Autonomy, identity, and design in the COVID-19 era

This chapter examines the state of response and likely long-term implications across the continuum of place types for older adults, from independent housing to skilled nursing, with a focus on how physical settings and technological systems can empower autonomy and identity. It does so by adopting a person-environment (P-E) exchange framework as articulated by Chaudhury and Oswald (J Aging Stud 51:100821, 2019) This framework is structured in three sections: components of P-E interaction, P-E processes, and environment-related outcomes. Components of P-E interaction include individual characteristics, social factors, physical/built environments, and technological systems with this chapter focusing on the last two. These components form a milieu within which the dialectic interaction between agency and belonging occurs and ultimately informs assessments regarding autonomy and identity. Emergent themes discussed in this chapter include a heightened emphasis on inclusive housing models, age-friendly integration of technology, environmental flexibility in design and programming, and enhanced support for the needs of caregivers. Examining place change through an integrative P-E framework offers a lens to understanding what implications to agency and belonging might be tied to modifications in the physical and technological environment in response to COVID-19 and how that might inform outcomes related to autonomy and identity among older adults. The environmental responses to COVID-19 will accelerate the ability of independent housing to serve individuals longer in their homes and should promote a radical embrace of small house approaches to skilled care, thereby challenging assisted living as a place type altogether. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

"It's Not a Sprint, It's a Marathon": Stages of Managing a Nursing Home Throughout the Pandemic.

OBJECTIVES: To qualitatively examine the impact of COVID-19 on nursing homes over the course of the pandemic from the perspective of nursing home administrators. DESIGN: In-depth, semi-structured interviews with nursing home administrators, repeated 3 months apart for a total of 4 each from July 2020 through December 2021. SETTINGS AND PARTICIPANTS: Administrators from a total of 40 nursing homes from 8 health care markets across the United States. METHODS: Interviews were conducted virtually or via phone. The research team identified overarching themes using applied thematic analysis, and iteratively coded transcribed interviews. RESULTS: Nursing home administrators across the United States reported challenges of managing nursing homes during a pandemic. We found their experiences could generally be categorized into 4 stages, not necessarily coinciding with surge levels of the virus. The initial stage was characterized by fear and confusion. The second stage, by a "new normal," a term administrators used to report feeling better prepared for an outbreak and how residents, staff, and families began to adjust to life with COVID. Administrators started using the phrase "a light at the end of the tunnel" to describe the third stage, characterized by the hope associated with the availability of vaccinations. The fourth stage was marked by "caregiver fatigue" as nursing homes experienced numerous breakthrough cases. Some challenges, like staffing issues and uncertainty about the future, were reported throughout the pandemic, as was a continued mission to keep residents safe. CONCLUSIONS AND IMPLICATIONS: As the ability of nursing homes to provide safe, effective care faces unprecedented and continued challenges, the insights reported here from longitudinal perspectives of nursing home administrators may help policy makers develop solutions to encourage high-quality care. Knowing how the needs for resources and support vary across the progression of these stages has the potential to be helpful in addressing these challenges.

Perspectives of nursing home administrators across the United States during the COVID-19 pandemic.

OBJECTIVE: To characterize the experiences of nursing home administrators as they manage facilities across the United States during the COVID-19 pandemic. DATA SOURCES AND STUDY SETTING: We conducted 156 interviews, consisting of four repeated interviews with administrators from 40 nursing homes in eight health care markets across the country from July 2020 through December 2021. STUDY DESIGN: We subjected the interview transcripts to a rigorous qualitative analysis to identify overarching themes using a modified grounded theory approach to applied thematic analysis. DATA COLLECTION METHODS: In-depth, semi-structured qualitative interviews were conducted virtually or by phone, and audio-recorded, with participants' consent. Audio recordings were transcribed. PRINCIPAL FINDINGS: Interviews with nursing home administrators revealed a number of important cross-cutting themes. In interviewing each facility's administrator four times over the course of the pandemic, we heard perspectives regarding the stages of the pandemic, and how they varied by the facility and changed over time. We also heard how policies implemented by federal, state, and local governments to respond to COVID-19 were frequently changing, confusing, and conflicting. Administrators described the effect of COVID-19 and efforts to mitigate it on residents, including how restrictions on activities, communal dining, and visitation resulted in cognitive decline, depression, and weight loss. Administrators also discussed the impact of COVID-19 on staff and staffing levels, reporting widespread challenges in keeping facilities staffed as well as strategies used to hire and retain staff. Administrators described concerns for the sustainability of the nursing home industry resulting from the substantial costs and pressures associated with responding to COVID-19, the reductions in revenue, and the negative impact of how nursing homes appeared in the media. CONCLUSIONS: Findings from our research reflect nursing home administrator perspectives regarding challenges operating during COVID-19 and have substantial implications for policy and practice.

