Insights and Issues: The 2020 Pandemic
Management and Policy on Approaching Clinical Issues
Personal Protective Equipment (PPE)
Protecting the Workforce
Design for Infection Control and Future Safety
Infections are common in long-term care facilities. Staff are trained to respond to outbreaks of respiratory tract infections, influenza A, and gastrointestinal infections. In 2020, we dealt with the outbreak of a global pandemic that stressed all systems. We were little prepared with experience, guidance, testing or personal protective equipment (PPE). LTSS providers needed to learn how to prevent, prepare, mitigate, test, isolate, and care for COVID-19-positive cases among both residents and staff with little direction or support.
As we struggled to obtain very limited PPE, residents were fearful, family members were anxious about their loved ones, staff were either “all in” or “all out” in response to stress and fear, and hospitals were preparing to transfer COVID-positive older adults to our communities. Though seemingly insurmountable at the onset, LTSS providers stepped up amid the worst of circumstances to do their best for those they serve, with quality, respect, and compassion.
Insights and Issues: The 2020 Pandemic
- Have We Failed Public Health? Commentary from LTSS Center Co-director Robyn Stone.
- Expert Insights on COVID-19: In this podcast series brought to you by Elsevier, experts share their invaluable insights into the mode of transmission and pathophysiology of the COVID-19 virus. Also included: how medical informatics and telemedicine are used to manage the pandemic, and best practices in emergency nursing crisis preparedness.
- The Coronavirus Pandemic: More Surges, Growing Concern (Harvard T.H. Chan School of Public Health): In this Facebook Live Q&A, participants examine the forces driving the latest wave of surges. Are hospitals and public health officials better prepared to handle them today than they were in the early days of COVID-19, and what can we expect in the next stage of the pandemic?
- The Coronavirus Pandemic: Latest Updates, Approaching the Holidays (Harvard T.H. Chan School of Public Health, Facebook Live Q&A): The COVID-19 death toll has surpassed 200,000 people in the United States, and areas of the country continue to see surges. With the holiday season fast approaching, epidemiologist William Hanage will review the latest science of the pandemic with The World’s Elana Gordon. Testing, vaccines, diagnostics, treatments—where do we stand? And how do we keep ourselves and our loved ones safe?
- “No One Should Be Shocked”: The US COVID-19 Response Failure and More. (Harvard T.H. Chan School of Public Health): COVID-19 has now killed more than 1 million people around the world—and one in five deaths have occurred in the United States. Despite all of its advantages, the country has been shockingly ravaged by the pandemic, leaving Americans frightened, angry, and confused.
- Preventing and managing COVID-19 across long-term care services: Policy brief, 24 July 2020 (WHO)
- GAO Science & Tech Spotlight: Herd Immunity for COVID-19
- COVID-19 Industry-Specific Resources (M3 Insurance, scroll down for resources under “Senior Living & Social Services” heading)
- Community spread causes spike in new COVID-19 cases in skilled nursing centers (Provider magazine): A new report released by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) shows skilled nursing facilities are experiencing an alarming spike in COVID-19 cases due to community spread among the general population.
- Heat Maps for Surveillance and Prevention of COVID-19 Spread in Nursing Homes and Assisted Living Facilities (JAMDA)
- Mitigating Risks for Contagion Stigma (APA Blog)
- Helping Those with Hearing Loss During COVID-19 (Clear Living)
- Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (CMS)
- Mortality associated with COVID-19 in care homes: international evidence (International Long-Term Care Policy Network): Includes insights from LeadingAge President and CEO Katie Smith Sloan.
- Where you live might matter when it comes to COVID-19 infection rates (JAMDA Journal pre-proof): Positive COVID-19 cases and deaths were “substantially higher” in assisted living communities and nursing homes compared with home- and community-based settings, according to a recent study in the Journal of Post-Acute and Long-Term Care Medicine.
- The AMDA-On-The-Go podcast series includes multiple past and scheduled podcasts on COVID-19, vaccinations, variants, and more. On The AMDA Update on COVID-19 page, a one-stop site for a wide variety of AMDA’s pandemic resources.
- Clinical papers from The Robert J. Margolis, MD, Center for Health Policy at Duke University:
LeadingAge LTSS Center at UMass Boston research reports:
- The Coronavirus May Never Go Away
- Study: Social Distancing Reduced COVID-19 Growth Rate
- Strengthening the Aging Immune System to Fight COVID-19
- Who Is Immune to the Coronavirus?
- COVID-19 Risk Among Community-Dwelling Older Adults
- Why Is COVID-19 So Lethal for Elders?
- A Post-COVID Aging Agenda: The COVID-19 health crisis presents significant opportunities to radically improve quality of life and meet person- and family-centered needs.
Management and Policy on Approaching Clinical Issues
What hit the U.S. in early March 2020 was not a rampant, unvaccinated strain of the flu or a natural disaster or a recession. It was worse than all of these; it had a beginning, but it does not have a predictable end.
What was needed to manage older adult housing, care and services in 2020 isn’t in an existing textbook and you can’t Google ideas or a template. It required “rethinking the wheel” in terms of management, policy development, infection control protocols, staff coverage, communications, and more. Providers in long-term services and supports created their own textbooks by quick thinking and complex problem-solving—one day at a time.
