Published: March 16,
2020 at 4:58 a.m. ET By Liz Seegert
A list of suggested questions to ask administrators of
long-term care facilities about general infection prevention procedures
As confirmed cases of the coronavirus
(Covid-19) continue to spread across the U.S., concern for our own health and
our loved ones’ health is understandably high. It’s especially worrisome for
older adults, who are more vulnerable to this infection; for people with
underlying health conditions or for those living in a congregate setting like a
nursing home or an assisted living facility.
The recent news of multiple deaths at a
nursing home near Seattle has led the American Health Care Association (AHCA),
representing more than 13,500 long-term care facilities, to recommend no social
visits to nursing homes. A statement to nursing home owners on the
AHCA’s website says: “The top priority at this point with Covid-19 is to
prevent the virus from entering your nursing home, given the high case fatality
rate in the elderly, which preliminary data shows at 15% or greater.”
As the New York Times reported, the
“no-visits” policy some nursing homes are adopting is causing hardship for
residents and family members who want to see each other.
People who are worried
about their loved ones in nursing homes and assisted living communities need to
know those facilities are doing all they can to protect residents, but how
can they be sure?
“It’s natural if family members are worried,”
says Dee Pekruhn, director of life plan communities services and policy
at LeadingAge, an association of nonprofit providers of aging services,
including nursing homes. Her own mother is in an assisted living facility.
“Know
who your loved one’s caregivers are, and be in contact with them. I certainly
do that with my mom regularly,” Pekruhn says, referring to the facility’s staff
members who regularly see and care for her mother.
LeadingAge has set up a webpage to help its members prepare and
minimize risk of a potential outbreak, following guidance
from the Centers for Disease Control and Prevention (CDC). Facilities should also be sharing
information about coronavirus with family members, similar to what
this Georgia-based nonprofit is doing.
Infections can spread
easily in long-term care
Over 4 million Americans are admitted to, or
reside in, nursing homes and skilled nursing facilities each year, and nearly 1
million live in assisted living facilities, according to the CDC. Data about
infections in long-term care settings are limited, but researchers estimate 1
million to 3 million serious infections occur every year. These include
respiratory tract, gastrointestinal and antibiotic-resistant illnesses like
influenza, pneumonia, respiratory syncytial
virus, norovirus and methicillin-resistant Staphylococcus
aureus (MRSA), among others.
Influenza ranks among the most commonly
reported causes of outbreaks of infectious disease in nursing homes; outbreaks
can occur even when resident vaccination rates are greater than 90%.
Nursing home residents tend to have multiple
chronic diseases and other conditions that make them more susceptible to
infection. They share sources of air, food, water and medical care, which
expedite the introduction and subsequent transmission of certain infectious
agents among vulnerable residents.
Visitors, staff and residents constantly come
and go, bringing in pathogens from the hospital and the community. That’s why
every facility is required to have an infection control and prevention
plan in place.
What is the facility
doing to protect people?
However, some experts worry that the national
staffing shortage in long-term care settings, especially among nurses, will
affect a facility’s capacity to respond appropriately to the coronavirus.
“The
biggest thing for families is to talk to administrators of the nursing homes
and find out exactly what they’re doing. And find out if they’re bringing in
more staff, if they have enough RNs [registered nurses] and if infectious
disease experts are looking at what they’re doing,” says Charlene Harrington,
professor of nursing and sociology at the University of California San
Francisco, who has advised the Centers for Medicare and Medicaid Services (CMS)
on nursing home quality for more than a decade. “Try to put the pressure on
because it’s not very feasible to move people.”
During a serious outbreak of any communicable
illness, a decision to ban visitors is usually made by the CDC, state or city
public health department. It’s not a call that’s made lightly. Facilities must
balance the resident safety with resident rights, says Jodi Eyigor, LeadingAge’s
director of nursing home quality and policy.
“If you’re living in a nursing home during
something like this, it’s pretty frightening to be cut off from your family
members,” Eyigor says.
Last week, CMS announced several
actions aimed at preventing the spread of Covid-19. It reminded health
care facilities to ensure appropriate infection control procedures are in
place; addressed concerns about screening staff and visitors and provided
guidance on steps to take if Covid-19 was suspected or identified.
CMS also plans to beef up inspections of
facilities for serious health and safety violations.
Prudent prevention in
place
Anywhere older people congregate in large
numbers is a source of concern for health officials. Anne Blesch, 66, a retired
nurse with a graduate degree in epidemiology, lives on the independent side of
a continuing care retirement community in Florida. Management there has taken
basic, but important, steps to help minimize the spread of infection.
“The self-serve salad and soup bars in the
dining room were closed, so two or three hundred people aren’t handling the
same sets of tongs,” she says. Instead, one person behind the counter now
serves residents.
Blesch says social events and activities have
been canceled. Notices were sent to residents asking them to stay in their
apartments if they were sick, telling sick visitors to stay away and to limit
even healthy visitors. Residents who use the building’s fitness center are
asked to wipe down equipment after use.
“I think they’re bending over backward not to
get too draconian about it. They’re doing really reasonable things,” Blesch
ays.
Questions to ask
administrators about infection prevention
CMS has a list of suggested questions loved ones of people in long-term care
facilities should ask administrators about their general infection prevention
procedures. Among them:
·
How does the facility
communicate with residents, family and visitors when an outbreak of any type
occurs?
·
Are ill staff members
allowed to stay home without losing pay? If they are not, they are more likely
to come to work sick and inadvertently infect residents.
·
Does the facility have
private rooms for residents who develop signs or symptoms of a potentially
contagious infection (cough, fever, abdominal pain)?
·
How are staffers
trained to respond to questions about hand hygiene from residents and family?
·
How is shared
equipment (such as objects in the therapy area or common room) managed to
prevent the spread of germs?
Family members may want to bring in hand
sanitizers and sanitizing wipes for loved ones living in long-term care
facilities. “I would just recommend that they always check with the nursing
home or make sure the staff knows that you’re doing that and that you are
communicating,” Eyigor says. That’s because some products may interact with disinfectants
the facility is already using.
Eyigor is confident that most nursing homes
are doing their utmost to minimize the risk of transmission. “These are
scenarios that our providers are very used to handling through their emergency
operating procedures and infection control plans,” she says.
However, Harrington thinks more pressure is
needed on state governments to enforce infectious disease management. “Even
supposedly good nursing homes are operating way below what they
should have on staffing, and they get these four and five stars (from
CMS’ Nursing
Home Compare), even though
staffing isn’t what experts say it needs to be,” she says.
Fewer than 5% of older adults live in nursing
homes and 2% live in assisted living, according to LeadingAge. Older adults
living in single-family and multifamily settings also are at risk for the
coronavirus, and may not have the benefit of heightened awareness and plans for
infection control.
Everyone needs to be mindful of older adults’
vulnerability about coronavirus, as well as other serious diseases like
influenza, and be proactive in following recommendations from public health
officials regarding prevention.
New York-based
journalist Liz Seegert has spent more than 30 years reporting and writing about
health and general news topics for print, digital and broadcast media.
This
article is reprinted by permission from NextAvenue.org, © 2020
Twin Cities Public Television, Inc. All rights reserved.
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