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The tragic COVID-19 outbreak at a Washington state nursing home at the onset of the pandemic in the United States has cast a harsh light on the industry and its unintended role as a communications hub during the pandemic this year.
The nearly 3 million nursing home residents in the United States will be among the first to receive a vaccine once cleared. But the designation came at a cost.
More than 100,000 residents and employees have died from the disease, representing about 40% of all deaths from COVID-19 in the United States, according to the Kaiser Family Foundation.
Despite obvious resource needs and a willingness to work with hospitals to keep vulnerable older people out of wards, nursing homes have faced intense pressure – without sufficient support, some say.
So, when Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma announced new rules for surveyors in March and the threat of heavy fines was posed to the industry, it created a sense of frustration. among health professionals who felt unfairly punished.
Some long-term care facilities lacked space and resources to care for mild to moderate COVID-19 cases, including sometimes not having the space to isolate suspected cases, according to Dr Ed McManus.
McManus, an infectious disease specialist with long-term care expertise in New Jersey, told Yahoo Finance that a confluence of circumstances has led nursing homes to become a center of transmission.
What happened
The first problem is that the composition of residents of long-term care facilities has changed over time. With the growth of assisted living and self-catering residences, nursing homes have increasingly oriented themselves to a greater number of acute care patients, both in terms of physical and mental health, McManus said.
John Whitman, a professor at the University of Pennsylvania and executive director of a nonprofit organization focused on care for the elderly, previously explained some of the changes and needs of long-term care, noting that facilities are also experiencing an increase in the population as baby boomers. aging in homes.
“We still tend to use the word ‘senior’, but it has become a totally inappropriate description. Seniors are now four to five decades old. They come from diverse backgrounds in terms of economic capacity, family support and ethnicity. We have individual retirement homes where up to five languages are spoken. This increases costs and creates a quality of care issue in terms of understanding what a patient needs, ”Whitman said in 2017.
Another problem for nursing homes is that they are generally not equipped to care for critical patients, and depend on hospitals to do so. This relationship, which has grown in importance as value-based models of care, has prompted nursing homes to do more to avoid repeat or regular admissions of patients to hospitals.
A similar request has been made in light of the outbreak.
“Hospital medical directors have contacted nursing homes to make plans to sit down and manage,” McManus said.
But this is leading to an increase in deaths in homes, with little space to house. Reports that paint a dire picture of nursing facilities have made facilities nervous, McManus said.
Discussions about managing end-of-life care for loved ones are already difficult, but the pandemic has made it even more important.
“It’s hard for someone to die in a nursing home now. People are afraid, ”he says.
Staff shortage
Staff shortages in nursing homes also played a role in the spread. A recent Associated Press study, based on data reported by nursing homes to government, found that nearly one in four facilities faced a nursing shortage.
Throughout the year, as states and local governments put locks in place and nursing homes restricted visitors, the virus was able to spread further, in part, due to mobility nursing home staff – and the lack of available tests made the situation even more difficult to control.
Even though patients were referred from hospitals to nursing homes, they were not tested upon discharge as hospitals attempted to retain tests for incoming patients and staff, McManus said. Some states have addressed the issue, with New York State requiring released patients to be tested before being transferred to nursing homes.
But the uneven nationwide response to the problems in nursing homes has resulted in a tragic environment surrounding these facilities, experts say.
“Nursing homes have been devastated by this pandemic,” said former NJ health commissioner Shereef Elnahal.
Elnahal recently told Yahoo Finance that in addition to residents being the most vulnerable to the virus, “staff are known to have contracted the disease and in fact donated to other establishments and residents of other establishments. “
“A lot of these direct care workers have to have multiple jobs depending on their pay,” Elnahal said. And some are carpooling to different places, which increases the likelihood of the spread, he added. On average, nursing home nurses earn about $ 66,000 per year, according to the United States Bureau of Labor Statistics.
A “ dark winter ”
Some say the industry has made strides to better protect patients and staff. CarePort Health, a software solutions company that supports long-term care facilities, has tracked progress since the virus first appeared in the United States.
In a recent survey, the company said more than 93% of the country’s more than 15,000 facilities are now able to provide timely data on case reports.
The same survey showed that 99% of establishments report being able to test all staff and residents from November 1. This was, in part, achieved through rapid antigenic testing, like Abbott’s BinaxNow (ABT) which was distributed by state governments to some facilities.
The AP study, however, found that for the week ending October 25, about 1 in 6 nursing homes in peak states did not report testing staff in the previous week. The government requires staff to be tested at least once a week in areas where the virus is spreading.
As coronavirus cases increase across the country, facilities and officials are bracing for what has been dubbed a ‘dark winter’ ahead.
In addition to the U.S. Centers for Disease Control and Prevention’s (CDC) Vaccine Advisory Committee recommending residents and nursing home staff to be among the first to receive vaccines, Operation Warp Speed has has contracts with major retail pharmacies CVS (CVS) and Walgreens (WBA) to administer the vaccines.
The U.S. Food and Drug Administration’s Vaccine Advisory Committee is set to review emergency use requests from Pfizer (PFE) on December 10 and Moderna (MRNA) on December 17.
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