Nursing facilities examine change brought about by pandemic

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The United States is learning from the COVID-19 pandemic. Among these is what works best for the care of the elderly.

Across the state of Missouri, all hands were on deck to find best practices as the pandemic worsened in 2020.

Public health officials felt they understood what it would take to get through a pandemic at the start of the year.

This was before the COVID-19 pandemic broke out in February.

Most of the plans focused on a 30- to 60-day crisis, said Steve Bollin, director of licensing and regulation for the Missouri Department of Health and Major Services.

Bollin, who had been in emergency management for communities for 15 years before arriving at licensing and regulation in October, said the Ebola outbreak in the United States in 2014 boosted confidence that a pandemic could be contained within a short period of time.

Ebola was first detected in the United States on September 30, 2014, when a man who traveled to West Africa contracted the disease in Dallas. He died on October 8, 2014. Two health workers who treated him tested positive for the disease. On October 23, 2014, a volunteer medical aide in Guinea was hospitalized in New York for this disease. Seven other people exposed to the disease in West Africa contracted the disease and were treated in the United States. However, strict prevention and control practices kept it from spreading further and the disease was contained in about 30 days.

“The pandemic was an area where you just never knew how long things were going to last,” Bollin said. “I think (COVID-19) went a lot further – technically we’re still there – but it’s gone a lot further than anyone expected.”

Questions arose every day. One day the answer was “no”. The next day the answer to the same question was ‘yes’, he said. It could be “no” the next day.

“Things were moving so fast – it was literally a day-to-day situation … from April 2020 to December,” he said. “When the vaccines started to show up, it was really when we felt we had taken a step forward – and that we really started to make progress. “

This was also when things started to change in retirement homes.

The Commonwealth Fund, which supports independent research on health issues and provides grants to promote better access and health outcomes, examined the challenges to improving the outcomes and experiences of nursing home residents after the pandemic.

Nursing homes were already in crisis before the pandemic, according to the Commonwealth Fund report, “Strengthening Nursing Home Policy for the Post-Pandemic World: How Can We Improve the Health Outcomes and Experiences of residents? “

According to the report, many healthcare facilities face poor quality of care, a flawed payment model, ineffective regulation and a lack of transparency regarding patient outcomes.

The residents are primarily Medicare or Medicaid beneficiaries, according to the report. While Medicare is “generous” as a payer, the report says, Medicaid often pays below the cost needed to care for individuals. So many facilities rely on admitting enough short-term Medicare patients to “subsidize” longer-term Medicaid patients.

And low wages prevent nursing homes from hiring and retaining skilled caregivers.

To align costs, the report suggests that the federal government contribute more to Medicaid so the program can pay higher rates to cover the costs of long-term care. The report encourages policies that require more clinicians on site. And he suggests increasing the salaries of caregivers.

Another challenge to be overcome is the provision of sufficient numbers of nurses and nurse assistants to meet the needs of residents.

Data shows that as of Friday, according to the Centers for Medicare and Medicaid Services, there have been 655,623 cases of COVID-19 in patients in nursing homes nationwide, with 132,703 deaths. In addition, 584,596 shelter staff were diagnosed with COVID-19 and 1,934 have died.

We still have a long way to go before the pandemic is over, but in recent months there have been reassuring signs of a return to something that looks like normal before the pandemic, officials said.

COVID-19 in nursing homes has been a difficult year for state health officials, said Shelly Williamson, administrator of the DHSS section for long-term care regulation.

“We have worked a lot with the outbreaks – supporting them in their epidemics,” said Williamson. “Just make sure they have all their resources and everything they need. “

Its section provides the advice nursing facilities need to manage their epidemics.

This has been his main focus over the past year, she continued, but he has been able to continue some of his normal activities, such as conducting inspections and surveys in nursing homes, a she declared.

The state didn’t have a good plan for the pandemic before it hit, but every pandemic is different, so it would have been nearly impossible to anticipate every correct mitigation step, Bollin said.

Nursing homes should report to the section when they have outbreaks of COVID-19 (a case is an outbreak), Williamson said. Once this happened, the section contacted the facilities and assisted them with testing and ordering personal protective equipment. This allowed some administrators to understand the quarantine, isolation and “cohortation” guidelines – separating those who tested positive for the virus from others in the homes.

And he tried to make sure the facilities had enough staff.

“They just need to provide them with different information and resources so that they can better manage this epidemic,” she said.

Missouri even contracted with a national temporary recruiting agency to make sure it always had a resource for nurses, registered nurses, therapists and even housekeepers, Bollin said.

The State therefore worked with the facilities to optimize the personnel available to them.

Staffing was an issue before the pandemic for many facilities, he said.

“Nursing has been a challenge for several years in hospitals and long-term care facilities. So it was an ongoing conversation, ”he said.

The state used funding from the Coronavirus Aid, Relief and Economic Security Act to provide some support to hospitals, which were operating at 110% of capacity and were trying to manage COVID-19 patients.

The flip side, Bollin said, was that long-term care facilities were seen as safety valves to remove patients who required a lower level of care from hospitals, making room for more COVID patients. -19.

Lesson number one, Bollin said, is to keep planning and keep working on the pandemic, and wait for the next problem to happen. Nursing homes were a good place to send patients, creating capacity in hospitals.

But they had to have more staff. And officials had to transport patients.

“We actually developed a map that showed where the hospitals are and where the long-term care facilities are around them, so that they can move patients if need be, close enough to where they are. their families were, ”he said. “So if their families wanted to go see their loved ones, they didn’t have to drive five hours to do so.”

That’s not to say there weren’t patients that hospitals were transporting four or five hours away because there was simply nowhere else to go. It has happened.

“We have learned a lot about handling cases in a crisis situation like this, which will help us in our future efforts,” Bollin said. “We also made a lot of transitions, improved a lot of our processes and made ourselves more efficient. Most importantly, we’ve learned that we need to better build intra-departmental, department-to-department partnerships across state. We also need to be much closer to our local partner healthcare agencies – the local providers who are there.

“Because it’s really a situation where everyone is on the bridge. “

In its report “Reimagining Nursing Homes in the Wake of COVID-19”, the National Academy of Medicine finds opportunities to improve facilities.

It calls for physical accommodation and operations to allow for increased patient isolation, social distancing and reduced bicycle trips by staff members.

The report calls for people with “matching” needs to be located in similar care sites – putting patients in palliative care with like-minded patients or placing relatively healthy patients who have “pure memory impairments” in care settings. “Memory centers”, designed to manage their specific needs.

He suggests that long-stay patients with multiple co-morbidities might be better served in smaller facilities, such as Green Houses, which offer home-style care environments and are limited to just 18 beds, where each resident has a bedroom and a private bathroom.


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