(Re)designing the continuum of care for older adults: The future of long-term care settings

This book broadens the visioning on new care environments that are designed to be inclusive, progressive, and convergent with the needs of an aging population. The contents cover a range of long-term care (LTC) settings in a single collection to address the needs of a wide audience. Due to the recent COVID-19 pandemic, rethinking the spatial design of care facilities in order to prepare for future respiratory and contagious pathogens is one of the prime concerns across the globe, along with social connectedness and autonomy in care settings. This book contributes to the next generation of knowledge and understanding of the growing field of the design of technology, programs, and environments for LTC that are more effective in infection prevention and control as well as social connectedness. To address these issues, the chapters are organized in four sections: Part I: Home- and community-based care;Part II: Facility-based care;Part III: Memory care and end-of-life care;and Part IV: Evidence-based applied projects and next steps. (Re)designing the Continuum of Care for Older Adults is an essential resource for researchers, practitioners, educators, policymakers, and students associated with LTC home and healthcare settings. With diverse topics in theory, substantive issues, and methods, the contributions from notable researchers and scholars cover a range of innovative programming, environments, and technologies which can impact the changing needs and support for older adults and their families across the continuum of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Grief, Social Support, Spirituality, and Depressive Symptoms Among Older Adults in Assisted Living in Kansas

Purpose Methods Results Discussion and Conclusion The purpose of this study was to explore the roles of grief, social support, as well as spirituality on the depressive symptoms of older adults in assisted living in Kansas. This study tested three hypotheses: a high level of grief will be related to a high level of depressive symptoms;high levels of social support (family, friends, and significant persons) will be associated with a low level of depressive symptoms;and high levels of spiritual experience and coping will be associated with a low level of depressive symptoms.This study recruited 316 older adult residents aged 65 or over from seven assisted living facilities in Kansas. This cross-sectional survey was done by face-to-face interviews using the purposive sampling method. Hierarchical multiple regression was used to test the three sets of variables in relation to depressive symptoms: socio-demographics, social support factors, and spiritual factors.Participants' mean age was 82.6 years, ranging from 65 to 102;70.9% were female. Married participants consisted of 18.7%, and over 64% were widowed. Hierarchical multivariate regression results indicated that a high level of grief was significantly related to a high level of depressive symptoms. On the other hand, high levels of social support from friends and spiritual coping were significantly associated with a low level of depressive symptoms.Assisted living facilities may consider developing appropriate bereavement, social support, and spiritual intervention programs, which will alleviate the depression issues of older adult residents after the COVID-19 pandemic. [ FROM AUTHOR] Copyright of Journal of Evidence-Based Social Work (2640-8066) is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Telemedicine Training to Improve Healthcare Access for Senior Living Community Residents in Lewistown, Montana

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.

COVID-19 Incidence and Mortality in Long-Term Care Facilities in Tennessee.

Background: Coronavirus Disease 2019, COVID-19, a viral infection, responsible for the latest pandemic has been shown to particularly affect the older population. Older adults, those aged 65 years and older, and individuals with serious underlying medical conditions are at a higher risk for severe illness from COVID-19 with a greater likelihood for hospitalization, admittance to the intensive care unit (ICU), and mortality. In this article, we describe the incidence and mortality rate found in Long Term Care facilities (LTCFs) and delineate any variations observed across varying types of LTCFs in the state of Tennessee (TN). Methods: Using aggregated data from the Tennessee (TN) Department of Health on COVID-19 Cases and Deaths from June 2020 to November 2021, we compare and contrast the incidence and fatality of COVID-19 among Long Term Care Facilities (LTCFs) in TN and describe the trends observed in these settings. Results: Our study indicates that there were major variations in COVID-19 prevalence rates in Nursing Homes (NHs) - 49% versus Assisted Care Living Facilities (ACLFs) in TN -16%. Although COVID-19 prevalence rates differed for NH and ACLFs, 12% of infected residents died in NHs while 13% of infected residents died in ACLFs. (Odds Ratio [OR]: 1.08 95% Confidence Interval [CI]: 0.93 -1.3, z-score: 1.37, p value: 0.085). Cases were more prevalent in five counties namely Davidson, Shelby, Hamilton, Knox, and Rutherford, majority of which were Metropolitan. Conclusion: As new variants continue to appear, counties with higher prevalence of COVID-19 should take continued effort to protect both resident and staff members especially in NHs settings and Metropolitan cities, where prevalence rate of the illness is higher.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic.

