ABSTRACT
Background: The COVID-19 pandemic has had significant impacts on nursing home residents. This study aims to examine how hospice utilization changed among long-stay nursing home residents between January and September in 2020, as compared with the same period in 2019, nationally. Design: A retrospective cohort study of residents present in US nursing homes as long-stay as of January 1st, 2019 and 2020, respectively. A subgroup of residents who died from January to September in each year was also examined. We utilized the Minimum Data and multiple administrative claims data. We compared hospice utilization rate between 2019 and 2020 nationally and by state.Outcomes: This study examined: 1) any hospice utilization among long-stay residents from January to September in 2019 and 2020 respectively, and 2) hospice utilization in the last 30 days of life among the decedent subgroup, which we also tracked as a factor of percent change in mortality rate at the state level. Results: The hospice utilization rate among long-stay residents was 19.4% in 2019 and 19.7% in 2020. The rate was 27.5% in 2019 and 24.2% in 2020 among the decedent subgroup (χ2=553.1, p< 0.001), although the absolute number of decedents using hospice in the last 30 days of life was higher in 2020 than 2019. Substantial state variation in hospice utilization was observed, mostly following patterns in community-level infections. Conclusions: Hospice managed to continue service delivery despite many challenges. The pandemic highlights the importance of integrating hospice and palliative care into emergency preparedness planning.
ABSTRACT
Efforts to protect assisted living residents from COVID-19 by limiting contact warrant attention. Assisted living was developed as a social model where care is provided in a home-like environment. Given the social dimensions of assisted living, we sought to better understand the effects of COVID-19-based restrictions in assisted living. We surveyed (online) assisted living community (ALC) administrators (N=130) between October 2020 and March 2021 as part of a larger project on COVID-19 in Florida. We then interviewed a subset of participants (N=26). Administrators of chain-affiliated ALCs (compared to non-chain) were 2.7 times more likely to report resident-contact limitations had disrupted care (p=0.02). Larger ALCs (25 or more beds) were marginally more likely to report care disruptions (p<0.10). Three main themes emerged from our qualitative interviews – varying interpretation of COVID-19 guidelines, effect of precautions on residents, assisted living as a home. Policy implications of these findings will be discussed.
ABSTRACT
COVID-19 has posed a multitude of challenges for nursing homes (NHs) and assisted living communities (ALCs). However, little information is known about how the pandemic impacted residents living with dementia. Using the convoys of care framework, we conducted a qualitative descriptive study to gain insight regarding administrators' perceptions of how care for residents living with dementia was altered. Forty-two participants, representing 16 NHs and 43 ALCs in Florida, participated in one 60-minute semi-structured interview. Thematic analysis revealed that the convoys of care for those living with dementia were strained by the competing demands associated with maintaining residents' social and medical care. Explicitly, participants emphasized how diminished family involvement, the increasing responsibilities of staff, and the climate of the industry, contributed to disrupted convoys of care. Consequently, this study may help inform policy and practice as it details which care strategies worked, which did not, and considerations for moving forward.