- Leadership Strategies for Infection Preparation and Response Checklist (Pathway Health): This tool serves as a framework and implementation guide for leaders as they assess their current processes, pandemic plan, and emergency preparedness plan to align with current guidance. The tool outlines key tactic areas that need to be conserved for effective pandemic planning.
- Affordable Housing COVID Disease 2019 Level 5 Playbook (National Church Residences)
- COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in Post-Acute and Long-Term Care (PALTC) Facilities: A document developed and written by the COVID-19 Healthcare Resilience Working Group, a partnership with the U.S. Dept. of Health & Human Services, the U.S. Dept. of Homeland Security, and other federal agencies, with assistance and content contributions from a number of professional associations.
Overall Policy for Suspected or Confirmed Positives
- COVID-19 Interim Policy for Suspected or Confirmed Coronavirus (Pathway Health): This template serves as an overall policy for an organization, outlining the key procedures performed by the provider for preparation, mitigation, and response to COVID-19. It is a comprehensive policy that incorporates the processes necessary to minimize exposure to respiratory pathogens, promptly identify residents or health care personnel with signs or symptoms of COVID-19, manage residents confirmed with COVID-19, and implement interventions based upon federal and state/local recommendations (to include admissions, visitation, standard and transmission-based precautions, hand hygiene, universal source control, PPE use, resident placement, and more).
Testing is a complex and ever-changing activity in pandemic identification and control. Early on, the Centers for Disease Control (CDC) began issuing guidance on testing in response to an outbreak. “Outbreak” was defined as one positive case of COVID-19 among either residents or staff. The CDC recommended that all residents and staff be tested upon identification of an outbreak. Week-to-week, and sometimes day-to-day, the guidance shifted as scientists learned more about the virus.
Among the main barriers to responsible and reliable testing are the cost, the significant staff time required to complete testing, the access to tests, and the need for rapid turn-around of results. In older adult care, routine staff testing can be overwhelming, logistically and financially.
- Policy for Nasopharyngeal and Oropharyngeal Swab Collection (COVID-19) (Pathway Health): Collection of upper respiratory specimens is recommended by CDC for SARS-CoV-2 initial diagnostic testing.
- COVID-19 Testing (Pathway Health): COVID-19 testing will be an instrumental aspect that will assist facilities in prompt detection of cases in order to implement actions to reduce the exposure and to halt transmission within the facility whenever possible.
- Visiting Nurse Service of New York’s VisitContactTrace system: an open-source application designed to facilitate contact tracing on visit-based data with a specific focus on providers of community-based health care.
- News article about the VisitTraceContact system: VNSNY Launches Open Source COVID-19 Contact Tracing Tool for Home-Based Care Providers (Home Health Care News)
- Screening tool for suspected or confirmed coronavirus for residents, staff, and visitors (Pathway Health)
- LeadingAge LTSS Center at UMass Boston research reports:
- Audio interview: Sept. 21, 2020: Evan Shulman of CMS on CMS Guidance on Visitation and Testing: Covers visitation, testing and false positives/negatives, and challenges of lab availability and turnaround
- Audio interview: Sept. 23, 2020: Daniel Larremore of UC-Boulder on Computer Modeling, Testing, and Prioritization of Vaccines
- 37% of members with rapid COVID tests from government not using them: LeadingAge survey (McKnight’s Senior Living): Approximately two-thirds (66%) of LeadingAge members responding to a new survey said they have received rapid-results antigen tests for COVID-19 from the federal government, but 37% of them have not used them, according to the results of the poll, released on 11/9/20.
- Audio interview: Sept. 23, 2020: Daniel Larremore on Computer Modeling, Testing, and Prioritization of Vaccines
- Risk Assessment and Testing Considerations for SARS-CoV-2 Transmission in Congregate Care Facilities (Rockefeller Fdn.): Testing protocols can ‘significantly’ reduce COVID transmission in senior living communities. A new report aims to help assisted living and senior housing communities reduce COVID-19 transmission and develop screening programs to regularly test residents and staff for the virus.
- The Coronavirus Pandemic: Testing, Vaccines, and the Way Forward (video from Harvard T.H. Chan School of Public Health): Learn about the role of rapid testing at this critical moment in the progression of the pandemic. How do rapid tests work, and how could they be deployed at large scale to stop the spread of the virus, with or without widespread vaccination?
- Pioneering a New, Game-Changing COVID Test (The New Jewish Home): While regular COVID testing has become familiar, the test that The New Jewish Home administers is a sensitive and accurate rapid antigen test developed by Abbot, which is just beginning to arrive in hospitals and nursing homes around the country.
There are many essential aspects to the prevention of the spread of COVID-19, as well as other pathogens, in long-term care settings. The environment plays a crucial role in the prevention of spread of infection. It is important to identify exactly how this virus spreads in order to find every way possible to prevent transmission in the facility.
- CDC Guidance on COVID-19 topics is regularly updated. Go to link for advice on:
- Symptoms of Coronavirus
- Masks and Social Distancing
- Duration of Isolation and Precautions
- Risk Assessment and Work Restrictions for Health Care Personnel With Potential Exposure
- Public Health Guidance for Community-Related Exposure
- Return to Work Criteria for Healthcare Personnel
- Many more related topics
- WHO issues new infection prevention, control guidance for assisted living operators facing SARS-CoV-2: (Jan. 8, 2021) Early detection, education and training, as well as consistent implementation of infection prevention and control policies are necessary to protect the mental and physical health of residents and staff members of assisted living communities and other long-term care and congregate living settings, according to updated guidance by the World Health Organization.