INTRODUCTION: Family/friend caregivers play an essential role in promoting the physical and mental health of older adults in need of care - especially during the COVID-19 pandemic and especially in assisted living (AL) homes, where resident care needs are similarly complex as in long-term care homes but fewer staffing resources and services are available. However, little research is available on caregiver involvement and concerns with care of AL residents prior to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this important knowledge gap. METHODS: This prospective cohort study used baseline and follow-up online surveys with primary caregivers to AL residents in Western Canada who were 65 years or older and had lived in the AL home for at least 3 months before Mar 1, 2020. Surveys assessed the following outcomes in the 3 months prior to and during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or communicating with residents, involvement in 16 care tasks, concerns with 9 resident physical/mental health conditions, perceived lack of resident access to 7 care services, and whether caregivers felt well informed and involved with resident care. RESULTS: Based on 386 caregiver responses, in-person visits dropped significantly in wave 1 of the pandemic and so did caregiver involvement in nearly all care tasks. While these rates increased in wave 2, most did not return to pre-pandemic levels. Correspondingly, caregiver concerns (already high before the pandemic) substantially increased in wave 1 and stayed high in wave 2. These were particularly elevated among caregivers who did not feel well informed/involved with resident care. CONCLUSIONS: Restricted in-person visiting disrupted resident care and was associated with worse perceptions of resident health and well-being. Continued caregiver involvement in resident care and communication with caregivers even during lockdowns is key to mitigating these issues.

The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: a qualitative descriptive analysis.

BACKGROUND: The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes. METHODS: We conducted 9 focus groups and 2 semi-structured interviews via videoconference. RESULTS: We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers. CONCLUSIONS: The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.

Designing Robots with the Context in Mind- One Design Does Not Fit All

Robots' visual qualities (VQs) impact people's perception of their characteristics and affect users' behaviors and attitudes toward the robot. Recent years point toward a growing need for Socially Assistive Robots (SARs) in various contexts and functions, interacting with various users. Since SAR types have functional differences, the user experience must vary by the context of use, functionality, user characteristics, and environmental conditions. Still, SAR manufacturers often design and deploy the same robotic embodiment for diverse contexts. We argue that the visual design of SARs requires a more scientific approach considering their multiple evolving roles in future society. In this work, we define four contextual layers: the domain in which the SAR exists, the physical environment, its intended users, and the robot's role. Via an online questionnaire, we collected potential users' expectations regarding the desired characteristics and visual qualities of four different SARs: a service robot for an assisted living/retirement residence facility, a medical assistant robot for a hospital environment, a COVID-19 officer robot, and a personal assistant robot for domestic use. Results indicated that users' expectations differ regarding the robot's desired characteristics and the anticipated visual qualities for each context and use case. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Experiences of COVID-19 Restrictions on Physical Activity in Assisted Living

Physical activity is an important health behavior for older adults in assisted living, however the COVID-19 pandemic may have disrupted this behavior. This study examined the effects of the pandemic on physical activity experiences in this population. Semi-structured interviews were conducted and analyzed using thematic analysis. Participants described barriers to physical activity, transitions in their physical activity habits, and health driven motivations for physical activity as three key themes, with seven additional subthemes. Each theme included experiences specific to pandemic measures in assisted living and everyday experiences. No participant reported increased physical activity during the pandemic, most participants reported decreases. [ FROM AUTHOR] Copyright of Activities, Adaptation & Aging is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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.

Now That You Have Retired -What's Next?

