuously assure residents, family and care teams of their personal and collective safety.
Vulnerable older adults residing in LTC facilities rely on their family involvement as crucial factors to enable them to reside and stay in a facility setting.
By the nature of this rapidly changing pandemic, the resident’s support network is often geographically dispersed, and conversations may be virtual and asynchronous. Family members receive and interpret pandemic communication in the context of the coronavirus spread in their own families and communities. They participate in facility-directed communication through their relationships and shared conversations with the resident and their care team.
Residents and families need shared communication experiences to make sense of these chaotic pandemic times -- most of all, to assure the health, wellbeing, and safety of their loved one.
LTC leaders need to build a sustainable pandemic communication strategy that mutually supports and strengthens resident and family wellbeing, trust, and safety. Effective communication practices will be the glue for the other efforts to manage protection and containment of the virus spread, including universal testing of residents and staff, and ensuring adequate personal protective equipment.
In the case of the corona virus, CMS requires nursing homes to report COVID-19 facility data to the Centers for Disease Control and Prevention (CDC) and to residents, their representatives, and families of residents in facilities.9 CMS also requires facilities to notify residents and their representatives to keep them up to date on the conditions inside the facility, such as when new cases of COVID-19 occur. These new COVID data sharing requirements are additive to the routine communication for care plan, condition, and treatment updates.
Today, many LTC facilities direct pandemic communication to residents, to their staff, and to family member, with separate timed and tailored messages. These approaches unintentionally fragment, rather than tie together, the communication to the resident and their family. LTC teams use a variety of communication channels to schedule and conduct family meetings and care plan updates including by phone, email, broadcast message, and virtual visit platforms. Updates and resources are also posted on websites.
While there are many communication methods, which in of themselves are good, these approaches do not tie the important information together efficiently for the care team and family members. The major problem of these siloed rather than integrated approaches is that communication is not easily visible, traceable, or tied to the resident at the center. Communication activities often are separate from clinical care and condition updates. Family members need meaningful clinical data about the care and condition of the resident, including changes in medications, diet changes and lab results. Families need integrated communication with their resident at the center.
During this pandemic, residents in LTC facilities are also making multiple and frequent care transitions. These may include more frequent bed transfers, or movements in and out of the facility, or to other facilities to accommodate isolation requirements or to escalate level of care. Sharing this care transition data with resident’s family caregivers is part of the new CMS regulatory requirement.
Family members cannot “escort” their loved ones through these care transitions. Shared and transparent communication practices, with opportunity for collaborative conversations are needed for residents, family, and care teams.
With the recent expansion and announcement of CMS funding and resources to protect nursing home residents against COVID-19, the multi-pronged intervention requires homes to participate in the Nursing Home COVID-19 Training to be qualified to receive this funding.
New Staff Testing Requirements
CMS requires that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week.
CMS will deploy over 15,000 testing devices over the next few months
Point of Care Tests are expected to have results within 15 minutes
This requirement will enhance efforts to keep the virus from entering and spreading through nursing homes by identifying asymptomatic carriers.
It will also require you to define and manage to the 5% positivity rate, and its variation over time.
Visitor and Family Caregiver Testing
The CMS Provider Relief Fund can be used to:
Align your communications to reflect how you define visitors and family caregivers.
The eligibility, frequency and cost of testing for visitors will need to be addressed, as well as processes for results reporting and contact tracing.
Frequent testing and results reporting for residents, staff and family caregivers is essential. The longer the results reporting is, the more opportunity for the virus to come into the facility, especially for those who are asymptomatic.
COVID-19 Strike Teams
Onsite Strike Teams will be deployed to nursing homes experiencing outbreaks to help reduce transmission and the risk of COVID-19 spread among residents.
The first deployments included 18 nursing homes in Illinois, Florida, Louisiana, Ohio, Pennsylvania and Texas between July 18-20, 2020
Residents and family caregivers may be alarmed with the presence, activities and media attention of the Strike Teams.
Provide reassurance about their role and the benefits of onsite technical assistance and education.
Teams are focusing in four key areas of support, including keeping COVID-19 out of facilities, detecting COVID-19 cases quickly, preventing virus transmission, and managing staff.
|Completion of CMS-CDC Nursing Home COVID-19 Training||
Online, self-paced, on-demand Nursing Home COVID-19 Training includes 23 modules.
The training will be available to all 15,400 nursing homes nationwide.
Specialized technical assistance is available for those with infection prevention deficiencies a recent CMS inspection, or recent COVID-19 cases based on data submissions to CDC.
A certificate of completion is offered, and recognition badges can be downloaded for nursing homes to display on their website
With the pandemic shaped by local conditions and public health guidance, it is important to listen to and follow guidance, and requirements from your local, county, and state health departments.
Additionally, advocacy organizations in the senior and aging communities continue to update their guidance. For example, AARP leaders recommend these pandemic communication best practices to ensure engagement and inclusion.
Care and communication experiences for LTC resident, families and care teams can be different. During this public health emergency, an “always on” secure digital communication platform and approach, assures and protects resident health, well-being, and safety.
CareLoop’s platform drives communication to those who need it most, be it residents in assisted living, skilled nursing facilities, patients in the emergency department or hospital. With a global shortage of personal protective equipment and visitation restrictions, CareLoop supports care teams to provide virtual care and virtual rounding, while streamlining one unified communication to patients and families.