- Sniffing out COVID: service dogs take on new role in Georgia assisted living communities (McKnight’s Senior Living): A Georgia-based senior living operator is partnering with a nonprofit service dog trainer to staff its metro Atlanta-based assisted living communities with COVID-sniffing canines.
Cleaning, Disinfection, and Hand Hygiene
Cleaning and disinfection practices will be essential. All departments must follow cleaning and disinfection policies and procedures.
- Cleaning and Disinfection Audit (Pathway Health): Auditing of facility practice is a key component for successful outcomes. This audit tool can be used by interdisciplinary team members.
- Infection preventionist surveillance audit tool (Pathway Health): Process surveillance during a pandemic is key for reducing community transmission. This tool is designed for an infection preventionist, and outlines specific tasks that need to be completed daily.
- Hand hygiene audit (Pathway Health): Hand hygiene is one of the foundational principles for infection control and prevention. This surveillance audit tool can be used by interdisciplinary team members.
- COVID-19 Prevention Messages for Long Term Care Staff (CDC Video Series)
- Proper handwashing (how-to video from National Church Residences)
- An Environmental Germ Testing Service that Enables Organizations to Quickly Determine if COVID-19 Virus is Present in their Facilities (Yahoo Money): In August 2020, Xenex Disinfection Services announced the launch of Trend™, a wastewater and environmental surface detection test for SARS-CoV-2.
- Purge Virus Webinar on COVID 19 Disinfection (YouTube video, 1/28/2021): This webinar covers different types of disinfection technology and devices that use ultraviolet light and bipolar ionization. The technologies in the presentation range from portable devices to in-duct HVAC solutions as well as ductless HVAC solutions such as PTAC disinfection, Mini-Split Systems and Ceiling Cassettes.
- Guidance about the best way to clean and disinfect wood furniture (H Contract): Includes best practices for cleaning and disinfecting, and comments on various commercially available cleaning products for wood furniture.
Dealing With COVID-Positive Residents
- Leadership Checklist for Potential COVID-19 Admissions (Pathway Health): The Leadership T.H.I.N.K. Ahead Strategies Guide can help an organization’s leaders think strategically about issues related to admitting individuals who are positive for COVID-19. T.H.I.N.K. refers to an organization’s “T-team,” or task force related to COVID-19; Human resource issues; Infection prevention and control issues; Notification issues; and Knowledge issues.
- Confirmed COVID-19 Resident Protocol Checklist (Pathway Health): This checklist, designed for facility leadership, outlines steps related to a confirmed COVID-19 resident. It was designed to highlight leadership, clinical, and staff actions in accordance with organizational policy and procedures, federal requirements, and state/local public health department requirements.
Other Infection Control Resources
- Disinfectants and COVID-19; Transmitting Without Symptoms (TTHealthWatch, a weekly podcast from Texas Tech)
- Senior Living Industry Confronts New Infection Control Reality (Senior Housing News)
- Infection Control in Senior Living Communities (American Seniors Housing Assn.)
- Use the Environment to Prevent and Control COVID-19 in Senior-Living Facilities: An Analysis of the Guidelines Used in China (SAGE Public Health Emergency Collection)
- Critical Infection Control Adaptations to Survive COVID-19 in Retirement Communities (Journal of Gerontological Nursing)
- Guidance on COVID-19 for the care of older people and people living in long-term care facilities, other nonacute care facilities and home care (WHO PDF)
- Protecting Long-Term Care Communities Through COVID-19 Surface Testing (white paper from Enviral Tech). This study used surface testing in 52 long-term care facilities over a 5-week period to determine if outbreaks can be detected earlier by monitoring the environment for the presence of the SARS-CoV-2 virus and to understand how the virus is distributed on indoor surfaces.
- LCS’ EverSafe 360° program, informed by COVID-19 experience, is designed to to boost overall safety for residents and staff. Elements include: creation of a medical advisory board; Engage, a resident assistance program; an enhanced telemedicine initiative; EverClean 360°, a program to improve cleaning solutions within communities; an initiative to improve indoor air quality; and a space management program to respect social distancing but support human interaction.
- The New Need for Infection Preventionists (HealthPRO Heritage Blog): Infection preventionists have quickly become key members of the interdisciplinary team and are responsible for critically important initiatives that will ultimately enable skilled nursing centers and senior living communities to safely care for our nation’s precious seniors.
- Airborne Transmission, Ventilation and Workplace Reopenings (The Forum, Harvard T.H. Chan School of Public Health): What is the latest scientific information about airborne COVID-19 transmission? (Dec. 11, 2020)
- COVID Impacts and Focus: Positioning to Survive and Excel (PharMerica recorded webinar): Part 1 of a collaborative fall webinar series between Premier and PharMerica examining the immediate impacts and learnings from the COVID-19 pandemic. Speakers present: key strategic actions essential for long-term organizational success; how to execute those actions to drive positive outcomes; essential strategic options to better prepare for the post-COVID landscape.
- COVID Impacts and Focus: Clinical Imperatives Moving Forward (PharMerica recorded webinar): Part 2 of a collaborative fall webinar series between Premier and PharMerica examining the immediate impacts and learnings from the COVID-19 pandemic. Identify key clinical imperatives stemming from the COVID crisis, differentiate between current and advanced SNF clinical models, and summarize other organizational practices around data-driven quality improvement.