Where is the Evidence on Acoustic Considerations for Dementia Care Settings: A Scoping Review...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To provide up to date evidence on the acoustic considerations for dementia care settings, to support healthspan and quality of life. Scoping Review. Institutionalized settings to include assisted living, nursing homes, rehabilitation centers, skilled nursing facilities, and other supported care environments. Individuals living with dementia. Per the nature of a scoping review, we are considering multiple levels of evidence and several aspects of the intervention of interest, to include the following: auditory environment, acoustic environment, or sound-based intervention or observation. Cognitive, behavioral, or other health related outcomes relative to participants with dementia. The initial search was carried out by a librarian and yielded 1671 articles for screening after duplicates were removed. Title and screening was carried out among 4 independent reviewers via Covidence review software. Of the initial 1671 articles, 101 were included for full text review. Full text review screening is ongoing. This will be followed by data extraction and the development of a thematic summary of the available evidence. We plan to complete this review prior to reporting at the conference. We anticipate our findings to provide preliminary insight into the importance of acoustic environments and interventions in supporting the day-to-day functional needs of older adults living with dementia in supported contexts. This preliminary insight will be used to guide future, high level evidence, needed to further elucidate this aspect of care. N/A.

Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities.

BACKGROUND: Implementation of new skilled nursing facility (SNF) Medicare payment policy, the Patient Driven Payment Model (PDPM), resulted in immediate declines in physical and occupational therapy staffing. This study characterizes continuing impacts of PDPM in conjunction with COVID-19 on SNF therapy staffing and examines variability in staffing changes based on SNF organizational characteristics. METHODS: We analyzed Medicare administrative data from a national cohort of SNFs between January 2019 and March 2022. Interrupted time series mixed effects regression examined changes in level and trend of total therapy staffing minutes/patient-day during PDPM and COVID-19 and by type of staff (therapists, assistants, contractors, and in-house staff). Secondary analyses examined the variability in staffing by organizational characteristics. RESULTS: PDPM resulted in a -6.54% level change in total therapy staffing, with larger declines for assistants and contractors. Per-patient staffing fluctuated during COVID-19 as the census changed. PDPM-related staffing declines were larger in SNFs that were: Rural, for-profit, chain-affiliated, provided more intensive therapy, employed more therapy assistants, and admitted more Medicare patients before PDPM. COVID-19 resulted in larger staffing declines in rural SNFs but smaller early declines in SNFs that were hospital-based, for-profit, or received more relief funding. CONCLUSIONS: SNFs that historically engaged in profit-maximizing behaviors (e.g., providing more therapy via lower-paid assistants) had larger staffing declines during PDPM compared to other SNFs. Therapy staffing fluctuated during COVID-19, but PDPM-related reductions persisted 2 years into the pandemic, especially in rural SNFs. Results suggest specific organizational characteristics that should be targeted for staffing and quality improvement initiatives.

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises

Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

Connect-Home transitional care from skilled nursing facilities to home: A stepped wedge, cluster randomized trial.

BACKGROUND: Skilled nursing facility (SNF) patients and their caregivers who transition to home experience complications and frequently return to acute care. We tested the efficacy of the Connect-Home transitional care intervention on patient and caregiver preparedness for care at home, and other patient and caregiver-reported outcomes. METHODS: We used a stepped wedge, cluster-randomized trial design to test the intervention against standard discharge planning (control). The setting was six SNFs and six home health offices in one agency. Participants were 327 dyads of patients discharged from SNF to home and their caregivers; 11.1% of dyads in the control condition and 81.2% in the intervention condition were enrolled after onset of COVID-19. Patients were 63.9% female and mean age was 76.5 years. Caregivers were 73.7% female and mean age was 59.5 years. The Connect-Home intervention includes tools, training, and technical assistance to deliver transitional care in SNFs and patients' homes. Primary outcomes measured at 7 days included patient and caregiver measures of preparedness for care at home, the Care Transitions Measure-15 (patient) and the Preparedness for Caregiving Scale (caregiver). Secondary outcomes measured at 30 and 60 days included the McGill Quality of Life Questionnaire, Life Space Assessment, Zarit Caregiver Burden Scale, Distress Thermometer, and self-reported number of patient days in the ED or hospital in 30 and 60 days following SNF discharge. RESULTS: The intervention was not associated with improvement in patient or caregiver outcomes in the planned analyses. Post-hoc analyses that distinguished between pre- and post-pandemic effects suggest the intervention may be associated with increased patient preparedness for discharge and decreased number of acute care days. CONCLUSIONS: Connect-Home transitional care did not improve outcomes in the planned statistical analysis. Post-hoc findings accounting for COVID-19 impact suggest SNF transitional care has potential to increase patient preparedness and decrease return to acute care.

