key: cord-0796099-qtjuq76e
authors: Rubano, Mario D; Kieffer, Elana F; Larson, Elaine L
title: Long-term Care and COVID-19: An Equitable Recovery
date: 2021-11-18
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2021.11.010
sha: 4df9d78719bac9cbcd653eeeec93a8ad7301e5c7
doc_id: 796099
cord_uid: qtjuq76e

nan

August 2021, influenced by the Delta variant, the mortality rate in NHs quadrupled while the rate in the general community doubled. 4 While the devastating impact of the pandemic on older adults in LTC settings may reflect society's deeply rooted ageism, the added dimension of race appears to compound these age-based inequities. An analysis of 13,312 NHs found that facilities with the highest proportions of non-White residents experienced over three times the number of deaths than those facilities with the highest proportion of White residents. 5 Efforts to maintain a safe environment free of the spread of infectious disease are also complicated by the inherently conflicted nature of these institutionsthey are expected to be both the primary residence and the primary provider of medical care for large numbers of older adults. While the high numbers of fully vaccinated residents are to be celebrated, the problem of IPC compliance among direct care workers (DCWs) persists. One study demonstrated a significant "bump" in acute care IPC compliance in the early stages of the pandemic that then trended downwards by the end of the five-month study period. 6 All this places considerable responsibility on the DCWs that provide life-sustaining interventions as well as the critical social and emotional connections during a time of restricted visitations. The neologism "COVID fatigue" is relatable to all of us who have experienced the pandemic, but the outsized burden borne by NH staff is unique among healthcare professionals.

Even before the pandemic, nurses in NHs had been shown to experience higher rates of burnout than nurses in any other setting. 7 Feelings of overwhelm and exhaustion can impact the quality of care that is provided. A survey of NH nurses found that 95% of nurses experiencing burnout reported at least one missed care event during their most recent shift. 8 In the context of COVID-protocol, poorly surveilling the early symptoms of COVID-19, or neglecting to use/misusing personal protective equipment (PPE)) could result in an outbreak within a unit and trigger the loss of morale that accompanies a sudden return to strict unit lockdown procedures. 9 Systemic and organizational changes must be implemented to support and protect the residents and staff that live and work in these communities. A focus on building a "just culture" within a NH organization can help to eliminate the many communication failures that occur between DCWs and unit managers and administrators. Frontline staff who fear punishment or penalty for reporting their own or a colleague's error will be less inclined to share this information with managers or supervisors, 10 yet knowledge of these events is critical for maintaining an effective IPC program. Systems of shared accountability, along with a pivot away from purely punitive policies, can encourage an organization to "learn together" and facilitate the building of more effective solutions that are unique to the needs of each community. It may also communicate from leadership an awareness of and sensitivity to the stress under which NH DCWs are working.

Research into these trends within NHs lags behind other healthcare settings and will likely continue to lag as the field of nursing research navigates the obstacles that have stalled, or stopped entirely, many ongoing studies. 11 If we are to see an equitable recovery to the pandemic, it is crucial that researchers prioritize projects that can help us to better understand the ongoing IPC needs of NHs.

Common infections in nursing homes: a review of current issues and challenges

COVID-19 nursing home data

Estimates of COVID-19 cases and deaths among nursing home residents not reported in federal data

Nursing homes experienced steeper increase in COVID-19 cases and deaths in August 2021 than the rest of the country

Factors associated with racial differences in deaths among nursing home residents with COVID-19 infection in the US

The impact of COVID-19 pandemic on hand hygiene performance in hospitals

Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care

Registered nurse burnout, job dissatisfaction, and missed care in nursing homes

Protecting nursing homes and long-term care facilities from COVID-19: A rapid review of international evidence

A just culture: the role of nursing leadership

COVID-19 and nursing research across five countries/regions: Commonalities and recommendations