- Infection Control Resources from LeadingAge:
- Medical experts discuss infection control practices for senior housing
- Home Health Infection Control Guidance
- Special Visitor and Infection Control Guidance for Hospice
- Template Screening Tool for Symptoms of COVID-19
- Infectious Disease Response for Affordable Housing Providers
- Environmental Cleaning and Disinfecting for Health (QuickCast)
- LeadingAge LTSS Center @UMass Boston research reports:
- Using COVID Sniffing Dogs in Assisted Living Communities (McKnight’s Senior Living): A Georgia-based senior living operator is partnering with a nonprofit service dog trainer to staff its metro Atlanta-based assisted living communities with COVID-sniffing canines.
Transfers and Admissions
- Transferring residents to and from acute care: FAQs from AMDA
- How should providers handle issues around sick workers and transfers from local hospitals? (LTSS Center research report)
Long-term care facilities, like all health care facilities, should prepare for potential shortages in clinical and non-clinical staff and have a plan and processes in place to mitigate such shortages. Part of the emergency planning process is to identify contingency and crisis capacity strategies to be considered.
Personal Protective Equipment (PPE)
- Infection Control, Prevention, and PPE: FAQs from AMDA
- COVID-19 Donning and Doffing of PPE (Pathway Health): Proper protection, including personal protective equipment (PPE), can contribute to the prevention of infection. This PPE process surveillance audit tool is specific to the current COVID-19 PPE sequencing requirements that can be used by interdisciplinary team members.
- Policy for donning and doffing PPE for COVID-19 (Pathway Health)
- How-to videos from National Church Residences:
- Policies for optimizing PPE supplies (Pathway Health):
- COVID-19: Chasing Science to Save Lives (The Forum, Harvard T.H. Chan School of Public Health): As the world sped towards the release of COVID-19 vaccines, cases were surging in record-breaking numbers. Dr. Anthony Fauci delivered the latest on the pandemic, vaccines, and the road to recovery. A global community of experts and scientists joined for this important discussion, which was moderated by Dr. Sanjay Gupta.
- Some Masks Will Protect You Better Than Others (Wall Street Journal): Scott Gottlieb, MD outlines how surgical masks outperform cloth, why an N95 is far superior to a bandanna, and more.
Protecting the Workforce
Maintaining appropriate staffing in facilities is essential to providing a safe work environment for our staff and to foster safe resident care. Long-term care facilities, like all health care facilities, should prepare for potential shortages in clinical and non-clinical staff and have a plan and processes in place to mitigate such shortages. Part of the emergency planning process is to identify contingency and crisis capacity strategies to be considered.
- Emergency Staffing Plan for COVID-19 Pandemic (Pathway Health): This tool provides key strategies for contingency staff planning as well as a policy template in alignment with current requirements.
- Flowchart for management of staff with exposure to a person with COVID-19 (Pathway Health)
- Competency Tool: Basic Nursing Skills for Non-Certified Caregivers (Pathway Health): This tool outlines the key skills and required competencies for non-certified caregivers. It is to be used in conjunction with the facility’s training plan for non-certified caregivers.
- Employer COVID-19 Screenings: Record Retention & Wage & Hour Responsibilities (M3 Insurance)
- A focus on staff helped several MI nursing homes limit the spread of COVID-19: study (McKnight’s): Making changes to where and how staff work and increasing pay appear to help reduce the spread of COVID-19 in long-term care, according to a study of approximately 215 residents at 3 Michigan skilled nursing facilities.
- Senior living operators wrestle with ‘holiday leave’ guidelines amid pandemic (McKnight’s Senior Living): The implications of “holiday leave” for residents eager to see loved ones and the toll another lockdown could have on older adults in their care.
- Strategies for Improving Staff and Resident Confidence in the COVID-19 Vaccine (AMDA): A list of ideas to help overcome hesitancy to get the new COVID-19 vaccine by staff and residents. You can choose which strategies best fit the needs of your community.
Emergency Use Authorization (EUA) authority allows the U.S. Food and Drug Administration (FDA) to facilitate the availability and use of medical countermeasures needed during public health emergencies.
On Dec. 11, 2020, the FDA issued the first EUA for a vaccine for the prevention of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 16 and older. This EUA allows the Pfizer-BioNTech COVID-19 vaccine to be distributed in the U.S.
On Dec. 18, 2020, the FDA issued an EUA for the second vaccine for the prevention of COVID-19, the Moderna COVID-19 vaccine, for individuals 18 and older.
The unprecedented speed of the clinical trials and approval of 2 vaccine options provided Americans with the first, albeit cautious, sense of optimism regarding COVID-19 mitigation. As expected, the extraordinary challenges associated with the distribution and administration of these vaccines to all receptive Americans over the age of 16 are daunting and unpredictable; consequently, information and guidelines are frequently modified based upon a wide range of field experiences.
Due to the volatility of guidance, accessibility, and overall detail associated with the vaccines and vaccination process, this Playbook features only vaccine-related content and resources that are more broad and less susceptible to frequent modification. Up-to-date, significantly more detailed information can be accessed on the LeadingAge website.
- Vaccination Toolkit
- CDC Hosts COCA Webinar on Post-Vaccine Events and Considerations
- CDC Holds Series of Calls on Pfizer COVID-19 Vaccine
- How to Automate Vaccination Pre-registration and Pre-filling of Consent Forms (LeadingAge CAST): An interview with Brandon Claps, CIO of Loretto. Completing the consent forms can be labor-intensive and time-consuming for organizations trying to vaccinate a large number of their residents and/or employees. The process can be automated and streamlined to save providers significant time.
