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Purpose of Study In response to the coronavirus pandemic, the Central Montana Medical Center (CMMC) in Lewistown, Montana bolstered its telemedicine program while restricting in-person visits. Patients inexperienced with technology- -especially the elderly-forwent care. The purpose of this study was to determine how telemedicine access can be improved for residents of Lewistown senior living communities (SLCs), defined as independent, assisted living and nursing home facilities for older adults. Methods Used CMMC administration cite patient inexperience with technology and clinician buy-in as the largest barriers to telemedicine utilization (personal communication, July 28, 2020). To elucidate, Lewistown SLC administrators were surveyed. The vast majority did not assist residents with telemedicine visits, but almost all expressed interest in offering it if training were provided. CMMC clinicians were also surveyed. Most had no telemedicine training and few felt comfortable using it. Therefore, SLC staff and clinician training were identified as avenues to improve telemedicine delivery. Two studies were evaluated to ascertain the benefit of such interventions. Summary of Results The first study found access to telemedicine and telemedicine-trained staff reduced emergency department (ED) use among SLC residents by 18% annually. Residents without access to such services experienced a 1% growth in ED visits (Shah et al., 2015). The second study assessed variability in medical care between virtual visit companies. Significant variations were observed across all measures, underscoring the necessity of provider telemedicine training (Schoenfeld et al., 2017). Both studies and SLC/clinician survey results were presented to CMMC administration. Conclusions Training SLC staff to assist residents with telemedicine visits may increase telemedicine usage and healthcare access. Similarly, training CMMC clinicians on virtual physical exams and history collection may improve their confidence in telemedicine technology and quality of virtual care. The survey results and literature suggest both interventions would have a significant impact on telemedicine delivery in Lewistown. Future steps include determining level of training for SLC staff and exploring telemedicine training programs for providers.
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Background. Adults aged >=65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes. Methods. Hospitalizations among LTCF residents aged >= 65 years from March 2020-January 2022 were described using data on a representative sample of hospitalizations from the CDC's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization. Results. Of 11,901 hospitalizations among adults aged >= 65 years reported during the study period, 2,965 (24.9%) were LTCF residents;most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or >= 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01-1.05) among LTCF residents compared to non-residents. Conclusion. Compared to non-residents, LTCF residents were older, had more underly ingconditions, and had a higher risk of in-hospital death. After adjusting formultiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.
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The article presents an interview with Nancy Sondag by Sally Bailey. The interview discusses about the effectiveness of drama therapy for persons with dementia on a secured unit in an assisted living facility during a pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Background: In March 2020, COVID-19 cases occurred in residential care facilities. To assist these facilities, the regional health agency of the Meurthe-et-Moselle administrative district ordered a support mission. Methods: Infection prevention and control mobile teams were formed under the coordination of the infection prevention and control department (IPCD) of a university hospital. Teams went to residential care facilities for the elderly, to facilities for people with disabilities (FPD) and independent living communities (ILC). They visited the facilities and met with the management and the ward staff to assess the situation and to identify any potential support needs. Results: Over two non-consecutive weeks, 104 residential care facilities were visited (9025 residents). If urgent needs were identified, the IPCD was directly informed by the teams to initiate an extensive assistance operation. Thereby, additional staff and equipment were provided for every facility in need. Although most of them had implemented good management to face the pandemic, four emergency field support operations took place in facilities with uncontrolled outbreaks. Conclusions: This is the first reported support action for residential care facilities during the pandemic in France. As no major outbreaks were noticed later, this mission was deemed a success and met the residential care facilities' needs for support. Many facilities have expressed the need to cooperate with infection prevention and control specialists in the future, both during outbreaks, also in routine daily practice. This report highlights the need to maintain support for residential care facilities and to implement a permanent collaboration between hospitals and residential care facilities.