Between a Rock and a Hard Place: COVID-19 Lessons Learned From Providers Rounding at Skilled Nursing Facilities in the Rural Midwest.

On March 11, 2020, coronavirus disease 2019 (COVID-19) was classified as a pandemic, setting in motion unprecedented practice changes across the healthcare industry. Never was this more evident than in Skilled Nursing Facilities (SNFs). SNFs were tested on multiple fronts, requiring innovation and perseverance at levels never before seen. Lessons learned from this setting to better prepare for the next pandemic include: updating and standardizing infection control and prevention policies, ensuring the supply chain keeps up with demand, updating infrastructure, creating a work environment that promotes well-being, and having clear communication plans.

The Advanced Practice Registered Nurse Leadership Role in Nursing Homes: Leading Efforts Toward High Quality and Safe Care.

This article highlights the critical role of advanced practice registered nurses in the care of older adults living in nursing homes. This population is one of the frailest, marginalized, and often neglected in the United States. The COVID-19 pandemic impact on nursing homes resulted in a stunning number of infections and subsequent resident deaths. This is a shameful reminder of the many challenges and gaps in the nursing home industry including inadequate staffing, high staff turnover, improper isolation technique, and lack of fundamental knowledge of how to adequately implement infection prevention and control processes. Strong advanced practice registered nurse leadership may have mitigated some of these factors.

Quality of care among skilled nursing facilities: A mixed methods investigation of person-centered care and workplace environment

Skilled nursing facilities (SNFs) across the United States strive to provide a high quality of care for their residents. Person-centered care is often seen as a domain of quality of care as it individualizes care to the resident. Along with attending to care needs, direct care professionals (DCPs) must navigate aspects of their workplace environment, such as staff burnout and engagement, that influence the quality of care provided. Additionally, recently SNFs have experienced the impact of the coronavirus disease 2019 (COVID-19) pandemic, which was an unprecedented event that produced challenges for SNFs and influenced care practices due to increased regulations and change in social interactions and safeguards. Therefore, the aim of the current study was to examine multiscale influences on the quality of care in SNFs (e.g., person-centered approaches, workplace characteristics), reflecting the long-term goal to improve quality of care and resident outcomes in SNFs.An exploratory mixed methods approach was utilized for data collection, analysis, and interpretation. Eleven SNFs in Iowa were recruited for this study. The recruited SNFs represented varied SNF characteristics (e.g., bed count, staffing hours) and Accountable Care Organization (ACO) affiliation was also considered during recruitment. Administrators from the SNFs participated in interviews (N=11), during which the researcher gauged perceptions of person-centered care (PCC), staff burnout and engagement, management and leadership principles, views of resident outcomes, and staff training. DCPs completed surveys (N=83) to assess perceptions of PCC, staff burnout, and engagement. Additionally, Centers for Medicare and Medicaid Services data were utilized to assess SNF characteristics (e.g., profit status, bed count) and Minimum Data Set resident outcomes (e.g., falls, urinary tract infections).The impact of the COVID-19 pandemic on SNFs constituted the primary focus in the first study. Results indicated resident outcomes that were worse than the national average increased from 2019 to 2020 and then decreased from 2020 to 2021. Slopegraphs were employed to provide visualizations of trends in resident outcomes over time. Thematic analysis revealed administrators reported SNFs were impacted by the pandemic by staff concern regarding COVID-19, financial strain, resident isolation, new regulations and protocols, and staffing challenges (e.g., turnover, shift coverage). DCPs reported SNFs were impacted by the pandemic by limited or no family/friend visits;required masks and personal protective equipment (PPE);resident death;staffing challenges;and resident isolation. Lastly, DCPs reported that the COVID-19 pandemic impacted their day-to-day work and burnout a great deal;however, overall DCPs reported low to moderate feelings of burnout. Care practices, regulations and policies, staffing issues, and establishing a new normal are important implications based on the findings from this study.Identifying associations between resident outcomes and PCC, burnout, engagement, and SNF characteristics was the focus of the second study. Results indicated PCC was positively correlated with engagement and negatively correlated with burnout. Scatterplots produced visualizations of trends between resident outcomes and PCC, burnout, and engagement. Themes from administrators and DCPs were identified surrounding common contributors to burnout (e.g., low wages, short staffing), factors influencing staff engagement (e.g., events, providing one-on-one care), and implementation of PCC (e.g., care planning, involving the resident). Lastly, clustering of SNFs that were associated with PCC, burnout, engagement, and resident outcomes were discerned based on profit status, Accountable Care Organization affiliation, and bed count. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Changes in Therapy Utilization at Skilled Nursing Facilities Under Medicare's Patient Driven Payment Model.