- Why Is It So Hard to Get Vaccinated? (LeadingAge LTSS Center @UMass Boston): The lack of a centralized health care system has led to poor coordination between providers and government agencies, and confusion among consumers.
CDC educational resources:
- New CDC Vaccine Communications Toolkit
- CDC: Benefits of Getting a COVID-19 Vaccine
- CDC: Answering Patient’s Questions on Vaccines
- Healthcare Professionals: Preparing for COVID-19 Vaccinations
- Dec. 13 CDC Presentation: What Clinicians Need to Know About the Pfizer-BioNTech COVID-19 Vaccine
- CDC: Ensuring the Safety of COVID-19 Vaccines in the United States
- CDC Video About Vaccine Safety
- Executive Summaries of State COVID-19 Vaccination Playbooks
- Vaccine Availability: CDC shares how long-term care providers can ensure access to COVID-19 vaccines after on-site clinics end (McKnight’s Senior Living): Operators can continue receiving COVID-19 vaccines in multiple ways.
LeadingAge audio interviews:
- Sept. 23, 2020: Daniel Larremore of UC-Boulder on Computer Modeling, Testing, and Prioritization of Vaccines
- Dec. 21, 2020: Dr. Martha Dawson of NBNA on Outreach to the African American Community on Vaccination
- Dec. 28, 2020: 4 LeadingAge Members Share Vaccine Clinic Insights (includes lessons learned from members who were among the first providers to receive COVID-19 vaccinations for staff and residents. They included tips on streamlining the process, keeping communication frequent and transparent, and a discussion of the mild side effects some people experienced.)
- Related article from McKnight’s Senior Living, based in part of these members’ insights: Communication issues, staff reluctance plague early long-term care COVID-19 vaccine clinics.
- Jan. 4, 2021: US Surgeon General Dr. Jerome Adams on COVID-19 Vaccines, Plus CVS Program Updates
- Jan. 6, 2021: Robin Jump on Responding to Fears About Vaccination
- Alleviating Fears about the Vaccine with Dr. Jim Wright (LeadingAge Virginia webinar): A webinar with Dr. Jim Wright (a founding member and Attending Physician of SNF/LTC Partners of VA in Richmond and Medical Director at Our Lady of Hope in Richmond, VA)
- Vaccine Forum Explores Challenges, Opportunities for Senior Housing Providers (LeadingAge panel discussion): As many HUD-assisted senior housing communities hold COVID-19 vaccine clinics through the CDC’s Pharmacy Partnership for Long-Term Care Program, LeadingAge hosted housing providers and experts on a Jan. 19, 2021 panel to share insights and answer questions. A recording of the forum is available.
- COVID-19 Vaccine Education and Equity Project
- Vaccine Briefing – Development, Safety and Distribution (webinar from PharMerica): Insight into how this effort has progressed over the past year and address issues related to vaccine safety and efficacy, and the processes used to ensure vaccine quality. Highlighting the protocols used to ensure vaccine quality and the processes established to ensure seamless vaccine distribution, administration and reporting.
- Trust, Timing, and Covid: A Vaccine Study Among US Seniors (Tivity Health Consumer Research): Perceived costs, potential side effects and expected availability of a COVID-19 vaccine are potential barriers to vaccination for older adults, a nationwide survey has found.
- The Coronavirus Pandemic: Surging Cases, Rapid Diagnostics, and New Vaccines (Harvard T.H. Chan School of Public Health): With spiking coronavirus cases, America is looking to measures such as COVID-19 vaccines and the first, FDA-approved rapid COVID-19 self-testing kit to lessen the numbers and to give hope as 2020 comes to a close. Still, steps such as mask wearing and social distancing remain important in the fight against the spread of the pandemic.
- Time is now for coordinating employee vaccine process (McKnight’s Senior Living): Providers should be developing plans for mass vaccinations in a way that allows for the tracking of who has received their first dose and of what vaccine, as well as when the second dose is due.
- COVID-19 vaccine now a condition of employment for some senior living operators (McKnight’s Senior Living): Some senior living operators are moving to make a COVID-19 vaccination a condition of employment to more quickly mitigate the effect of the virus in their communities.
- How does an mRNA Vaccine Work? (University of Texas Medical Branch): A slideshow on mRNA vaccines, plus vaccine and agency links on other COVID-19 vaccine topics.
- The COVID-19 Vaccine Rollout – What’s Ahead? (The Forum, Harvard T.H. Chan School of Public Health): As the rollout of COVID-19 vaccines unfolds in the United States, numerous questions around distribution, supply, hesitancy, and efficacy persist. In this discussion, experts reviewed the COVID-19 vaccine distribution plan, addressed safety concerns, explored upcoming expected vaccines, and discussed implications of virus variants.
- Some senior living operators add vaccine access to marketing toolkits to help rebuild occupancy (McKnight’s Senior Living): As the COVID-19 pandemic sends occupancy rates plummeting in senior living communities, some operators are adding vaccine access to their marketing toolbox in a bid to entice prospective residents and fill vacant units.