PLANS A, B, AND C It's important to have your plan A but also a plan B or even a plan C. As an example, you may have envisioned lots of travel, and then along came COVID, or a new partner, or health problems that make travel less likely. Amenities in these retirement communities include gyms, restaurants, golf courses, tennis courts, swimming pools, and interesting lectures\classes that make your retirement pleasurable. [...]you might want to improve your gardening skills, landscape your yard, paint the fence, clean the garage, and sit and watch the sunset. Look into courses at a local community college or university;many higher education centers allow individuals to take non-credit classes at a low cost.

Ambient intelligence health services using IoT

Ambient intelligence refers to the combination of pervasive ubiquitous computing, big data and artificial frameworks, IoT, sensor networks, and human-computer interaction (HCI) technologies. This technology paves the way for a futuristic world in which sensors incorporated into everyday devices create a smart envi-ronment that is seamlessly adapted to customer requirements and wishes. With patient health status records and patient electronic medical record (EMR), updates can help to provide a better and more straightforward narrative for the healthcare sector. It can assist healthcare workers, such as physicians and nurses, in providing quality care by analyzing patient data, such as prior treatments, allergic reactions, and more. Ambient intelligence helps the elderly in countries with a higher population of senior citizens by remotely monitoring their health and enabling them to live independently through ambient assisted living (AAL) technology. In this chapter, a case study related to the COVID disaster will be discussed with the help of ambient intelligence and new technologies. © 2023 Scrivener Publishing LLC.

Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada.

OBJECTIVES: To examine the prevalence of coping behaviors during the first 2 waves of the COVID-19 pandemic among caregivers of assisted living residents and variation in these behaviors by caregiver gender and mental health. DESIGN: Cross-sectional and longitudinal survey. SETTING AND PARTICIPANTS: Family/friend caregivers of assisted living residents in Alberta and British Columbia. METHODS: A web-based survey, conducted twice (October 28, 2020 to March 31, 2021 and July 12, 2021 to September 7, 2021) on the same cohort obtained data on caregiver sociodemographic characteristics, anxiety and depressive symptoms, and coping behaviors [seeking counselling, starting a psychotropic drug (sedative, anxiolytic, antidepressant), starting or increasing alcohol, tobacco and/or cannabis consumption] during pandemic waves 1 and 2. Descriptive analyses and multivariable (modified) Poisson regression models identified caregiver correlates of each coping behavior. RESULTS: Among the 673 caregivers surveyed at baseline, most were women (77%), White (90%) and age ≥55 years (81%). Alcohol (16.5%) and psychotropic drug (13.3%) use were the most prevalent coping behaviors reported during the initial wave, followed by smoking and/or cannabis use (8.0%), and counseling (7.4%). Among the longitudinal sample (n = 386), only alcohol use showed a significantly lower prevalence during the second wave (11.7% vs 15.1%, P = .02). During both waves, coping behaviors did not vary significantly by gender, however, psychotropic drug and substance use were significantly more prevalent among caregivers with baseline anxiety and depressive symptoms, including in models adjusted for confounders [eg, anxiety: adjusted risk ratio = 3.87 (95% CI 2.50-6.00] for psychotropic use, 1.87 (1.28-2.73) for alcohol use, 2.21 (1.26-3.88) for smoking/cannabis use). CONCLUSIONS AND IMPLICATIONS: Assisted living caregivers experiencing anxiety or depressive symptoms during the pandemic were more likely to engage in drug and substance use, potentially maladaptive responses. Public health and assisted living home initiatives that identify caregiver mental health needs and provide targeted support during crises are required to mitigate declines in their health.

Long-Term Care and the COVID-19 Pandemic: Lessons Learned.

US nursing homes and other long-term care (LTC) communities such as assisted living and adult day care services have been disproportionally affected by COVID-19. Nurses and health care workers provided care and services despite health concerns for themselves and family members. Nurses on the frontline were called to act with extraordinary tenacity, skill, flexibility, and creativity to prevent infection; prevent complications; and optimize function, health, and well-being. The purpose of this article is to provide an overview of the challenges posed by the COVID-19 pandemic and the strategies prioritized and implemented by nurse and interdisciplinary colleagues in LTC settings.

Caregivers' Concerns About Assisted Living Residents' Mental Health During the COVID-19 Pandemic: A Cross-Sectional Survey Study.

