Pandemic Preparedness in the U.S. Healthcare System

 

In late 2019, a novel virus of COVID-19 (commonly known as the “coronavirus”) began sweeping across the globe, creating a devastating and deadly pandemic. With very little known about transmission or treatment of the virus, it quickly became the largest pandemic the world has faced in modern history. As a result, healthcare organizations have been required to quickly adapt their workplace practices to face the unknown and effectively serve their community in need. Throughout this process, it has become clear that without proper policies in place, or an adequate supply of personal protective equipment, healthcare systems lacked preparedness for an effective response to a pandemic of this scale. Recommended strategies for preparing for future pandemics include: developing policies and procedures; laboratory research and testing; employee support; as well as technology and training. 

                  The COVID-19 pandemic first presented in Southeast Asia, with individuals exhibiting severe respiratory distress and flu-like symptoms. Review of the phylogeny of genomic sequences of the first cases produced evidence supporting the claim that the virus was introduced to the human race via the animal kingdom (Heymann et. al., 2020, pg. 543). The virus appeared to have many similarities when compared to severe acute respiratory syndrome coronavirus (SARS-CoV), but was found to have the closest genetic similarity to a coronavirus strain found originating in bats. After the first outbreak, the transmission of COVID-19 was shown to be almost entirely from human to human contact via the respiratory tract through sputum. “The coronavirus is known to live on surfaces for hours or days, but it is also effectively killed by available disinfectants when properly used” (Adams et al., 2020, pg. 1). Once an individual is infected with COVID-19, the virus replicates efficiently through host cells in the upper respiratory tract. COVID-19 is spherical in structure and is covered in spike shaped glycoproteins that help the virus attach and enter the host cell (Ralph et al., 2020, pg. 7). Interestingly, individuals can have little to no onset symptoms for approximately a fourteen-day period. This unique characteristic intensifies the spread of the virus due to newly infected asymptomatic individuals spreading the virus to others during contact through everyday life and international travel. At the current time, there are no licensed vaccines or antivirals for COVID-19 which has resulted in an emphasis on preventing transmission through social distancing, handwashing, and mask wearing. Many countries have implemented travel bans and lockdowns to slow the pandemic and reduce community transmission. As a result, the timeliness of the reaction time and the scale of protective measures within a community have directly affected the impact within the related region. More timely reaction times and larger scale protective measures have resulted in less impact of the pandemic in related communities.

Conclusion

                  This pandemic required healthcare organizations and their workers to quickly adapt workplace practices to effectively serve their community. Through this time period, it became clear that the nation’s healthcare system was ill prepared in effectively responding to the COVID-19 pandemic. With so much uncertainty and very little knowledge of the virus and its transmission, this resulted in widespread hospitalizations and deaths throughout the U.S.  This underscored the importance for healthcare organizations to plan and prepare for future pandemics.

                  To learn from this experience, healthcare organizations must first develop policies and procedures for facing pandemics. In the midst of the COVID-19 pandemic, the lack of tools, policies, and procedures caused uncertainty and unpreparedness. Not only do policies and procedures need to be developed for direct patient care, but also for human resources and throughout the healthcare system. Having reference tools and manuals readily available for employees will enable organizations to reduce stress and uncertainty while facing the pandemic head-on.

                  Once effective policies and procedures are implemented, annual training and tools should be developed to ensure that employees feel adequately prepared. It is noteworthy that throughout this pandemic, technology utilization has increased for communication and healthcare services.  By utilizing technology, healthcare organizations can provide ongoing staff preparation. Technology and training simulations enable organizations to be prepared, with ease and safety at any location. 

                  Another significant hurdle faced throughout the U.S. was reliance upon outside countries for medical equipment.  This resulted in healthcare workers providing care without proper protection.  Going forward, organizations should investigate the viability of developing emergency reserves that can be used during a pandemic.  By maintaining reserves of supplies, healthcare organizations can ensure that adequate supplies are available when needed. Living and working in the healthcare field during this pandemic has resulted in learned experience that will help the U.S. be more prepared in the future. The U.S. must learn from these experiences. By following the recommendations of early action, policy preparedness, medical supply monitoring, and epidemiological investigations, healthcare organizations can be better equipped for future pandemics. Implementing these steps can allow the country to be ahead of a pandemic curve and adequately serve those patients in need.