- Most older adults optimistic about COVID-19 vaccine rollout but want more information (Kaiser Family Foundation Vaccine Monitor, 1/22/2021): A majority (70%) of adults aged 65 or more years are optimistic about the rollout of COVID-19 vaccinations, but they also don’t believe they have enough information about when (58%) and where (59%) they will be able to get vaccinated, according to the latest KFF COVID-19 Vaccine Monitor Poll.
- The Second COVID-19 Shot Is a Rude Reawakening for Immune Cells (The Atlantic): Side effects are just a sign that protection is kicking in as it should.
- The Coronavirus Pandemic: Variants, Vaccines and More (video from Harvard T.H. Chan School of Public Health): In this online Q&A, epidemiologist William Hanage and The World’s Elana Gordon will explore the implications of these variants for vaccine effectiveness, prioritization, and distribution. They will also discuss the continuing need to socially distance, wear masks and undertake other steps to stay safe.
- The COVID-19 Vaccine Rollout: What’s Ahead? (video from Harvard T.H. Chan School of Public Health): Safety and side effects, global equity, who goes first, hesitancy, and takeaways.
- On The AMDA Update on COVID-19 page, a one-stop site for a wide variety of AMDA’s pandemic resources.
- State Strategies for Ongoing Post-Acute and Long-Term Care Resident and Staff COVID-19 Vaccination (PDF): This guidance helps prepare for ongoing vaccination programs to cope with the usual turnover in residents and staff in a long-term care community. (On The AMDA Update on COVID-19 page, a one-stop site for a wide variety of AMDA’s pandemic resources.)
- Interim Recommendations for Communal Activities and Visitation in Post-Acute and Long-Term Care Facilities (AMDA PDF): This guidance covers the need for continued masking, physical distancing, and use of other essential infection control precautions, and discusses risks from vaccine hesitancy, continued community outbreaks, and more.
- Vaccination tied to all-time low in long-term care COVID-19 deaths (Kaiser Family Foundation issue brief): COVID-19 cases deaths among assisted living and nursing home residents and staff members have fallen dramatically since vaccines were introduced in December, with deaths declining by almost 89% and cases by nearly 92%, according to a Kaiser Family Foundation analysis.
Resources to Support Discussions about Vaccine Hesitancy in Nursing Homes:
- The Institute for Healthcare Improvement (IHI) has developed 2 documents to help support conversations about vaccine hesitancy with nursing home staff: COVID-19 Vaccine Education: A Guide for Conversations with Nursing Home Team Members (includes a script outline and ideas for preparing and having conversations about vaccine hesitancy) and accompanying slides.
- The American Health Care Association/National Center for Assisted Living has many toolkits and resources to support these discussions on the AHCA #GetVaccinated website.
- Vaccination Communications Tool Kit (ACHA/ NCAL): Encourages long term care staff and residents to get the COVID-19 vaccine. Includes tips for communicating the importance of vaccination and highlighting progress, along with template letters, sample social media, and media prep material.
- Protect Pregnant Women Through Research not From Research (NPR): Doctors who treat pregnant patients are finding themselves in a tough and familiar spot as the COVID-19 vaccines roll out: making decisions about the use of a particular medicine in this group of patients without any clinical evidence to guide them.
- Safe Pregnancy as COVID Surges: What’s Best for Mom and Baby? (NPR)
- Addressing Vaccination Myths and Misconceptions (New York Times): We are concerned about how inaccurate, extreme and widespread these theories have become, because getting vaccinated is the best way for women to protect themselves and their families.
- Mother to Infant Transmission of COVID 19 Appears to be Rare (NIH): Pregnant women who experienced severe symptoms of COVID-19 had a higher risk of complications during and after pregnancy, according to preliminary findings from a National Institutes of Health study. Compared to COVID-19 patients without symptoms, those with severe symptoms were at higher risk for cesarean delivery, postpartum hemorrhage, hypertensive disorders of pregnancy and preterm birth.
- COVID Vaccine Efforts: The Push to Reach Wary Medical Workers (New York Times)
- Outline for Vaccine Hesitancy Conversations (Institute for Healthcare Improvement handout): “We developed two short resources (a text document and a slide presentation) to guide nursing home leaders in conversations with staff members and residents. These materials are designed to help each individual think through whether or not they would like to receive the COVID-19 vaccine and to address any questions or concerns.”
- Outline for Vaccine Hesitancy Conversations (Institute for Healthcare Improvement slide deck)
- CCRC operator encouraging employee COVID-19 vaccinations with cash bonuses (McKnight’s Senior Living): AZ-based Sun Health is providing cash bonuses to employees who receive their COVID-19 vaccinations, as well as paid time off should side effects prevent any vaccinated employee from being able to work.
- Tyler Perry on Vaccine Acceptance (YouTube video): The half-hour special provides helpful and factual information for viewers looking to protect themselves and their families from this unprecedented crisis. Tackling issues head-on, Perry asks the hard-hitting questions to help the community gain insight into this new vaccine.
- Not here, not us: Internal vaccine campaign allows senior living community’s residents to “get their lives back” (McKnight’s Senior Living): A few weeks out from the one-year anniversary of one of the earliest clusters of COVID-19 in the country, Lambeth House [a LeadingAge member] is looking forward to letting residents “get their lives back.”
- Vaccine success at Peconic Landing is a story worth repeating (Newsday editorial, 2/7/2021): Residents of Peconic Landing [a LeadingAge member] won the lottery last week, when representatives from Stony Brook Medicine showed up to the Greenport retirement community to administer about 650 doses of the COVID-19 vaccine. State, county, and hospital officials must find ways to replicate this success story.
