Government Actions Impact Nursing HOme Outcomes

 

Government Actions Impact Nursing Home Outcomes

By: Deborah Franklin

On January 19, 2020, the first case of coronavirus 2019 (COVID-19) was confirmed in the United States (Holshue, 2020). President Donald Trump formed a federal task force for the COVID-19 pandemic, headed by Vice-President Pence. In addition to the federal emergency orders that were activated, each state's governor also declared a state of emergency as cases of COVID-19 became present in their state. The Centers for Disease Control and Prevention (CDC) issued guidance that patients residing in skilled nursing facilities were at the highest risk due to the congregate nature and the population served (CDC, 2020). The actions taken by both the federal and state governments made a difference in the nursing home COVID-19 outcomes. Some governors made decisions based on CDC guidelines and took action early to protect the most vulnerable, while others hardly mentioned the nursing home sector in their strategy. The high mortality rate at skilled nursing facilities can be attributed to a combination of the population's vulnerability, a lack of personal protective equipment (PPE) to mitigate the risk, and the actions made by federal and state governments. The policy and regulatory changes implemented by federal and state governments were intended to prevent virus spread (Chen, 2020). By evaluating the COVID-19 outcomes for each state and comparing it to the government's emergency orders, the data should show if the nursing homes were a priority in the pandemic strategy.

            Each state governor had different approaches and responses to the COVID-19 pandemic in nursing homes. The governors from New York, New Jersey, Pennsylvania, Michigan, California, and Minnesota all ordered nursing homes to accept patients discharged from hospitals with active COVID-19 infections. Following their orders, nursing homes in these states had a surge of COVID-19 outbreaks. The CDC recommends that hospitals only discharge patients with COVID-19 diagnoses to nursing homes capable of implementing all recommended infection control procedures. 

               The Federal Government took action to stop the spread of the virus, educate the public, and educate the healthcare community. Additionally, the Federal government processed funding to the states and health care entities to fight the virus. Each state implemented specific strategies to fight the pandemic by issuing emergency orders. The CDC issued education and guidance daily and researched the virus, its symptoms, and its prevention. The actions that the federal and state governments took made a difference in the outcomes of the pandemic. Those outcomes may be harmful or beneficial, as each action caused unintended consequences.

Early in the crisis, some governors stopped visitation to long-term care centers to prevent resident exposure. The Federal Government also implemented waivers and programs to ease the regulatory requirements in the pandemic. Knowing that potential staff quarantine would cause the skilled nursing facilities to experience staffing issues, emergency waivers for training and nursing assistants' certification was implemented.  Additionally, emergency staff programs to supplement facility staff when needed were implemented (Brown, 2020). To keep the positive COVID-19 patients from spreading the virus to the other residents in skilled nursing facilities, some states developed COVID-19 facilities and units to care for positive patients until they recovered (Flynn, 2020).

Innovative actions helped to save lives in several states. The Centers for Medicare and Medicaid Services (CMS) took steps to lift regulatory restrictions early in the pandemic to make it easier to transfer patients within facilities and transfer to other outside facilities. This waiver permitted states to create COVID-19 facilities and units to specialize in treatment, infection control protocols, and minimize the spread in other nursing homes (Flynn, 2020).  Florida contracted for 23 facilities and units statewide so that hospitals, skilled nursing facilities, assisted living facilities, and independent living facilities could transfer residents with COVID-19 infections to be cared for in these COVID Isolation Centers until the patient was no longer a risk for contamination.

The virus continues to move through the skilled nursing communities, some more than others. More studies are needed to compare the facility's age, the number of beds per room, the HVAC capabilities, and other systems that may have impacted the virus spreading. The shortage of Personal Protective Equipment (PPE) could have contributed to the virus's spread within skilled nursing facilities. COVID-19 has morphed several times. The way it spreads continues to be investigated since there is more to be learned to effectively protect the most vulnerable individuals.

            Much can be learned from the government's pandemic response to long-term care and measures taken to protect those most at-risk. Comparing COVID-19 statistical data with actions can help identify best practices that should be underscored for future pandemics.

References

Andrews, M. (2020, August 28). Is Cuomo Directive to Blame for Nursing Home COVID Death Claims? Retrieved September 26, 2020, from https://www.managedhealthcareconnect.com/content/cuomo-directive-blame-nursing-h Brown, D. (2020, September 18). This emergency staffing program 'critical' for nursing homes during health emergencies - News. Retrieved September 26, 2020, from https://www.mcknights.com/news/this-emergency-staffing-program-critical-for-nursing-homes-during-health-emergencies/?utm_source=newsletterhome-covid-deaths-us-official-claims

CDC. (2020, September 11). Certain Medical Conditions and Risk for Severe COVID-19 Illness. Retrieved September 26, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html

CDC. (2020, June 25). Preparing for COVID-19 in Nursing Homes. Retrieved September 26, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

Chen, A. T., Ryskina, K. L., & Jung, H. (2020). Long-Term Care, Residential Facilities, and COVID-19: An Overview of Federal and State Policy Responses. Journal of the American Medical Directors Association, 21(9), 1186-1190. DOI:10.1016/j.jamda.2020.07.001

Flynn, M. (2020, September 13). How COVID-19 Units Helped Nursing Homes Weather the Storm - and How They Can Fight the Flu This Fall. Retrieved September 26, 2020, from https://skillednursingnews.com/2020/09/how-covid-19-units-helped-nursing-homes-weather-the-storm-and-how-they-can-fight-the-flu-this-fall/

Holshue, M. L., MPH, Lofy, K. H., MD, Spitters, C., MD, DeBolt, C., MPH, Lindquist, S., MD, Wiesman, J., Dr.PH, . . . Cohn, A., MD. (2020, May 07). First Case of 2019 Novel Coronavirus in the United States: NEJM. Retrieved September 20, 2020, from https://www.nejm.org/doi/full/10.1056/NEJMoa2001191

Robinson, D., Barchenger, S., & Powers, K. (2020, May 01). States ordered nursing homes to take COVID-19 residents. Thousands died. Here's what happened. Retrieved October 02, 2020, from https://www.recordonline.com/story/news/coronavirus/2020/05/01/states-ordered-nursing-homes-to-take-covid-19-residents-thousands-died-heres-what-happened/111852534/

About the Author

With over 35 years in Long-Term Care Administration, Deborah Franklin, MHA, NHA, serves as the Senior Director of Quality Affairs for Florida Health Care Association, the association which represents skilled nursing and assisted living centers. This blog post was adapted from her recent graduate "Capstone" research.