 

 

 

About the Author

 With a background in healthcare management, Gabrielle Conrad works at NorDx Laboratories at Maine Medical Center in Portland, Maine, where she has been promoted to Quality Specialist. In addition, she has recently completed her MHA degree with Saint Joseph's College / Maine.   This blog post was adapted from her graduate Capstone research, “Pandemic Preparedness in the United States Healthcare System.” 

 

References

Adams, J. G., & Walls, R. M. (2020). Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA: Journal of the American Medical Association, 323(15), 1439–1440. https://ezproxy.sjcme.edu:2102/10.1001/jama.2020.3972

 Heymann, D. L., Shindo, N., & WHO Scientific and Technical Advisory Group for Infectious Hazards. (2020). COVID-19: what is next for public health? Lancet, 395(10224), 542–545. https://ezproxy.sjcme.edu:2102/10.1016/S0140-6736(20)30374-3 

Ralph, R., Lew, J., Tiansheng Zeng, Francis, M., Bei Xue, Roux, M., Ostadgavahi, A. T., Rubino, S., Dawe, N. J., Al-Ahdal, M. N., Kelvin, D. J., Richardson, C. D., Kindrachuk, J., Falzarano, D., & Kelvin, A. A. (2020). 2019-nCoV (Wuhan virus), a novel Coronavirus: human-to-human transmission, travel-related cases, and vaccine readiness. Journal of Infection in Developing Countries, 14(1), 3–17. https://ezproxy.sjcme.edu:2102/10.3855/jidc.12425

 

Homeless Older Adults: Health, Affordable Housing and Long-Term Care Accessibility

 

Homeless Older Adults: Health, Affordable Housing and Long-Term Care Accessibility

 

Introduction

Living on the streets is an inhumane and unsafe lifestyle that causes health disparities among the youth, adults and senior citizens. The elderly homeless population is one of the most vulnerable groups, being victimized and facing many challenges with accessing healthcare and affordable housing. The aging homeless population is designated as being 50 years of age and older. Within the United States, approximately 31% of the homeless population is older, in poor health, and trying to survive horrific conditions (Burns & Sussman, 2018). Not having stable shelter will eventually take a toll on aging individuals who are homeless due to major concerns with safety, lack of nutrition, unhealthy living conditions, and exposure to inclement weather. Homeless individuals are forced to reside on park benches, in crowded shelters, under bridges, in cars and tents. These living conditions are unsanitary and contribute to the deterioration of their health.

Over time, such living conditions will increase the rate at which one ages and will lead to premature death. Prevalent health conditions include depression, mental illness, HIV infections, tuberculosis, hypertension, diabetes, asthma, loss of hearing, and loss of eyesight (Brown, Thomas, Cutler, & Hinderlie, 2013). The aging homeless population often lives from pillow to post, which results in not getting adequate sleep, nutritious meals, proper hygiene, or access to preventive medical care.

         The reasons for becoming homeless later in life are multi-faceted.  Among the contributing factors are job loss, divorce, ineligibility of benefits due to age, drug and alcohol abuse, and limited affordable housing. Others may have earned minimum wages during their working years and, as a result, were not able to save for life’s challenges and retirement (Burns & Sussman, 2018). It is difficult for this population to maintain good health while living in unstable circumstances. These homeless older adults are in urgent need of affordable housing, health care services, transportation, and nutritious food. These necessities should be accessible and have no eligibility restrictions.

            The benefits of health care services for aging individuals will improve overall health status, decrease hospital visits, and stabilize their mental state (Van, 2005). Health care and housing work hand-in-hand as poor health can be both the cause and result of homelessness (Henwood, Cabassa, Craig, & Padgett, 2013). It has been reported that people experiencing homelessness are three to six times more likely to become ill than housed people (Stafford & Wood, 2017). Affordable housing and senior homes are scarce in the United States, which causes housing complexes to have long waiting lists.