OBJECTIVES: The Patient Driven Payment Model (PDPM) was implemented in October 2019 to reimburse skilled nursing facilities (SNFs) based on Medicare patients' clinical and functional characteristics rather than the volume of services provided. This study aimed to examine the changes in therapy utilization and quality of care under PDPM. DESIGN: Quasi-experimental design. SETTING AND PARTICIPANTS: In total, 35,540 short stays by 27,967 unique patients in 121 Oregon SNFs. METHODS: Using Minimum Data Set data from January 2019 to February 2020, we compared therapy utilization and quality of care for Medicare short stays before and after PDPM implementation to non-Medicare short stays. RESULTS: The number of minutes of individual occupational therapy (OT) and physical therapy (PT) per week for Medicare stays decreased by 19.3% (P < .001) and 19.0% (P < .001), respectively, in the first 5 months of PDPM implementation (before the COVID-19 pandemic). The number of group OT and PT minutes increased by 1.67 (P < .001) and 1.77 (P < .001) minutes, respectively. The magnitude of PDPM effects varied widely across stays with different diagnoses. PDPM implementation was not associated with statistically significant changes in length of SNF stay (P = .549), discharge to the community (P = .208), or readmission to the SNF within 30 days (P = .684). CONCLUSIONS AND IMPLICATIONS: SNFs responded to PDPM with a significant reduction in individual OT and PT utilization and a smaller increase in group OT and PT utilization. No changes were observed in length of SNF stay, rates of discharge to the community, or readmission to the SNF in the first 5 months of PDPM implementation. Further research should examine the relative effects of individual and group therapy and their impact on the quality of SNF care.

SATISFACTION WITH THE QUALITY OF LIFE IN A HOME FOR THE ELDERLY DURING THE PANDEMIC COVID-19

The appearance of the SARS-CoV-2 virus caused a pandemic that had a huge impact on life, but also brought about changes in the lifestyle of all the inhabitants of the planet Earth. The pandemic particularly affected the elderly population living in homes for the elderly and infirm. This has caused a number of problems and misfortunes that have been tried to overcome in the best possible way for users of nursing home services. Therefore, there is a need to research satisfaction with the quality of life of home users for the elderly and infirm during the pandemic COVID-19. The research was conducted by empirical testing on a sample of 102 elderly respondents who use home accommodation services for the elderly and infirm. The aim of the research is to find out whether the users of services in the home for the elderly and infirm are satisfied with the quality of life during the pandemic COVID-19. The tasks of the research are to acquire knowledge about satisfaction with instructions and information during a pandemic, feelings of tension, nervousness, fear, depression and sadness due to separation (isolation) from their loved ones. Research on the quality of life of home users for the elderly and infirm during the pandemic showed that respondents are satisfied with the quality of life, have no strong sense of fear, are satisfied with epidemiological guidelines, but not measures because they show extreme dissatisfaction, isolation and inability to visit loved ones. In general, it can be concluded that users of homes for the elderly and infirm are satisfied with the quality of life, but as respondents seem to be a very vulnerable group in society, their quality of life should be frequently checked and improved in every way.

