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A new public health crisis: caring for older adults living in nursing homes, assisted living and senior care

Lori Spencer and her husband Michael Spencer visit her mom, Judie Shape
REUTERS/Jason Redmond
Lori Spencer and her husband Michael Spencer visit her mom, Judie Shape, 81, who tested positive for coronavirus outside her room at Care Center of Kirkland, the Seattle-area nursing home which is one of the epicenters of the coronavirus outbreak.

It is imperative that we put Minnesota’s older adults living in nursing homes, assisted living and senior care at the top of our COVID-19 priority list. This unprecedented pandemic is turning a spotlight on the limitations of these living arrangements and the need to better care for our most vulnerable citizens. Even before the COVID-19 outbreak, these facilities suffered from frequent staff shortages, significant staff turner, low wages and inconsistent infection control measures. Now added to these weaknesses are the need for personal protective equipment (PPE) and more extensive testing of staff, an increase in staff shortages due to the virus and widespread outbreaks centered in senior care facilities.

Tetyana Shippee
Tetyana Shippee
The estimated 1.3 million people currently living in nursing homes are particularly vulnerable to infection because of their age and their high prevalence of chronic health conditions, including heart disease, diabetes and dementia. Due to these conditions, they are more likely to face a serious case of COVID-19 and more likely to die.

While we have read about notable cases in places like Seattle and New Jersey, Minnesota is not immune. More than 80,000 Minnesotans live in nursing homes and assisted-living facilities. Residents and staff from these settings account for a disproportionate share of Minnesota’s COVID positive cases (nearly a quarter) and, as of April 26, more than three-quarters of the confirmed COVID deaths. The number, of course, does not include the experience of residents who died but were never tested.

The Minnesota Department of Health (MDH) has made every effort to implement guidelines from the Centers for Disease Control and Prevention (CDC) regarding COVID-19 working in partnership with care providers and other stakeholders. Ill individuals and staff in congregate living settings are now a priority for COVID-19 testing. Care providers are also engaged and recommend that nursing facilities immediately fill unmet workforce needs; look to furloughed and laid off health professionals in other health care settings for new hires; allow for rapid onboarding of new staff by modifying training rules; and expedite reactivation of lapsed license/registrations.

While it is critical to address the spread of the virus in these facilities, we must not forget that the residents also need human interaction and the support of their families. With the new extensive infection control procedures, the majority of residents are isolated, confined to their rooms and cut off from interaction with other residents or their families. Social isolation and loneliness is linked to both physical and mental health including elevated levels of anxiety and depression.

Beth Virnig
Beth Virnig
Based on guidance from the MDH, the CDC, and the Centers for Medicare and Medicaid Services (CMS), visitation of family members is now strictly forbidden. We recognize these precautions are a necessary means to address risk of infection, but it is also important to stress that older adults, like all us, need personal connection and activity. We need to think creatively on how to do this while acknowledging the constraints of the staff who now have to meet both physical and social needs of residents.

We have heard that many homes have furloughed their activity staff because they were not essential. This should be reversed! Activity staff are more essential than ever! Facilities should emphasize maintaining social connections with families and volunteers through technology such as FaceTime video chats or the old fashion telephone. Online resources can be used to stream movies, music programs, and concerts, but nothing replaces interactive, human contact.

Lynn Blewett
Lynn Blewett
We agree with the recent recommendations made by The Commonwealth Fund regarding social isolation by encouraging facilities to screen residents for isolation and facilitate connection to support services and digital applications; expand access to telehealth for mental health care and support; and increase access to the internet and smartphones, iPads and other devices that support one-on-one connection.

We must make sure that in the process of addressing the spread of COVID-19 we do not lose sight of the social and personal needs of the residents of nursing homes, assisted living facilities and senior housing. Minnesota must keep up and enforce ongoing efforts to address these critical needs. As Hubert H. Humphrey so famously articulated, “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

Tetyana Shippee, Beth Virnig and Lynn A. Blewett are faculty members of the Division of Health Policy and Management at the University of Minnesota, School of Public Health.

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