          An alternative to housing is a long-term care (LTC) facility, which offers both housing and health care. LTC facilities may encompass assisted living as well as nursing homes that offer assistance with bathing, dressing, continence, eating, rehabilitation, counseling, medication management, post-hospital care, three meals a day, and 24-7 geriatric trained staff (Moore, 2019). LTC services are necessary for the older homeless population to help alleviate pain, decrease health deterioration and provide a sense of safety. However, there are numerous barriers encountered by older adults that prevent them from obtaining health care and affordable housing in a timely manner.  

 

 

 

 

Conclusion

It is widely acknowledged that chronic homelessness exists in the United States because un-housed individuals are seen residing in unsanitary and unsafe environments daily. Such conditions, in turn, are key contributors to adverse health outcomes. The aging homeless population is a particularly vulnerable group with health concerns and needs that are not addressed, voluntarily or involuntarily. The U.S. homeless population is composed of 31% of aging individuals who lack information pertaining to assistance in obtaining health care services and housing. Research indicates that homelessness will age anyone prematurely and lead to life expectancy years shorter than that of the general population due to lack of the basic essentials, such as health care and housing (Culhane, Kane, & Johnston, 2013).

 It is critical that older homeless individuals have equal access to health care and housing as they are more susceptible to chronic illnesses and diseases that require ongoing medical attention. This lack of support and resources puts this population at greater risk of aging in poverty and becoming homeless (Garibaldi, Conde-Martel, & O’Toole, 2005). Many older, homeless individuals end up falling through the cracks as a result of eligibility restrictions that deny them access to needed assistance.  As reported in research findings, the majority of these individuals have paid taxes throughout their younger working years only to be rejected when they are most in need of assistance and support. In the opinion of this author, such treatment seems cruel and without compassion. 

The health status and safety of the aging homeless population must be a top priority at all levels of government:  local, state, and federal. The urgency of removing older adults from living in inhumane conditions should be executed immediately in the United States. From an economic standpoint, most aging homeless individuals rely heavily on inpatient care and emergency health services, which are costly for providers (Goldberg, 2016).

 

About the Author

With over 17 years of health care experience, Nikiya Ward has a background in Medical Laboratory Technology & Radiologic Science. In addition, she has recently completed her M.H.A. degree from Saint Joseph’s College of Maine. This blog post was adapted from her graduate “Capstone” research.

  

 

References

Brown, R.T., Thomas, L., Cutler, F.D., & Hinderlie. (2013). Meeting the Housing and Care Needs of Older Homeless Adults. A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 126-135, vol 21 (1).

Burns, V.F., & Sussman, T. (2019). Homeless for the First Time in Later: Uncovering More Than One Pathway. The Gerontologist, 59(2), 251-259. Retrieved from https://doi.org/10.1093/geront/gnx212

Culhane, D.P., Kane, V., & Johnston, M. (2013). Homelessness Research: Shaping Policy and Practice, Now and Into the Future. American Journal of Public Health, 103 (S2), S181-S 183. Retrieved from https://ezprozy.Sjcme.edu:2102/10.2105/AJPH.2013.301728

Garibaldi, B., Conde-Martel, A., & O’Toole, T, P. (2005). Self-reported comorbidities perceived needs and sources for usual care for older and younger homeless adults. Journal of General Internal Medicine, 20(8),726-730, Retrieved from https://doi.org/10.1111/j.1525-1497.2005.0142.x

Goldberg., J. (2016). How to Prevent and End Homelessness Among Older Adults. Justice in Aging. Retrieved by https://www.justiceinaging.org

Henwood, B.F. Cabassa, L.J., Craig, C.M., & Padgett, D.K. (2013). Permanent Supportive Housing: Addressing Homelessness and Health Disparities? American Journal of Public Health, 103 (S2), S 188-92. Retrieved from https://ezproxy.Sjcme.edu:2102/10.2105/AJPH.2013.301490

Moore., R.L. (2019). The Basics of Assisted Living. National Caregivers Library. Retrieved from https://www.caregiverslibrary.org

Stafford, A., & Wood, L. (2017). Tackling Health Disparities for People Who are Homeless? Start with Social Determinants. International journal of environmental research and public health, 14(12), 1535. Retrieved from https://doi.org/10.3390/ijerph14121535

Van, W.R. Homelessness Among Older Adults with Severe Mental Illness: A biological based developmental Perspective (2005). Journal of Human Behavior in the Social Environment. 10(4):39-49 (11p).