Nursing home residents tend to be frailer, have more functional limitations, and have more chronic and complex conditions than the general adult population. According to the Centers for Disease Control and Prevention, older adults and people who have severe underlying medical conditions, like heart or lung disease or diabetes, are likely to develop more serious complications from the novel coronavirus, or COVID-19. This fact puts nursing home residents at the highest risk for serious illness as a result of exposure, but it’s not the only risk.
Most nursing home residents require assistance with one or more activities of daily living, such as turning and repositioning, getting in and out of bed, using the toilet, bathing, feeding, incontinent care and more. In order to adequately provide these services, nursing homes must be sufficiently staffed. Unfortunately, inadequate staffing is one of the biggest problems associated with nursing homes. When attention/care is not sufficiently provided, there is often a rapid decline in residents’ health due to pressure sores, weight loss, infections and increased numbers of falls.
Federal and state regulations require that infection prevention, surveillance and management be part of new staff orientation and ongoing quality assurance and improvement efforts at nursing homes. However, infections are one of the leading adverse events that occur in these facilities, and a lack of infection control in long-term care settings has existed for years.
The first reported outbreak of COVID-19 in a U.S. nursing home was at a facility in Seattle, which resulted in 35 total deaths. On March 30, the CDC reported that more than 400 long-term care facilities nationwide had residents who were infected, which was an increase of 172% from 146 on March 23. Since then, the numbers have only gone up.
As the public has learned, social distancing and hand washing are the best ways to prevent the spread of COVID-19. But essential person-to-person interactions like the ones described above must still occur for residents to receive adequate care. However, without ample supplies to minimize infection transfer, residents and staff are more likely to spread the virus to one another. This increased risk of illness and illness itself has created another urgent concern: workforce shortage. If staff members fail to come to work due to personal illness, having to care for their own family members or due to other issues, this will have a direct impact on resident care.
In the past, evidence showed that nursing home and assisted living facility residents’ whose families could visit frequently tended to receive the better care. With safer-at-home and shelter-in-place orders being enforced across the country, federal regulations are being rolled back regarding family members visiting loved ones. This fact, combined with staffing and supply shortages, will likely lead to a decline in care, especially for residents with behavioral issues or those who have respiratory issues. Meanwhile, stories about nursing home infections and deaths continue to surge.
Anxiety, loneliness and depression stem from social isolation. And a lack of visibility creates the opportunity for elder mistreatment, neglect and abuse. These conditions were prevalent long before social distancing, and the risk is certainly heightened now.
If you or your loved ones have concerns about any of these issues, contact your local Adult Protective Services Agency or legal representative for support. It’s okay to report suspected mistreatment even if you don’t know for sure that it’s happening.