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Objective: To evaluate caregiver views of care changes in memory disorder patients during early COVID 19 pandemic lockdown Background: Memory disorder patients often depend on caregivers for oversight of medical and daily care. The early lockdowns of the COVID 19 pandemic included restrictions which may have affected such care. Design/Methods: We developed a questionnaire to assess caregiver views on change in care of memory disorder patients during the early lockdowns of the COVID 19 pandemic. The questionnaire assessed caregiver views on 1: changes in daily care quality in patients living at home vs. a community care setting (skilled nursing, assisted living);2: changes in communication with physician offices;and 3: telehealth experiences. Patients had an established diagnosis, a virtual telehealth visit 4/06/2020 - 9/06/2020, and a caregiver able to survey by phone. Results: 89 patients met criteria, 69 living at home, 20 in community settings. 1. Regarding perceived quality of daily care, for patients living at home, 81% of caregivers saw no change, 12% worsening and 6% improvement. For patients living at community facilities, 50% of caregivers saw worsening, 5% improvement and 45% no change. 2. Regarding physician office communication, 67% of caregivers saw no change, 16% worsening, and 17% improvement. 3. Across all patients, 46% had a video telehealth physician visit. Of these, caregivers of 80% were satisfied with the encounter, 17% neutral, and 2% dissatisfied. 53% of caregivers were likely to choose future telehealth physician visits for the patient, 21% were neutral, and 17% unlikely. Conclusions: For memory disorder patients in the early pandemic lockdowns, for those living at community facilities, most caregivers perceived worse quality of daily care, but the average caregiver saw no change in physician office communication. Most caregivers were satisfied with, and would choose, video telehealth physician visits for follow up.
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BACKGROUND: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. OBJECTIVE: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. METHODS: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. RESULTS: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents' use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents' use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. CONCLUSIONS: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents' engagement and communication opportunities, such as another pandemic.
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Background: Home visits were an essential former practice where a patient is evaluated and treated in their own house. With a growing elderly population in personal care homes, some homebound visits on-site become a more necessary service. During the COVID-19 pandemic the need of healthcare providers on-site has become imperative due to restrictions for leaving the facilities. Telemedicine visits are difficult for elderly in Assisted Living Facilities (ALF) where WiFi and smart phone technology are limited. While the need for medical care remains at higher demand during the pandemic, it is important to provide accessible and high-quality care to patients in these facilities. Surveys are used to assess if on-site visits are favored by patients and families. Design: We built a survey questionnaire that focused on patient/ family satisfaction of having provider visits on-site. The survey was conducted after an on-site visit and was done or via phone call. If the patient was unable to meaningfully answer the survey, the family member or POA was contacted via phone. The patient satisfaction survey was used to translate their satisfaction in measurable and comparable data to classic office visits. Results: Overall, 100% of responders had a favorable opinion of the on-site physician visits and preferred them to in-person office visits. The survey demonstrates that patients are able to recognize the on-site visits as more convenient and less stressful with the same quality as in-office visits. Some families also pointed out that on-site visits are financially more favorable as there is no need for transportation organization and fees. Conclusion: On-site visits by the physician or APP were very favorable in this survey. This service is bringing comprehensive care to patients directly at their facilities in the community. Patients are benefiting from on-site visits with the same high quality of care while having the convenience of remaining in their own home at the ALF.
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Background: Long-term services and supports (LTSS) settings have long experienced licensed nurse (LN) and certified nursing assistant (CNA) staffing challenges: shortages, turnover, lack of qualified applicants, and low wages. The COVID-19 pandemic exacerbated these challenges, resulting in further staffing shortages. A goal of our Geriatric Workforce Enhancement Program is to provide LTSS settings in our state with staff training and support. The purpose of this project was to better understand current and anticipated LN and CNA staffing concerns. Methods: In partnership with state LTSS organizations, we developed an anonymous online 34-item questionnaire to assess COVID-related LTSS staffing challenges as perceived by administrators from: Assisted Living (ALF), Intermediate Care (ICF), and Skilled Nursing (SNF) facilities;Home Health (HH), Hospice (H), and Personal Care (PCA) agencies. Non-parametric statistical analyses were performed in R. Results: 106 questionnaires (55% AL, 13% HH, 10% H, 3% ICF, 12% SNF, 6% PCA) were completed. Significantly more open full- and part-time positions were reported for CNAs (mean=3.5 AL, 10.4 ICF, 5.9 SNF, 10.0 PCA) than LNs (mean=0.3 AL, 1.6 ICF, 2.6 SNF, 0.0 PCA) in most settings (p≤0.05 Mann-Whitney U), but not HH (mean=2.1 CNA, 1.3 LN) or H (mean=2.7 CNA, 2.3 LN). Respondents predicted significantly more open positions post-vaccine mandate for CNAs (mean=4.1 AL, 9.9 SNF, 17.0 PCA) than LNs (mean=0.2 AL, 3.7 SNF, 0.0 PCA) in most settings (p≤0.05 Mann-Whitney U), but not HH (mean=3.3 CNA, 2.7 LN) or H (mean=2.4 CNA, 1.9 LN). Top barriers to reaching ideal staffing ratios included wages, candidate pool, competition, and turnover. There were no differences in predicted CNA resignations post-vaccine mandate (mean=11.7 HH, 30.0 H, 36.7 ICF, 24.4 SNF, 16.3 PCA) compared to LNs (mean=16.0 HH, 27.0 H, 33.3 ICF, 22.9 SNF, 60.0 PCA) in all settings except AL (mean=33.4 CNA, 11.5 LN) (p=0.00 Mann-Whitney U). Conclusions: LTSS settings are facing severe nursing staffing shortages that our results predict will increase post COVID-19 vaccine mandate, particularly for LNs. Multi-faceted, multi-level approaches are needed to integrate COVID policies and processes into training and provide emotional and financial support to retain and build the workforce in LTSS settings.