El cohousing senior en España. Cambios desde la economía social en los alojamientos y en la economía de los cuidados para personas mayores

RESUMEN: Es un hecho que ha crecido el número de personas mayores que viven solas y que los servicios sociales en la actualidad presentan muchas deficiencias, que se han evidenciado especialmente con el COVID-19. Estos hechos han convertido al cohousing senior en una atractiva alternativa de alojamiento para ellos. El avance del cohousing senior supone un empuje hacia la modernización de los alojamientos y servicios sociales para las personas mayores, en particular de las residencias. El cohousing senior lleva varios años de experiencia en otros países europeos, y representa una forma de convivir deseable entre los mayores y/o las familias que desean compañía y compartir tareas. Para conocer mejor la posible evolución futura del cohousing senior se introducen algunos apuntes del desarrollo de estos alojamientos en Suecia, un país modelo y guía en materia de políticas de viviendas y cuidados para personas mayores. El objetivo de este artículo es analizar el crecimiento de los alojamientos colaborativos para personas mayores en España desde la economía social, y conocer los problemas encontrados en su implementación, y las soluciones e impulsos políticos a su desarrollo. Hemos revisado la literatura española e internacional sobre cohousing senior durante la última década, y buscado datos en España sobre estos alojamientos en la prensa local y nacional y en la base de datos del proyecto MOVICOMA para determinar su grado de implantación y características. También se consultaron los barómetros de UDP sobre cohousing. Y hemos encontrado que su funcionamiento en España es incipiente, y que existen pocas iniciativas consolidadas, aunque bastantes en marcha, y se comprueba que la economía social juega un papel primordial. El Covid-19 ha elevado la demanda de estos alojamientos y alternativas de cuidado porque promueven y facilitan contactos sociales, evitan riesgos de las residencias, y mantienen a los participantes activos. Pero su implementación es lenta porque cuentan con importantes limitaciones a nivel de diseño, localización, financiación, burocracia excesiva y escaso apoyo público. Últimamente, a nivel político hay un mayor interés por estos alojamientos. Los planes de recuperación del Gobierno de España y algunas regulaciones de las CCAA y Ayuntamientos incorporan estrategias específicas sobre viviendas, otras para la Economía Social y cooperativas, y para el cuidado de los mayores (SAAD) que afectan directa o indirectamente al cohousing senior.Alternate :The advancement of senior cohousing is a push towards the modernization of housing and care for older people, and a challenge for present nursing homes. Cohousing has several years of experience in other European countries, and it is an attractive way of living for older people and/or families who want company and to share tasks. This article analyzes the growth of cohousing for older people in Spain from Third Sector, its barriers, and political impulses, and compares it with the experience in Sweden. Its functioning in Spain is incipient, and the Social Economy plays a key role. There are few consolidated initiatives, and quite a few underway, but the progress is slow due to numerous administrative and financial obstacles. The Covid-19 pandemic has raised the demand for these accommodations and care alternative because they promote and facilitate social contacts, some of the the risks of nursing homes, and comply with sustainable development objectives (SDG). Both Spain and Sweden have a variety of co-housing types, with a big role for cooperatives, but in Sweden they are primarily seen as a type of housing, where older people share fewer activities and maintain their privacy. Recently, there is greater political interest in cohousing. The recovery plans of the Spanish government and some regulations of the Autonomous Communities and City Councils incorporate specific strategies on housing, for the Third Sector, and the care of older people (SAAD) that affects senior cohousing.

Evaluating the Effectiveness of BREATHE for Nurse Practitioners During COVID Pandemic.

The current health care system incorporates multidimensional strategies of improving patients' care experiences, promoting the health of populations, and reducing per capita cost of health care. These strategies include reducing readmission rates by keeping patients in the community and out of the skilled nursing facilities. Unfortunately, patients' outcomes were severely threatened during the coronavirus disease 2019 pandemic due to staff burnout. This project evaluates the effectiveness of the BREATHE program on the perceived stress level of nurse practitioners during the coronavirus disease 2019 pandemic. Emotional exhaustion and depersonalization decreased 1 month after nurse practitioners completed the program.