Family or friend caregivers' concerns about assisted living (AL) residents' mental health are reflective of poor resident and caregiver mental health. COVID-19-related visiting restrictions increased caregiver concerns, but research on these issues in AL is limited. Using web-based surveys with 673 caregivers of AL residents in Western Canada, we assessed the prevalence and correlates of moderate to severe caregiver concerns about residents' depressed mood, loneliness, and anxiety in the 3 months before and after the start of the COVID-19 pandemic. Caregiver concerns doubled after the start of the pandemic (resident depressed mood: 23%-50%, loneliness: 29%-62%, anxiety: 24%-47%). Generalized linear mixed models identified various modifiable risk factors for caregiver concerns (e.g., caregivers' perception that residents lacked access to counseling services or not feeling well informed about and involved in resident care). These modifiable factors can be targeted in efforts to prevent or mitigate caregiver concerns and resident mental health issues.

Eyes Recognition for Inner Canthus Temperature Detection using YOLOv5 Algorithm

Viral infections severely attack the physically frail elderly population, resulting in fatal drawbacks. The fact of having massive elderly population growth in Europe gives high priority to the detection of physical frailty and infectious diseases. This paper presents a safe, accurate, fast temperature detection system that could be integrated into homes or assisted living residences. The presented work aims to detect one of the symptoms of contagious diseases: elevated body temperature. In order to do so, we worked on recognizing eyes in thermal face images followed by scanning the detected eyes region for inner canthus temperature. Eyes detection was done by training four different sizes of You Only Look Once 5th version (YOLOv5) object detection algorithm: nano, small, medium and large. A total of 4,255 thermal images were implemented for the training process after merging two different datasets and applying data augmentation techniques. Results show a similar mAP score (99.5%) for the different trained models. The large YOLOv5 model was the fastest, working at 115 FPS. © 2022 IEEE.

A Feasibility Study of Remote Non-Contact Vital Signs (NCVS) Monitoring in a Clinic Using a Novel Sensor Realized by Software-Defined Radio (SDR).

The COVID-19 outbreak has caused panic around the world as it is highly infectious and has caused about 5 million deaths globally. A robust wireless non-contact vital signs (NCVS) sensor system that can continuously monitor the respiration rate (RR) and heart rate (HR) of patients clinically and remotely with high accuracy can be very attractive to healthcare workers (HCWs), as such a system can not only avoid HCWs' close contact with people with COVID-19 to reduce the infection rate, but also be used on patients quarantined at home for telemedicine and wireless acute-care. Therefore, we developed a custom Doppler-based NCVS radar sensor system operating at 2.4 GHz using a software-defined radio (SDR) technology, and the novel biosensor system has achieved impressive real-time RR/HR monitoring accuracies within approximately 0.5/3 breath/beat per minute (BPM) on student volunteers tested in our engineering labs. To further test the sensor system's feasibility for clinical use, we applied and obtained an Internal Review Board (IRB) approval from Texas Tech University Health Sciences Center (TTUHSC) and have used this NCVS monitoring system in a doctor's clinic at TTUHSC; following testing on 20 actual patients for a small-scale clinical trial, we have found that the system was still able to achieve good NCVS monitoring accuracies within ~0.5/10 BPM across 20 patients of various weight, height and age. These results suggest our custom-designed NCVS monitoring system may be feasible for future clinical use to help combatting COVID-19 and other infectious diseases.

COVID-19-Associated Hospitalizations among Long-Term Care Facility Residents Ages >=65 Years - COVID-NET, 14 U.S. States, March 2020-January 2022

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.

COVID-19 Pandemic Experiences across the Shelter-Care Continuum in Older Adults

The COVID-19 pandemic's impact on older adults (55+) living at the mid-point of the shelter-care continuum, in seniors housing (SH) and assisted living (AL), remains largely unexplored. This study compares survey responses of SH and AL residents with those of age peers living in private conventional community-based dwellings (CD) in British Columbia, Canada. Despite more SH/AL residents reporting feelings of isolation and changes to social support access, the pandemic appears to have had a greater negative impact on the routines of CD older adults. AL residents were more likely to engage in advance care planning discussions before and since the COVID-19 outbreak. These data are important for improving response to current and future disasters across the shelter-care continuum, particularly in ways to reduce the psychosocial effects of isolation or routine disruption, and strategies to increase advance care planning engagement.