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Noncommunicable Diseases (NCDs) are one of the major health challenges, which has caused global concern due to their magnitude and high social cost. Industry 4.0 will significantly bring in IoT in the healthcare sector in an age of great growth in connected devices (up to 100 billion by 2030). The COVID-19 pandemic further accentuates the importance of using IoT in healthcare settings for both the providers and NCD patients due to controlled movements and enforced self-isolation throughout the world including Malaysia. In this regard, the improvement of “connected devices” has had a remarkable effect upon the entire healthcare sector and has been noticeably appreciated in “remote clinical monitoring”, “chronic disease management”, “preventive care”, and “assisted living” for senior NCD patients. This study intends to interpret the significance of IoT in connection with wearable technologies and digital healthcare. The study discusses several benefits of IoT like reducing cost, rising profits for the healthcare service providers in Malaysia, a higher level of success and productivity, and precision of “health monitoring and treatment systems”. The insights of this study will help the elderly NCD patients’ community and healthcare providers to recognise the significance of IoT Enabled Health Monitoring and Assistive Systems due to their significant contribution to improving healthcare in the country in the long run.
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Background. Large social gatherings during the COVID-19 pandemic have been linked to extensive community transmission. Healthcare workers (HCW) that engage in these social gatherings pose a risk to the vulnerable patients they serve. Public Health-Seattle & King County identified a COVID-19 outbreak associated with a wedding in July 2020 when the 14-day incidence rate was 105 cases per 100,000 residents. HCW who attended the wedding were subsequently linked to 45 outbreaks in healthcare settings across three counties in the next month. Methods. COVID-19 case interview data was used to identify HCW cases who reported the wedding as their exposure event. The Washington Disease Reporting System (WDRS), the state database in which COVID-19 cases and epi-linkages are tracked, was queried to identify healthcare outbreaks linked to the HCW wedding-attendee cases and the HCW that they infected. NodeXL was used to visualize the resulting chains of wedding-associated healthcare transmission using a Harel-Koren Fast Multiscale layout where the network visualization's directed arrows represent putative links and direction of transmission. Numbers of associated settings, cases, and deaths were calculated. Results. Seven HCW wedding attendees were linked to outbreaks in healthcare facilities that they worked at while infectious;HCWs linked to as many as six subsequent healthcare outbreaks. In total, the wedding was connected to 45 healthcare facilities: adult family homes (N=1), hospitals (N=1), supported living agencies (N=7) and associated group homes (N=38), assisted living (N=1), home health services (N=1), behavioral health (N=2), and rehab centers (N=1). Across the settings, 277 cases were identified, including 15 deaths. Conclusion. A series of COVID-19 healthcare outbreaks was traced back to a wedding. Cases worked in multiple homes, agencies, and other healthcare settings which likely facilitated rapid and wide transmission;the structure of these healthcare settings often do not facilitate a single job providing enough hours and income to support an individual. In terms of public health learnings, addressing these outbreaks require effective contact tracing, multijurisdictional coordination, and for supported living, interventions need to be applied across households sharing staff.
