How Nursing Homes Are Handling COVID-19: Best Practices from Maryland and Massachusetts
Feature Story
By Stephanie Miceli
Last update April 29, 2020
The 1.3 million nursing home residents in the U.S. make up less than 0.5 percent of the nation’s population, but represent approximately 15 percent of COVID-19 related deaths to date. Often, they are more likely to have disabilities and chronic conditions that increase their susceptibility to the virus that causes COVID-19. On top of that, many regularly experience the social isolation and loneliness that some people are only experiencing for the first time.
“We all love longevity, and we all love a story of a 95-year-old aunt. But we stumble when it comes to taking care of them,” said webinar moderator Terry Fulmer, president of the John A. Hartford Foundation, a private philanthropic organization dedicated to improving the care of older adults.
On April 22, the National Academies held a webinar on keeping nursing home residents and staff safe during the COVID-19 outbreak, the first in a planned series on the pandemic response in nursing homes. Experts highlighted how the states of Maryland and Massachusetts are tackling a number of challenges — including staffing shortages, expanding access to COVID-19 testing, and maintaining transparent communications with residents’ families and the public.
Keeping Nursing Home Residents and Staff Safe in the Era of COVID-19: A Webinar from The National Academies on Vimeo.
Keeping Nursing Home Residents and Staff Safe in the Era of COVID-19: A Webinar from The National Academies on Vimeo.
A ‘No Man’s Land’ Between Hospitals and Nursing Homes
Hospitals need to discharge patients who no longer need critical care. However, these patients may not be able to return to the nursing home, due to fears they’ll spread the infection to other residents and staff.
“We’re trying to be mindful of treating residents in the nursing home environment, where they’re most comfortable,” said Timothy Chizmar, state EMS medical director for the Maryland Institute for Emergency Medical Services Systems (MIEMSS). Recently, MIEMSS launched a set of questions that emergency medical personnel can use to quickly assess whether a nursing home resident who tests positive for COVID-19 needs hospital care, or if his or her symptoms are mild enough to recover in place.
Maryland’s new statewide initiative is designed to prevent overcrowding at hospitals during the COVID-19 pandemic, while encouraging “cohorting” of symptomatic residents and rigorous infection control practices. However, panelists agreed that cohorting will have limited success without widespread testing.
Expanding Access to Testing
On a state level, Maryland has only been able to offer COVID-19 testing to symptomatic residents of nursing homes, said Morgan Katz, director of antimicrobial stewardship at Johns Hopkins Bayview.
“But in the day you spent awaiting test results, the number of symptomatic residents would go up,” said Katz. “These facilities were chasing their tails.”
Johns Hopkins has started to work with public and private hospitals, academic institutions, federal agencies, and other partners to expand access to testing in nursing homes and assisted living facilities. Testing is critical for both symptomatic and asymptomatic residents and staff, said Katz, “because there’s reason to believe asymptomatic staff are a big source of transmission.”
However, deploying widespread testing in nursing homes comes with a Catch-22, she warned.
“When staff test positive for COVID-19, they have to [stay home] — which leads to staffing shortages,” said Katz. “And when you have to contract with temp agencies, you have more cross-over of staff who have been in multiple facilities. Nursing homes need to have backup plans when they’re testing staff and finding positives.”
Addressing Staffing Shortages
Nursing home staff are often paid less than minimum wage, despite the difficult nature of their work, panelists acknowledged.
“The pandemic has revealed to those of us working in long-term care for decades that there are staffing and other structural issues that we can hopefully resolve,” said Alice Bonner, director of strategic partnerships and adjunct faculty at the Johns Hopkins University School of Nursing.
Some states have turned to temporary workers, while others are encouraging retired health providers to rejoin the workforce. Bonner, who is based in Massachusetts, said the state established a job portal to quickly match job seekers with facilities hiring for long-term positions.
MIEMSS director Chazik also encouraged states to follow Maryland’s lead by providing behavioral health services for staff at nursing home and assisted living facilities. “It’s important to check on staff well-being,” he said, “particularly those who have experienced the loss of a resident or colleague.”
Picking Up the Phone
Loneliness was a problem in nursing homes well before COVID-19 arose, Michele Bellantoni, associate professor and clinical director in the division of geriatric medicine and gerontology at Johns Hopkins University School of Medicine. With residents being confined to their rooms, and family visits barred, the problem is magnified, she said.
Community members can help by volunteering to deliver meals or host virtual activities. Local chefs and fitness teachers are leading classes via Zoom, for example. One nursing home in Maryland even brought in a local band for a garden concert that residents could watch from a distance.
“The human kindness that we all need during this crisis is something that our nursing home and assisted living residents need even more,” said Bellantoni. “It’s as simple as calling nursing home and asking, ‘how can I help?’ There are 1,300 of us on this webinar — if we all made a call to an organization, that would be tremendous.”
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The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and world. Our work helps shape sound policies, inform public opinion, and advance the pursuit of science, engineering, and medicine.
