COVID-19 policy amendments put nursing home residents at risk

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Early data from China and Italy shows that the outbreak disproportionately kills older adults. The rapid spread of these infections in the United States has triggered informal and formal efforts to protect frail and vulnerable populations like those in nursing homes.

Informal recommendations like social distancing have greatly changed the day-to-day lives of most Americans but have played a lesser role for those living in long-term care. These residents have instead been subjected to contradictory formal policy amendments that put our elderly loved ones at risk.

Historically, Medicare covers up to 100 days of long-term care service after an individual has been treated for three consecutive days in a hospital. The Centers for Medicaid and Medicare Services (CMS) has now waived the three-day hospital stay policy. By eliminating this rule, the health care system can target skilled nursing facilities – or nursing homes – as places to treat the expected overflow of COVID-19 patients. On the other hand, CMS guidance has restricted all non-essential visits – including family – to protect residents from contracting the infection. While these two regulations address some specific challenges, they fail to capture the holistic issues.

Our nursing homes cannot serve as a viable option for COVID-19 patient overflow. These facilities are characterized by close living quarters and immunocompromised residents. Already, these communities are plagued with perpetual bacterial and viral outbreaks, such as the seasonal flu. A virus such as COVID-19 that has a slower onset of symptoms than the influenza virus could easily be transmitted to the majority of the facility.

We do not have to rely on hypothetical examples to understand the disastrous impact of an outbreak in this setting. Two instances have already occurred in the United States. The Willowbrook nursing home near Chicago confirmed that 30 residents and 12 staff have tested positive for COVID-19. Additionally, at this time, 29 residents at Life Care Center nursing home in Kirkland, WA, have been killed by the virus, and 30 of the remaining 43 residents have contracted it. These two breakouts in nursing homes in Illinois and Washington clearly demonstrate the consequences of individuals with COVID-19 entering these vulnerable communities.

What are some alternative approaches to explore? A CNN opinion piece suggests mobilizing the military to construct treatment centers, and ultimately build a parallel health care system, lessening the burden on already over-strained health care workers. Another option is leaning further into home health care to prioritize hospital beds only for those patients who truly require them. Dr. David Grabowski, a professor of health care policy at Harvard Medical School, proposes that for facilities that have the resources to do so, physical separation between buildings or units could be used to cordon off COVID-19 patients from others. Grabowski predicts that all possible measures will be investigated, even options as extreme as “finding excess capacity in assisted living communities and hotels.”

COVID-19 legislature’s restriction of visitors has far-reaching implications in nursing homes. Even before the COVID-19 regulations, 60 percent of long-term care residents had fewer than two visitors per year. Now, these socially isolated individuals are even more disconnected from their families and support systems. Loneliness in older adult populations is closely tied to depression. The consequences of loneliness are not only restricted to mental health; the physical impacts of loneliness in seniors have equated with smoking 15 cigarettes a day, and social isolation increases mortality by 29 percent. In an attempt to keep our older adults safe, we may be inflicting more harm by disconnecting them from their humanity.

Even though it is necessary to restrict visitors from entering long-term care communities, it is crucial to invest more effort into other resources to keep families connected during these difficult times. Research has shown that simply video chatting reduces loneliness and depressive symptoms. Facilities already make use of Skype and FaceTime in accordance with Medicare’s recent inclusion of these technologies to provide telehealth services. Therefore, it would be a simple step to integrate these tools to help provide social support as well.

The difficulty of addressing the various facets that come with protecting our older adults during this pandemic cannot be overstated. As we dive deeper into this crisis, our resources and solutions will be stretched. Yet, with meticulous planning and constant communication between policymakers, health care administration, and families, we can ensure that the older adults in our communities are effectively safeguarded.

Harsh Moolani is an undergraduate student.

Image credit: Shutterstock.com

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