The current COVID-19 crisis has drawn attention to the lack of safety, quality, staff shortages, and other issues that long-term care facilities have been grappling with for a while.

According to an analysis by the Kaiser Family Foundation (KFF), in the 23 states that publicly report mortality statistics, there were over 10,000 reported deaths due to COVID-19 among residents and staff in long-term care facilities (as of April 23, 2020), representing 27% of deaths due to COVID-19 in those states. In six states that have reported data (Delaware, Massachusetts, Oregon, Pennsylvania, Colorado, and Utah), deaths in long-term care facilities made up more than 50% of all COVID-19 deaths.

The question is, do these number reflect a higher rate of testing in the long-term care facilities and lower rates of testing among the general public, or have quality and safety issues resulted in these numbers?

What Makes These Facilities Vulnerable?

The most important consideration is the resident demographic. Long-term care facilities—skilled nursing homes, rehabilitation homes, assisted living, and continuing care retirement communities—have residents who are the most vulnerable and in fragile health. They have co-morbidities, which can complicate their healing from the primary condition that they are in the facility for. According to a 2017 analysis by KFF, 16% of all residents in nursing facilities across the US needed respiratory treatment. Away from home and their family for an extended period of time, in addition to being sick, makes the residents anxious and depressed. With COVID-19, visitors to these facilities have been restricted to reduce the risk of exposure; this lack of physical contact with close family members could accentuate the mental health issues that some of these residents may already have been facing.  

As for infection control, that is the most common problem reported by nursing facilities, and so facilities that have existing deficiencies with infection control, could be at a heightened risk of a COVID-19 epidemic among the residents and staff as well. When healthcare staff at the facilities get sick, is that creating staff shortages? And how does that affect patient care and the functioning of the facility?

How Is the Government Helping?

The Centers for Medicare & Medicaid Services has directed long-term care facilities to report positive cases of COVID-19 to the Centers for Disease Control and Prevention (CDC) as well as to residents and families, while continuing to report these numbers to the state. 

The CDC has developed a detailed guide that explains how long-term care facilities can prevent or control infections among residents. Additionally, there are recommendations for how a facility can respond to and manage patients and healthcare providers who are infected with the SARS-COV-2 virus. 

Advice for Families

In conversation with Kaiser Health News (KHN), experts and advocates familiar with the problems associated with long-term care facilities provided the following advice for families who may be worried about their loved ones residing in such a care facility:

  • Stay in touch via phone or video calls. It can be uplifting for your loved one while letting the facility staff know that family members are vigilant. “When a facility knows someone is watching, those residents get better care,” Daniel Ross, senior staff attorney at Mobilization for Justice, told KHN. Consider buying a device that can be used by your family member for a video visit. 

Meanwhile, AARP is advocating for Congress to allocate monies that will provide technology at these facilities to enable virtual visits.

  • Coordinate with other families who may have similar concerns as yours regarding the need for information and reach out to the administrator at the facility asking for a weekly update for families via a conference call.
  • Connect with your state’s long-term care ombudsman who is responsible for advocating for addressing complaints of nursing home residents.
  • Lodge a complaint with the administrator or a nurse at the facility and ask for a care plan meeting if you feel your family member is being ignored. If you do not get a response, the experts recommend lodging a complaint with the agency that oversees nursing homes in the state.
  • If you are considering bringing your family member home, think through your ability to care for them. A decision aid developed by researchers in Ottawa can guide you through other considerations in case your relative develops a severe COVID-19 infection.