Outbreak response activities conducted by public health programs in healthcare facilities nationwide, August 2019–July 2020

Background: Rapid response is critical to control healthcare-associated infection (HAI) and antibiotic resistance threats within healthcare facilities to prevent illness among patients, residents, and healthcare personnel. Through this analysis, we aimed to quantify public health response activities, by healthcare setting type, for (1) novel and targeted multidrug-resistant organisms or mechanisms (MDROs), (2) SARS-CoV-2, and (3) other possible outbreaks. Method: We reviewed response activity data submitted by US state, territorial, and local health department HAI/AR programs to the CDC as part of funding requirements. We performed descriptive analyses of response activities conducted during the funding reporting period (August 2019–July 2020). SARS-CoV-2 response activities were reported from January through July 2020. Data were analyzed by response category (novel or targeted MDRO, SARS-CoV-2, other HAI/AR responses), and healthcare setting type. Results: During August 2019–July 2020, 57 HAI/AR Programs (50 state, 1 territorial, 5 local health departments, and District of Columbia) reported 18,306 public health responses involving healthcare facilities. These data included 3,860 responses to 1 or more cases of novel or targeted MDROs, 13,992 responses to SARS-CoV-2 outbreaks (beginning in January 2020), and 454 responses to other possible outbreaks. Novel and targeted MDRO responses most frequently occurred in acute-care hospitals (ACHs, 64.5%), skilled nursing facilities (SNFs, 24.5%), and long-term acute-care hospitals (LTACHs, 5.8%). SARS-CoV-2 responses most frequently occurred in SNFs (55%), and assisted living facilities (24%). Other HAI/AR responses most frequently occurred in ACH (50%), SNF (28.4%), and outpatient settings (19.6%). Of the "other” HAI/AR responses, 76% were responses to cases, clusters, or outbreaks, and 23.8% were responses to serious infection control breaches including device and instrument reprocessing, injection safety, and other deficient practices. Conclusions: During the study period, public health programs performed a high volume of HAI/AR response activities largely focused on SARS-CoV-2 in nursing homes and assisted living facilities. Other important response activities occurred across a range of other healthcare settings, including responses to novel and targeted MDROs, HAI outbreaks, and serious infection control breaches. Whereas SARS-CoV-2 response activities largely centered in long-term care settings, MDRO and other HAI/AR responses occurred mostly in acute-care settings. These data demonstrate the importance of building and sustaining public health response capacity for a broad array of healthcare settings, pathogens, and patient populations to meet the range of current and emerging HAI/AR threats.Funding: NoneDisclosures: None

COVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource.

The COVID-19 pandemic had a big impact on assisted living (AL), a vital setting in long-term care (LTC). Understanding the strengths and opportunities for improvement through practice, policy, and research are essential for AL to be prepared for the next pandemic and other challenges. AL communities experienced the pandemic in unique ways, because of varying regulatory environments, differences in familiarity with using and procuring personal protective equipment not typically used in AL (such as N95 masks), loss of family involvement, the homelike environment, and lower levels of licensed clinical staff. Being state rather than federally regulated, much less national data are available about the COVID-19 experience in AL. This article reviews what is known about cases and deaths, infection control, and the impact on residents and staff. For each, we suggest actions that could be taken and link them to the Assisted Living Workgroup Report (ALW) recommendations. Using the Center for Excellence in Assisted Living (CEAL) 15-year ALW report, we also review which of these recommendations have and have not been implemented by states in the preceding decade and half, and how their presence or absence may have affected AL pandemic preparedness. Finally, we provide suggestions for policy, practice, and research moving forward, including improving state-level reporting, staff vaccine requirements, staff training and work-life, levels of research-provider partnerships, dissemination of research, and uptake of a holistic model of care for AL.