ABSTRACT
We develop a discrete event simulation model for a network of eight major intensive care units (ICUs) in British Columbia, Canada. The model also contains high acuity units (HAUs) that provide critical care to patients that cannot be cared for in a general medical ward, but do not require the full spectrum of care available in an ICU. We model patient flow within the ICU and HAU for each of the hospitals, as well as patient transfers to address ICU capacity. Included in the model is early discharge from ICU to HAU, sometimes called 'bumping', when the ICU is full, as well as ICU overflow beds. The simulation model, which is calibrated using the British Columbia Critical Care Database, will be used to support planning for critical care capacity under endemic and seasonal COVID-19. © 2022 IEEE.
ABSTRACT
Background: COVID-19 has challenged assisted living (AL) communities, given their congregate nature and population of residents who are vulnerable to COVID, but lack the capacity of nursing homes (NHs). This presentation (a) summarizes recommendations from six key organizations related to preparation for and response to COVID in AL in relation to resident health and quality of life;(b) compares recommendations for AL with those for NHs;and (c) assesses implications for the future of AL. Methods: We collected, categorized, and summarized recommendations related to preparation for and response to COVID in AL, long-term care in general, and NHs, from six key organizations: the Centers for Disease Control and Prevention, the Centers for Medicare& Medicaid Services, the American Geriatrics Society, the Society for Post-Acute and Long-Term Care Medicine, the American Health Care Association/National Center for Assisted Living, and the Alzheimer's Association. Results: Recommendations for AL and NHs were similar in many areas, while differences provided insight into the ways that the pandemic has challenged AL in particular, and may have implications for the evolution of AL. Differences include recommending more flexible visitation and group activities for AL, providing screening by AL staff or an outside provider, and suggesting that AL staff should access resources to facilitate advance care planning. Recommendations for both AL and NHs that provide insight into how AL may be integrating more health care into their offered services include working with consulting clinicians who know both the resident and the AL setting when making transfer decisions, and suggesting that AL communities follow guidance for testing as recommended for NHs. Conclusions: COVID may accelerate the integration and/or closer coordination of social work and medical care into AL, because recommendations suggest AL would benefit from the services and expertise of licensed nurses, social workers, and physicians. There seems to be an unmet need to mitigate loneliness in AL, which warrants specific attention moving forward.