La Covid-19 : un basculement vers une organisation par le care ? Les cas d'EHPAD et d'établissements de travail social

La Covid-19 a dévoilé des professions jusqu'ici plongées dans une non-reconnaissance sociale : les métiers du care. Cet article a pour objet de comprendre et de mettre en lumiere leurs expériences professionnelles en ces temps de crise sanitaire et de mettre au jour les potentialités de nouvelles configurations organisationnelles et managériales. L'étude s'appuie sur 24 entretiens collectifs effectués a l'issue du premier confinement et réunissant 170 travailleurs d'EHPAD et d'établissements de travail social d'une méme association. La Covid-19 a bouleversé les relations d'accompagnement entre travailleurs et bénéficiaires. Or, une nouvelle configuration de la pratique professionnelle du care a émergé. La logique du care s'est étendue au collectif et au management, résultats qui poussent a reconsidérer le paradigme managérial traditionnel.Alternate :COVID-19 highlighted non-recognized professions : the care professions. The purpose of this article is to understand their professional experiences of health crisis and to stress the potential of new organizational and managerial configurations. The study is based on 24 focus group involving 170 workers of nursing homes and social work centers. This article points out that COVID-19 has broken the relationships between caregivers and care-receivers. It outlines new configurations of care practices and their extension to the team and managerial relationships. Now, these results may reconsider the traditional managerial paradigm.

Clinical outcomes of monoclonal antibody therapy during a COVID-19 outbreak in a skilled nursing facility-Arizona, 2021.

BACKGROUND: Adult residents of skilled nursing facilities (SNF) have experienced high morbidity and mortality from SARS-CoV-2 infection and are at increased risk for severe COVID-19 disease. Use of monoclonal antibody (mAb) treatment improves clinical outcomes among high-risk outpatients with mild-to-moderate COVID-19, but information on mAb effectiveness in SNF residents with COVID-19 is limited. We assessed outcomes in SNF residents with mild-to-moderate COVID-19 associated with an outbreak in Arizona during January-February 2021 that did and did not receive a mAb. METHODS: Medical records were reviewed to describe the effect of bamlanivimab therapy on COVID-19 mortality. Secondary outcomes included referral to an acute care setting and escalation of medical therapies at the SNF (e.g., new oxygen requirements). Residents treated with bamlanivimab were compared to residents who were eligible for treatment under the FDA's Emergency Use Authorization (EUA) but were not treated. Multivariable logistic regression was used to determine association between outcomes and treatment status. RESULTS: Seventy-five residents identified with COVID-19 during this outbreak met eligibility for mAb treatment, of whom 56 received bamlanivimab. Treated and untreated groups were similar in age and comorbidities associated with increased risk of severe COVID-19 disease. Treatment with bamlanivimab was associated with reduced 21-day mortality (adjusted OR = 0.06; 95% CI: 0.01, 0.39) and lower odds of initiating oxygen therapy (adjusted OR = 0.07; 95% CI: 0.02, 0.34). Referrals to acute care were not significantly different between treated and untreated residents. CONCLUSIONS: mAb therapy was successfully administered to SNF residents with COVID-19 in a large outbreak setting. Treatment with bamlanivimab reduced 21-day mortality and reduced initiation of oxygen therapy. As the COVID-19 pandemic evolves and newer immunotherapies gain FDA authorization, more studies of the effectiveness of mAb therapies for treating emerging SARS-CoV-2 variants of concern in high-risk congregate settings are needed.

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Skilled Nursing Facility Residents and Staff Members-Los Angeles County, August-September 2020.

BACKGROUND: The prevalence of current or past coronavirus disease 2019 in skilled nursing facility (SNF) residents is unknown because of asymptomatic infection and constrained testing capacity early in the pandemic. We conducted a seroprevalence survey to determine a more comprehensive prevalence of past coronavirus disease 2019 in Los Angeles County SNF residents and staff members. METHODS: We recruited participants from 24 facilities; participants were requested to submit a nasopharyngeal swab sample for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing and a serum sample for detection of SARS-CoV-2 antibodies. All participants were cross-referenced with our surveillance database to identify persons with prior positive SARS-CoV-2 results. RESULTS: From 18 August to 24 September 2020, we enrolled 3305 participants (1340 residents and 1965 staff members). Among 856 residents providing serum samples, 362 (42%) had current or past SARS-CoV-2 infection. Of the 346 serology-positive residents, 199 (58%) did not have a documented prior positive SARS-CoV-2 PCR result. Among 1806 staff members providing serum, 454 (25%) had current or past SARS-CoV-2 infection. Of the 447 serology-positive staff members, 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR result. CONCLUSIONS: Past testing practices and policies missed a substantial number of SARS-CoV-2 infections in SNF residents and staff members.