Older adults at ‘ground zero’ during COVID-19 pandemic

As the numbers of COVID-19 cases and deaths in long-term care settings continue to climb, post-acute care leaders are calling for more funding, testing, staffing and PPE.

“Older adults are living at Ground Zero in the worst pandemic in a century,” Katie Smith Sloan, president and CEO of LeadingAge, a national association of aging services providers, said Monday during a press conference. “How many of the most vulnerable Americans must die before we see meaningful relief?”

The situation in long-term care is becoming increasingly dire as community spread of COVID-19 skyrockets across the country. Long-term care leaders are calling on government officials and all Americans to help stop the spread of COVID-19.

“This is a plea. Nursing homes really are at the brink. We are at our financial brink. We are at our operational brink. We are at our emotional brink,” said Deke Cateau, CEO of A.G. Rhodes, an Atlanta nursing home provider.

Positive cases for nursing home residents rose 21% from the first week of November to the second, according to the American Health Care Association and National Center for Assisted Living, which represents nursing homes and assisted living communities. In the U.S., there were 12,429 resident cases the week of Nov. 8.

At Friendship Haven, a life plan community with independent and assisted living, skilled nursing and memory care in Fort Dodge, Iowa, there were 11 new resident cases last week and another new case Monday, President and CEO Julie Thorson said. Twelve employees are out with COVID-19, and another 17 are off with symptoms or from exposure, she said.

“What’s frustrating is that community spread is not only still happening, it’s worse than ever before,” Thorson said. “It’s time for us to focus on solutions. It’s time for us to focus on lifting each other up.”

As hospitals run out of beds and capacity, nursing homes, facing staffing concerns and infection control precautions, are struggling to accept patients, said LeadingAge Wisconsin President and CEO John Sauer.

Sauer, whose son has since recovered from COVID-19, urged Americans to take personal responsibility for the safety of older Americans.

“It’s a form of ageism for us to ignore that the virus will attack and kill older adults. We have to take that on as a responsibility,” Sauer said. “We need to think beyond just ourselves. We need to think about the rest of society and how we can contribute.”

LeadingAge and its state leaders issued an open letter to the public Monday asking Americans to wear masks, to physically distance and to wash their hands to prevent the community spread of the virus.

They wrote, “Please ask yourself: As COVID-19 surges, would you want your grandmother or grandfather to be exposed to the virus? How bad would it be if your older loved ones got sick? What if they had other health conditions, like asthma or diabetes, that make them more vulnerable to death from COVID? Each of us has the power to protect the older adults we love, and those who live in our neighborhoods and communities. Working together, we can save lives.”

Heading into the holiday season, the isolation necessary to protect long-term care residents from community spread will make the pandemic more challenging, leaders said. Families won’t be able to visit residents, group meals among residents won’t happen and volunteers won’t be able to come in to celebrate, they said. Instead, staff will turn to virtual visits and, in some cases, outdoor visits, Smith Sloan said.

Smith Sloan said her organizations has tried to work closely with CMS during the pandemic but has been “very disappointed” by the lack of coordination and the lack of planning by the agency.

“At the beginning of this pandemic, we knew older adults were the most impacted. We had a chance to put together a national strategy and plan. But instead it’s really been patchwork series of responses and it continues to be,” Smith Sloan said.

As cases climb, tests still aren’t being turned around fast enough to prevent the spread of COVID-19 in nursing homes, according to a recent study completed by researchers at the University of Rochester, Harvard University and Brigham and Women’s Hospital.

The federal government sent rapid point-of-care diagnostic testing devices to nursing homes and requires surveillance testing based on community spread levels, yet many nursing home favor PCR tests, which are known to be more accurate but also require lab processing instead of providing on-site results, said David Grabowski, a professor of healthcare policy at Harvard Medical School and one of the study’s authors. There also are regulations at state and local levels that require PCR tests, leaving nursing homes to figure out what to do with the antigen tests from the government.

Cateau said he is very grateful for the tests that have been sent by the government, noting that “A test is better than no test.” But he said it would be very helpful to get more PCR testing.

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