- Ways to boost COVID-19 vaccination uptake—a report by the COVID-19 Vaccination Uptake Behavioral Science Task Force (February 2021). This report “integrates insights and concrete/practical recommendations from a high-level team of behavioral science experts regarding a specific question—how can we increase COVID-19 vaccine uptake among employees of long-term care facilities?” Components include: an initial review of research findings about factors correlated with vaccine uptake, and meta-analysis of predictors of COVID-19 vaccine uptake specifically; and specific suggestions to improve vaccine uptake among long-term care facility staff from each task force member. Listen to a March 2021 LeadingAge interview with Dr. Sigal Barsade, the Task Force Chair.
- 3 keys to optimal COVID vaccine campaigns for senior living organizations (McKnight’s Senior Living): Organizations that make COVID vaccinations part of their health and wellness programs will put everyone in a better position for what’s ahead.
- Nursing home employee vaccination rates trail those of other health care workers (VTDigger): About 60% of workers at Vermont’s skilled nursing facilities have been vaccinated — a far cry from the vaccination rate at other types of health care facilities, where up to 90% of workers have received the vaccine.
- Going from 20% to 86% Staff Acceptance of Vaccines: The Rev. Dr. Derrick DeWitt, chief financial officer with the Maryland Baptist Aged Home, joined the LeadingAge Coronavirus Update Call on Feb. 10, 2021 to talk about his experience with COVID-19 and with overcoming staff member vaccine hesitancy.
- Vexed by vaccinations? 5 communication strategies to encourage ongoing adoption (McKnight’s Senior Living): Approximately 40% of health care workers are reticent to take the COVID-19 vaccine. The reality is, if we cannot figure out the best ways to communicate, then vaccine adoption will continue to lag, plaguing health care workers and the broader public.
- Listening is key to addressing senior living staff vaccine hesitancy (McKnight’s Senior Living): Combatting vaccine hesitancy in senior living staff members is as easy as listening, according to a senior adviser in the National Institutes of Health.
- Facts Over Fear – The COVID-19 Vaccines (video from Harvard T.H. Chan School of Public Health): Vaccine fears are as old as vaccines themselves. But vaccine denialism has emerged as one of the biggest global health threats of the 21st century, with misinformation and rumors threatening to undo one of the greatest scientific achievements of the last 200 years.
- The Coronavirus Pandemic: Vaccine Acceptance and Public Attitudes (The Forum, Harvard T.H. Chan School of Public Health): As coronavirus vaccinations increase in the United States, questions about vaccine acceptance linger.
- Civitas Senior Living joins providers mandating employee COVID-19 vaccination (McKnight’s Senior Living): Civitas Senior Living is the latest senior living owner and operator to announce a mandatory COVID-19 vaccination policy for employees.
- Enlivant and Sunrise added to the list of operators mandating COVID-19 vaccines for employees (McKnight’s Senior Living): Enlivant and Sunrise Senior Living will require employees to be vaccinated against COVID-19 as a condition of employment. They join a growing list of senior living operators, among them ALG Senior, Atria Senior Living, Civitas Senior Living, Juniper Communities, and Silverado, in announcing such policies.
- Long-term care staff vaccine hesitancy: Safety, efficacy, newness, distrust top factors (McKnight’s Senior Living): Safety, efficacy and the newness of the COVID-19 vaccine, as well as distrust of the government, were among the major factors that long-term care and other health care workers cited as reasons for not receiving a coronavirus vaccine in a recent survey.
- ‘Knowledge is power’ in campaign to improve staff vaccine uptake (McKnight’s Senior Living): Forest Hills of DC, an assisted living, memory care, skilled nursing and short-term rehabilitation provider in the nation’s capital, used that mantra to move the needle on staff vaccine uptake from 50% to 86%. See this CNN video interview with Forest Hills CEO Tina Sandri.
- Paid time off, additional education may help employers counter COVID vaccine hesitancy (McKinsey & Company): Paid time off for vaccination and recovery is one of the most influential actions employers can take to increase COVID-19 vaccination uptake, according to a report examining vaccine hesitancy of employees at approximately 400 U.S.-based companies across a broad range of industries, conducted by management consultant firm McKinsey & Co.
Design for Infection Control and Future Safety
Among the many necessary changes to post-pandemic senior living will be the need to modify existing floor plans and develop new architectural designs to mitigate the spread of infection. Whether it’s as simple as designing common areas to be more spacious, or as complex as constructing an entrance area that accommodates several employee/visitor screening methodologies, we must design defensively to combat this and possible future viral outbreaks. Several LeadingAge business members have generously offered to share their approaches to infection control via design for our Playbook.
- Designing for Independence (DiMella Shaffer): Nine fundamental design principles are outlined here to create a community that can adapt quickly when unplanned events occur that require adjustments to operations and resident life.
- Designing Senior Housing for Safe Interaction (MASS Design Group document)
- How Will Senior Living Change in the Wake of COVID-19? (DiMella Shaffer): Over 70 senior living providers, designers, representatives from AARP, LeadingAge, and the City of Boston convened for a virtual discussion centered around the lessons learned so far, and how the development of healthy senior living environments will change in the wake of COVID-19.
- Where Do We Go from Here? The COVID-19 Sentiment Report (RLPS Architects): Valuable insights to help reshape communities and services for market strength and resiliency.
