The spread of the coronavirus in nursing homes and assisted living facilities as we know is a real threat to these communities. The worry that it causes family members is completely understandable. If you are unsure of the best practices that should be followed by your family member’s nursing home, we put together the latest information from the CDC (Center for Disease Control and Prevention), Department of Veterans Affairs, American Health Care Association, and the Centers for Medicare & Medicaid Services for you.
Keeping in Touch Remotely
The new recommendation from industry officials is that nursing homes and assisted living facilities, where older people live in close quarters, should not allow outsiders — including contractors, government officials and even staff members — to enter unless their task is considered essential.
The Department of Veterans Affairs also suspended most new admissions and barred outsiders from all of its 134 nursing homes and 24 spinal cord injury centers. The exception to the no-visitors' rule: when a patient is expected to die soon.
"Nursing homes may have more to fear from visitors and staff carrying the virus than vice versa, as their residents are highly susceptible to the virus," Michael Dark, staff attorney at California Advocates for Nursing Home Reform (CANHR) in San Francisco, wrote in email.
But restricting visits doesn’t mean curtailing communication from family and friends, he said. Instead, they can email, use Facetime or Skype or even make an old-fashioned telephone call to check in.
Terry Fulmer, president of the John A. Hartford Foundation, a New York City-based national group dedicated to improving the care of older adults, suggested that family members and residents “stay in touch with your facility and closely monitor their messages. You can ask the facility about their infection plan.”
All of these senior living communities are required to have plans to prevent and monitor infections, she said in email.
Don’t Move Patients
Advocates are urging family members not to panic and say it is unwise for them to bring loved ones home to try to avoid infection.
“Moving an older adult from a long-term care center is risky and could have long-lasting impacts,” geriatrician David Gifford, chief medical officer of the American Health Care Association and the National Center for Assisted Living, wrote in an email.
The federal Centers for Disease Control and Prevention (CDC) does not recommend such moves, he said.
Others echoed that recommendation, saying germs are likely to flow more freely outside these communities than inside. Plus, residents are in nursing homes because they need higher levels of care than generally can be provided at home.
“In most cases, it is probably not a good idea” to move residents, Fulmer wrote in email. Instead, residents can take an active role in monitoring their nursing homes and assisted living facilities.
“Remember, you can use your voice! It’s OK to remind facility staff to wash their hands and maintain good hygiene,” she wrote. “Ask your facility about their plans for staff, who should stay home if they become sick.”
Staff Must Sanitize Shared Surfaces
A Centers for Medicare & Medicaid Services memo issued to states last week advised nursing home and assisted living center staff to limit the sharing of medical equipment among residents. When sharing equipment is necessary, it should be properly cleaned and disinfected before it is moved to another patient.
Staff also should avoid sharing items such as pens and pads. When phones, internal communication devices or nursing stations are shared, they should be disinfected frequently, the memo said.
“All staff, including housekeeping staff, receive in-service COVID-19 infection control training in addition to online infection control training,” spokesman Larry Elveru of Kendal, a Kennett Square, Pennsylvania-based nonprofit that operates continuing-care communities in eight states, wrote in an email. Staff are required to demonstrate what they’ve learned.
Residents and family also can review CDC guidelines for health professionals.
Dealing with the Short Supply of Gowns, Masks and Other Protective Items
“Be aware that a number of long-term care facilities are having trouble getting supplies made in China, hard hit by the coronavirus,” Gifford said Friday. “Most needed are basic surgical masks and gowns. “Some suppliers are getting very low,” he said.
Long-term care companies and individual facilities are posting information online about how they’re guarding against the virus.
Brookdale Senior Living, a long-term care company based in Brentwood, Tennessee, is focusing on preventing the spread of the virus, spokeswoman Heather Hunter wrote in email.
Some facilities have posted notices on how to properly wash hands. Kendal residents also are referred to the CDC COVID-19 website, Elveru wrote.
If a facility has suspected cases of COVID-19, experts provide these recommendations:
• Staff should use gowns, gloves and face masks or goggles when treating ill patients.
• Residents suspected of having the virus should be placed in single rooms with closed doors.
• Dining rooms may be closed and meals delivered to all residents’ rooms.
Those who feel they must visit any group living situation for older residents should be prepared for detailed questions.
Kendal-Crosslands Communities in Chester, Pennsylvania, went last week from asking guests to sign in and disclose prior travel to requesting that nonessential visits be postponed indefinitely even though the area about 15 miles southwest of Philadelphia is considered low risk. The continuing-care community has 500 independent living homes and apartments as well as more intensive care, and officials don't want residents who have the means to come and go on their own to participate in events with large crowds.
Facilities should stay in contact with their local health departments “to determine if their surrounding community is high risk,” Gifford wrote.
Here is the CDC’s COVID-19 preparedness checklist for nursing homes and other long-term care settings that you may also find helpful. It has extensive information to help keep their residents safe.
CDC (Center for Disease Control and Prevention),
American Health Care Association
Centers for Medicare & Medicaid Services