The public health response to COVID-19 in assisted living communities in New York highlights the need to identify those communities at highest risk of infectious disease outbreaks to provide necessary support, according to a new paper.
The New York State Department of Health and the Westchester County Department of Health reviewed pandemic guidance documents and advisory letters from the state health department issued to assisted living providers between March 2020 and December 2022. They used that data to create a timeline of efforts to contain and prevent the spread of COVID-19 to serve as a future reference for assisted living communities.
In a recent report in the Journal of Public Health Management & Practice, the authors said that the death rate in assisted living communities due to SARS-CoV-2 was found to be almost tenfold the rate of the general population overall, according to researchers who looked at death rates in 39 states in October 2020.
COVID-19 vaccines changed that statistic.
Last spring, a report from the National Investment Center for Seniors Housing & Care and NORC at the University of Chicago found that residents of continuing care retirement communities were “significantly safer” from dying from COVID-19 than were older adults living in noncongregate residential settings in the greater community — and independent living, assisted living and memory care residents were as safe or almost as safe as those living in the greater community — once COVID-19 vaccines became available.
The New York study authors said that the advanced age and rate of multiple medical conditions among assisted living residents put them at high risk for COVID-19. The social nature of the setting also was credited with the spread of the virus.
The authors found substantial variation among assisted living communities regarding admissions, resident care needs and staffing but found that all settings provide a level of medical assistance while allowing some autonomy and promoting socialization.
“Consideration of resident population and geographic factors could be important to identify assisted living facilities that are at higher risk of outbreaks to ensure that these facilities have sufficient support,” they concluded.
A Center for Excellence in Assisted Living, or CEAL@UNC, report from January 2023 published similar findings regarding infection prevention and control preparedness and supports for assisted living providers.
The CEAL report noted that infection control and preparedness in assisted living was hampered by inadequate state and federal support, low staffing levels and limited clinical expertise and medical oversight of staff members. The CEAL report said that revised emergency preparedness plans should include infection control practice information, personal protective equipment use training for all staff, access to supplies, stronger partnerships with local health departments, temporary relaxation of administrative requirements and surveillance.
Effects of pandemic infection control strategies
As in other congregate care settings, infection control measures taken in assisted living communities during the pandemic included symptom screening, isolation, quarantine, visitation restriction, elimination of communal dining and group activities, staff testing, vaccination and reopening guidance.
“Enacting these measures required an enormous amount of support, both physically by staff, and financially to acquire the appropriate supplies,” the New York report authors wrote. “The events that ensued show that controlling the COVID-19 pandemic in assisted living facilities required a layered approach, including physical distancing, use of personal protective equipment, and medical and social interventions.”
Isolation, identified as a “major consequence” of infection control measures, was met with a list of best practices by the state to keep residents’ families involved during the pandemic. Establishing strong lines of communication between staff members and members of resident families emerged as a “critical determinant” of families’ experiences during the pandemic, the authors noticed.
“It was found that when facilities provided proactive, frequent, detailed information about residents’ status and needs, families felt reassured and confident, whereas when communication was lacking, families felt uninformed, anxious and fearful,” the authors wrote.
Isolation measures also led to the rapid use of telehealth, which worked well for the general population but created “significant technological barriers” for older adults, according to the report. Residents who received communication technology support from their community were more likely to use telehealth, but the authors noted that those settings are not federally funded and did not receive grants to buy communication technology during the pandemic.
“This difference in financial support may be important to consider in response to future needs for technological assistance so that assisted living facilities can best meet the healthcare needs of their residents,” they wrote.
Source: McKnights Seniorliving