key: cord-0857074-6k0qolpf authors: Davidson, Patricia M.; Szanton, Sarah L. title: Nursing homes and COVID‐19: We can and should do better date: 2020-05-11 journal: J Clin Nurs DOI: 10.1111/jocn.15297 sha: 18fe567646ce3da71a691d34ed49ce5f7beb86c9 doc_id: 857074 cord_uid: 6k0qolpf The COVID-19 pandemic is providing us with many painful lessons particularly the vulnerability of individuals living with chronic conditions and the need for preparedness, coordination, and monitoring. Long-term care facilities, including nursing homes, skilled nursing facilities, and assisted living facilities, provide care for some of the most vulnerable populations in society, including older people and those with chronic medical conditions. In the United Kingdom, there are about 17,000 people living in nursing and residential care homes and 200,000 Australians live or stay in residential aged care on any given day. States signalled the beginning of the COVID-19 pandemic in the United States, where there were 35 deaths in a single King County facility. The numbers of positive cases and deaths in nursing homes from COVID-19 continue to rise in other residential facilities across the world (Adalja, Toner, & Inglesby, 2020; Bedford et al., 2020) . Nursing homes have been documented as having high transmission rates for infectious diseases for a range of reasons including crowding, sharing of bathroom facilities and gathering in common areas as well as low preparedness for infection control. Recognising the high risk associated with these facilities, the Centers for Disease Control in the United States has released interim guidance for the prevention and control of COVID-19 (Centers for Disease Control & Prevention, 2020). Staffing shortages and frequent staff turnover, high resident-to-staff ratios, supply shortages, and inadequate infection prevention and control measures are well documented in these settings but solutions are less apparent (Dorritie et al., 2020) . In recent times, there has been a focus on admissions to acute care from nursing homes because of lack of resources to manage clinical deterioration (Considine et al., 2019) . Strategies have been trialled to augment nursing care, such as nurse practitioners providing consultation, but these are not systemic solutions; we need to be strategic and data driven in health workforce planning. A global pandemic increases the salience of ensuring safe environments for care of the most vulnerable (Bedford et al., 2020) . Over recent decades, the complexity of management has increased in long-term facilities including the care of individuals with tracheostomies and complex wounds. Although the word "nursing" is in Geng and colleagues studied a number of facilities and found that greater than half of the facilities met the expected staffing level less than 20% of the time. These staffing issues were most evident for RNs, where 91% of the facilities met guidelines less than 60% of the time (Geng et al., 2019) . A welcome advance in the context of COVID-19 has been the expansion of telehealth and telemedicine services to nursing homes, which may provide opportunities to improve care in the longer term. Recent events have demonstrated the need for well-funded, responsive and efficient workforce models that protect both residents and healthcare workers. This is a delicate dance, as we need to provide adequate clinical care without excessive medicalisation of what is an individuals' home. Nevertheless, events over prior weeks that continue to unfold challenge us and for many of us it is not appropriate in a just and civilised society to deny our most vulnerable access to quality care. Many may argue that this is an aberration in the context of a pandemic but data over many decades tell us, this is not the case. The COVID-19 pandemic has taught us failing to address staffing and care models in nursing homes and skilled nursing facilities is in fact a public health issue. There will be many valuable examples Priorities for the US health community responding to COVID-19 Factors contributing to serious adverse events in nursing homes COVID-19: Towards controlling of a pandemic Preparing for COVID-19: Long-term care facilities, nursing homes Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration Support of nursing homes in infection management varies by US State Departments of Health Daily nursing home staffing levels highly variable, often below CMS expectations Look-up: How nursing home staffing fluctuates nationwide An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality Comparing nursing home assistive personnel in five countries The future of nursing: Leading change, advancing health The relationship between nurse staffing and quality of care in nursing homes: A systematic review