- Post-Pandemic Priorities: Interior Design Strategies for Senior Living (RLPS Interiors): See a different approach to senior living design strategies, such as space layouts, finish materials or furniture and equipment selections, to help senior living communities respond to changing priorities.
- Moving Forward: A Senior Living Post-COVID Design Toolkit (Perkins Eastman): A concentrated, collaborative approach to strategic planning and conceptual design services to address the resiliency of your community during pandemics or other major disruptive events. Assesses operational, marketing, and financial strategies to determine design standards for maintaining the emotional and physical well-being of residents and staff. Three related webinars:
- Senior Living Readiness Assessment (Amenta Emma Architects): Examines readiness of facilities (including checklists), sample visitation and resident-ready plans, and more.
- Nursing Home Renovations in a Post-COVID World (graphic diagram from Amenta Emma Architects)
- Design Strategies for Safer Senior Living Communities (American Institute of Architects): This resource is intended to provide design professionals, employers, building owners, and public officials with tools and resources for reducing risk when re-occupying buildings during the pandemic.
- Designing the future of senior living with lessons from the pandemic (McKnight’s Senior Living): It’s time to look more purposefully to the future and to consider not just how our communities should function in light of the coronavirus pandemic, but how they should be designed, configured and, ultimately, reimagined.
- Audio interview: Oct. 21, 2020: Dr. Ken Mead of NIOSH on Air Purification, Filtering, and COVID-19
- New community incorporating infection control design changes (McKnight’s Senior Living): This 81-unit assisted living and memory care community will include sanitation stations, touchless faucets and light switches in common spaces, needlepoint bipolar ionization through HVAC systems, and electrostatic sprayers that disperse positively charged particles to neutralize infectious diseases.
- State of Ohio offers $28 million air quality program for senior living facilities: Deadline extended to June 30, 2021. (Ohio Dept. of Aging): In the continuing battle to weaken COVID-19’s spread, the state of Ohio is offering $28 million in federal CARES Act dollars to reimburse facilities serving older Ohioans that invest in air quality and air flow improvements during the pandemic.
- CDC Guidance: Ventilation in Buildings. SARS-CoV-2 viral particles spread between people more readily indoors than outdoors. When indoors, ventilation mitigation strategies help to offset the absence of natural wind and reduce the concentration of viral particles in the indoor air.
- Safe, Breathable Air: The Long-Term Playbook (Erlab, Inc.): Document regarding air quality upgrades in commercial spaces.
- Operational, design changes adopted during pandemic will continue (Perkins Eastman survey results): The COVID-19 pandemic severely affected the senior living sector, and the disruption likely will generate long-term changes in design and operations, according to a survey of 200 industry professionals conducted by New York-based architecture firm Perkins Eastman.
- Designing Safer Long Term Care Facilities (McKnight’s webinar): Revolutionizing infection prevention, visitor management, and more, all through the power of autonomous monitoring and AI. Featured speaker: Todd Schmiedeler of Trilogy Health Services.
In the midst of an emergency as impactful as a pandemic, we must often act first and reflect later. It’s common for leaders to ask themselves retrospective questions, such as:
- Did I act too quickly or too slowly?
- What could I have done differently?
- Did my approach of choice work as well as I anticipated it would?
- How can I improve my responses if a pandemic recurs?
- And then, of course, there are a lengthy series of “What ifs” that we ponder.
LeadingAge has received numerous “lessons learned” tips from members during the COVID-19 pandemic, which we are sharing at the conclusion of each related Playbook Section. In addition, a compilation of shared Lessons Learned may be referenced in the Playbook Appendix.
- April 6, 2020: Carla Rafferty of Asbury Place Maryville on Coronavirus Policies for Assisted Living, Independent Living, and Skilled Nursing.
- May 11, 2020: Neal Buddensiek, M.D., of Benedictine on a Multi-State Provider’s Pandemic Preparation, and Concerns About Testing
- May 15, 2020: Carol Silver-Elliott of The Jewish Home Family on Fighting COVID-19 in the New Jersey Hotspot.
- June 1, 2020: Maureen Carland of Maine Veterans’ Homes on Handling a Large Outbreak of COVID-19, and Why Planning for it is so Hard.
- June 19, 2020: Capt. Joselito Ignacio of FEMA on Quality and Decontamination of PPE.
- June 30, 2020: Katrina Gray of Buckner Retirement Communities on Procuring and Managing PPE.
- Dec. 2, 2020: Joshua Weitz of Georgia Institute of Technology on Community Spread and Risk
- Readiness Design: 5 Insights for Senior Living Communities to Consider Post-Pandemic (Meyer Senior Living Studio). How design will change and affect senior living communities in the immediate future and in the long term. Insights cover layout and flexibility; technology; building systems; materials and finishes; and wellness.
- Factors Associated With COVID-19 Cases and Deaths in Long-Term Care Facilities: Findings from a Literature Review (Kaiser Family Foundation): Spread in the greater community, staff member infections, facility size and the racial makeup of residents are among the factors associated with COVID-19 cases and deaths in long-term care facilities, according to the results of a Kaiser Family Foundation study.
- What these senior living operators did to get through pandemic COVID-free (McKnight’s Senior Living): Remaining COVID-free during a global pandemic, according to the leader of a Wichita, KS, assisted living community, took a group effort of strict adherence to infection prevention protocols.