key: cord-315920-9p6ar3cr
authors: Quigley, Denise D.; Dick, Andrew; Agarwal, Mansi; Jones, Karen M.; Mody, Lona; Stone, Patricia W.
title: COVID‐19 Preparedness in Nursing Homes in the Midst of the Pandemic
date: 2020-05-12
journal: J Am Geriatr Soc
DOI: 10.1111/jgs.16520
sha: 
doc_id: 315920
cord_uid: 9p6ar3cr

nan

On average, NHs used two to five guidance documents for COVID-19. The most common were: Center for Disease Control and Prevention (88%), state or local health departments (84%), corporate (53%), World Health Organization (48%), local hospital/healthcare organization (39%), and the Association for Professionals in Infection Prevention and Epidemiology (27%). Staff responsible for preparedness most often included infection preventionists (39%), directors of nursing (32%), and administrators (27%).

Slightly more than half of NHS (54%) had separate COVID-19 plans, and others included COVID-19 in their current disaster preparedness plan (46%). All had: plans for training staff to address COVID-19 (100%), processes to limit/restrict visitors (100%) and outside vendors/consultants (100%), policies regarding ill employees returning to work (100%), and guidance for employees regarding COVID-19 outbreak (100%). Almost all (96%) had policies for screening visitors. Some (29%) conducted COVID-19 outbreak simulations.

NHs reported clear lines of communication and relationships with hospitals. Most (68%) indicated they had a local referral hospital accepting their patients under investigation for COVID-19. Most indicated clear lines of communication with public health officials (96%) and nearby hospitals (87%) regarding their role in containing/managing the pandemic. One-fourth (25%) indicated they were counted on as an alternative care site for hospitalized COVID-19 patients, and more than three-fourths (79%) were accepting non-COVID-19 patients as hospital overflow. Few (18%) planned to discharge residents to free beds for hospital patients.

Two-thirds reported access to COVID-19 testing (66%), with testing available for patients (100%) and some staff (53%). Nearly three-fourths (72%), however, reported having inadequate supplies. Among those were N-95 respirators (90%), gowns (90%), face guards/eye protection (88%), alcohol-based sanitizer (67%), surgical masks (64%), and gloves (39%). Five-sixths (83%) expected significant staff shortages. Common strategies to address staff shortages included having staff volunteer for extended hours (55%) and nonclinical staff filling different roles (45%). Less common were using contracted/agency staff (19%) and mandating extended hours (16%). When asked their greatest COVID-19 preparedness concern, administrators cited lack of supplies (43%), staff shortage (34%), and resident health and safety (14%).

Equipment concerns typically related to availability of personal protective equipment (PPE) (29%), including N-95 masks and respirators, face shields, and plastic zipper tents. One administrator lamented, "Not having enough PPE to keep up with a COVID-19 outbreak and sufficient staffing if staff become ill." Another noted, "Not enough available supplies for staff, such as an N-95 masks or respirators or face shields; now we are using cotton-made face masks and…sanitary pads as an additional barrier."

Staff shortages focused on licensed staff. One cited, "Licensed staffing availability, specifically RN/LPN [registered nurse/licensed practical nurse] are hard to recruit in our market. We have plenty of nonlicensed staff." Another cited, "Not enough staff to deal with the increased needs of patient[s]."

Few NHs indicated the COVID-19 financial impact was unknown (14%) or nil (13%). Most indicated increased costs for supplies (58%) and employee hours (38%), or fewer admissions (27%). One administrator said, "Employee fears are affecting call-ins and the ability to replace staff on the floor, resulting in increased overtime." Another noted "social distance" requirements meant more staff time was needed to serve meals. Several noted postponement of elective surgeries led to fewer admissions for postsurgery rehabilitation.

NHs are having trouble responding to the COVID-19 pandemic, despite Medicare and Medicaid changes that have recently increased infection prevention infrastructure. 7 Our national results are similar to a survey of Michigan NHs, 8 demonstrating the extent of this problem. Our small sample means we can only offer descriptive results. Nevertheless, our results do indicate the need for NHs to continue refining their preparedness strategies in response to local virus prevalence, resident population, and local regulations, including state policies on accepting COVID-19 patients discharged from hospitals.

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Conflict of Interest: The authors have no conflicts.Author Contributions: Denise Quigley, Lona Mody, and Patricia Stone formulated the study concept and design, analyzed the data, prepared the manuscript, and worked with Mansi Agarwal, who administered the survey and drafted the table, along with Andrew Dick, Patricia Stone, and Karen Jones, who helped in the interpretation of the data and final drafting of the manuscript. Lynn Polite assisted with formatting and submission of the documents.Sponsorʼs Role: The sponsor approved of the concept of the study.Financial Disclosure: Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01 NR013687.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.