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Purpose of Study During the COVID-19 pandemic, the State of Louisiana implemented a quarantine to decrease the risk of infection. This situation led to a decrease in social interaction which is a risk factor for anxiety and depression, among the elderly population confined in residences. The objective was to determine whether being quarantined while living in a residential community would negatively affect the mental health of the elderly. Methods Used A short longitudinal assessment and analysis to assess anxiety and depression. Data was initially collected, then at 6 weeks, and 12 weeks during the quarantine. We used the Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI) as these screening tools are designed for the elderly, to assess the incidence and severity during the quarantine. Summary of Results 57 residents of a Continuous Care Retirement Community (CCRC) in the New Orleans metropolitan area, stratified as nursing home residents, assisted living, and independent living of a 37 (80%) of the 46 patients were females, with a mean age of 86.1 (SD 9.1) years old;25 (54.3%) were nursing home residents, 13 (28.3%) were in assisted living, and 8 (17.4%) were in an independent living community. 16 (34.8%) patients were diagnosed with depression before taking the survey, and five (10.9%) had previously diagnosed anxiety. Anxiety scores decreased significantly from baseline (average 4.35 vs. 3.28, p-value =0.045) at 6 weeks but did not change from time 0 to week 12 or week 6 to week 12. Depression, scores did not change significantly between the time periods. Conclusions Our data indicate a trend toward an increase in depression and anxiety during periods of pandemic quarantine isolation. Because the elderly are particularly susceptible to loneliness and resulting depression assessing these indicators may help mitigate the economic burden and cognitive decline resulting from the complications of depression and anxiety in the elderly population residing in community centers during periods of unanticipated extended quarantine isolation.
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INTRODUCTION: Most adults receiving mRNA vaccines for SARS-CoV-2 (SCV2) exhibit IgG antibodies (Ab) targeting the S1 spike protein within a week of dose 2. However, correlates of protection are still not fully understood. The aim of this study was to better quantify the % of neutralizing Ab (nAb) that develop after dose 2 and also identify factors affecting the timing and degree of nAb production. METHODS: Using a fluorescence immunoassay to quantify the % of SCV2-Ab capable of blocking S1 at its receptor binding domain (for attaching to ACE-2 receptors), residents/ staff (n=70;ages 23-100 yrs) of an assisted living facility had blood samples measured on day 7 and 21 following dose 2 of the Pfizer-BioNTech mRNA vaccine. Based on existing research, %nAb < 30% is delineated as inadequate protection (“nAb negative”). RESULTS: Except for a 58 yo man taking daily prednisone (asthma) and a 55 yo man on levothyroxine, 100% of those < 70 yrs (n=33) were nAb+ (>30% nAb) on day 7 after dose 2. However, if >70 yo (n=37), the % of nAb+ findings diminished with age. Only half of those 71-80 yo, 33% of those 81-90 yo and 11% of those >90 yo were nAb+. Nonetheless, 2 weeks later, the %+ among those tested had increased to 83%, 71%, and 50% for those respective age groups. When examining the average of nAb% measurements within each of the various age group stratifications 1 week after dose 2, the averages ranged 96-100% for the 3 age groups < 50 years (ie, 23-30, 31-40 and 41-50), while the age group averages were borderline or inadequate for those >70 yo. However, 21 days after dose 2, the average %nAb measurement had become 91% for those 61 to 70 years of age, 75% for those 71-80, and 55% for those 81-90. For persons > 90 yo (n=8), the average %nAb was 35% but half of those persons (n=4) had no detectable nAb, either at day 7 or day 21. No persons had any significant declines in %nAb between Day 7 and 21 and the majority sustained or improved their %nAb. CONCLUSIONS: Escalating age and immunomodulating medications/conditions do impact the timing and degree of nAb developing after mRNA vaccination. Most persons < 90 yo are observed to be “positive” for protective levels of nAb by 3 weeks after dose 2. On-going investigations are addressing the duration and sustained degree of nAb+ findings as well as external validation of the tool used in this research.
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Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing-based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.
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Assisted Living Facilities/statistics & numerical data , Asymptomatic Infections/epidemiology , Coronavirus Infections/epidemiology , Health Personnel/statistics & numerical data , Pneumonia, Viral/epidemiology , Skilled Nursing Facilities/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19 , California/epidemiology , Cities/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Household Work/statistics & numerical data , Humans , Maintenance/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , PrevalenceABSTRACT
This policy brief sets forth the American Geriatrics Society's (AGS's) recommendations to guide federal, state, and local governments when making decisions about care for older adults in assisted living facilities (ALFs) during the coronavirus disease 2019 (COVID-19) pandemic. It focuses on the need for personal protective equipment, access to testing, public health support for infection control, and workforce training. The AGS continues to review guidance set forth in peer-reviewed articles, as well as ongoing and updated guidance from the US Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and other key agencies. This brief is based on the situation and any federal guidance or actions as of April 15, 2020. Joining a separate AGS policy brief on COVID-19 in nursing homes (DOI: 10.1111/jgs.16477), this brief is focused on ALFs, given that varied structure and staffing can impact their response to COVID-19. J Am Geriatr Soc 68:1131-1135, 2020.