Impact of COVID-19 on Structure and Function of Program of All-Inclusive Care for the Elderly (PACE) Sites in North Carolina.

OBJECTIVES: The novel coronavirus disease 2019 (COVID-19) deeply affected all forms of long-term care for older adults, highlighting infection control issues, provider and staff shortages, and other challenges. As a comparatively new, community-based long-term care option, the Program of All-Inclusive Care for the Elderly (PACE) faced unique challenges. This project investigated the impact of COVID-19 on operations in all PACE programs in one US state. DESIGN: Qualitative study. SETTING AND PARTICIPANTS: Structured interviews with administrators of all 12 PACE programs in North Carolina. METHODS: Interviews were conducted December 2020 to January 2021 by trained interviewers over Zoom; they were transcribed, coded, and qualitatively analyzed using thematic analysis. RESULTS: Reported COVID-19 infection rates among PACE participants for 2020 averaged 12.3 cases, 4.6 hospitalizations, and 1.9 deaths per 100 enrollees. Six themes emerged from analyses: new, unprecedented administrative challenges; insufficient access to and integration with other health care providers; reevaluation of the core PACE model, resulting in a transition to home-based care; reorientation to be more family-focused in care provision; implementation of new, creative strategies to address participant and family psychological and social well-being in the home; and major reconfiguration of staffing, including transitions to new and different roles and a concomitant effort to provide support and relief to staff. CONCLUSIONS AND IMPLICATIONS: While facing many challenges that required major changes in care provision, PACE was successful in mounting a COVID-19 response that upheld safety, promoted the physical and mental well-being of participants, and responded to the needs of family caregivers. Administrators felt that, after the pandemic, the PACE service model is likely to remain more home-based and less reliant on the day center than in the past. As a result, PACE may have changed for the better and be well-positioned to play an expanded role in our evolving long-term care system.

Pneumonia Identification Using Nursing Home Records.

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research. [Res Gerontol Nurs. 2016; 9(3):109-114.].

Vile vigilance: An integrated theoretical framework for understanding the state of Black surveillance.

The family is the principal source of socialization and protection against racism for many Blacks. Transmitting values, norms, morals, and beliefs (i.e., racial socialization) to successive generations is done to promote racial awareness and to prepare an individual to survive in racist environments. Further, developing a sense of security, resiliency, and cultural pride provides psychological protection against racial prejudice and discrimination. Protective socialization is even more critical when it becomes the difference between life and death at the hands of law enforcement-a fate faced by too many Black males as a result of racist policing practices, including the over-patrolling of Black communities. Because discriminatory surveillance and over-patrolling can incite a number of social, physical, and mental health issues, a holistic approach to understanding the interaction between Blacks and law enforcement is critical. This article reviews the Mundane Extreme Environmental Stress (MEES) model, racial socialization theory, and Family Stress Model in the development of a theoretical framework for understanding the patterns of interactions between Blacks and law enforcement, the immediate and long-term effects of unjustified shootings on Black families and communities, and the response of sociopolitical systems. The new theoretical framework will be used to inform the work of human service providers and practitioners by identifying targets for interventions to improve relations and trust between Black communities and law enforcement institutions.