Nursing Home Challenges Related to COVID-19 and Improvements For the Future Natalia Kulis B.S. Health Science ‘23, Dr. Corinne Kyriacou Population Health Department, Hofstra University, Hempstead, NY 11540-0151
Introduction Nursing homes have been disproportionally impacted by the COVID-19 virus due to the vulnerability of those who reside in them. Many nursing home residents present with multiple comorbidities and are immunocompromised. These factors make nursing home residents especially vulnerable to contracting the COVID19 virus and suffering from severe complications. Nursing homes were facing challenges regarding infection control and staffing shortages prior to the pandemic which were only exacerbated by the virus. Nursing homes across the country have reported that they were insufficiently prepared for the impacts of the virus. Many experienced a lack of personal protective equipment (PPE), loose infection control policies, staffing shortages and staff burnout, confusing and inadequate guidance from government officials, cross-facility spread, and limited or no visitation policies. This study aims to explore how nursing homes in New York State are modifying and planning to improve their organization, structure and delivery to better prepare for ongoing challenges related to COVID-19.
Literature Review An annotated bibliography with over 80 articles from the peer reviewed literature, trade publications, and the popular press was constructed to better understand how nursing homes faired during the early part of the COVID19 pandemic and up until this day. Key Areas of Concern: Nursing homes were facing policy and administrative issues prior to the pandemic: • Low standard of care due to staffing shortages and poorly trained staff • Low wages & high turnover rates • Inadequate government support (state and federal level) The pandemic has exacerbated these issues and has created new ones: • Cross-facility spread of COVID-19 • Insufficient infection control policies • Visitation restrictions & social distancing/isolation and the mental health impact on residents • Confusing health guidelines from officials • Screening and surveillance testing • Vaccination hesitancy among staff and residents • Staff fear of becoming infected • Staff burnout • Decrease in revenue
Methods A Qualtrics survey is under development and will include open-ended and close-ended questions about nursing home demographics, issues faced due to the pandemic, what methods worked and what methods did not work, and what policies nursing home leaders are considering to improve to better prepare for future pandemics and to improve the quality of care being provided moving forward. Selected survey domains and concepts are presented in the table to the left. The survey will be disseminated via email as well as traditional mail to 667 nursing homes in New York State. A database of each nursing home in NYS was compiled by directly contacting each nursing home facility via telephone call for the required information and by using data from a NYS Nursing Home Administrator Email List provided by the New York State Department of Health. We also plan to hold stakeholder interviews with key nursing home leaders to further explore the specific hardships that they have experienced managing the impacts of the virus and to learn of their views on what reforms are needed to improve. We will submit the study proposal for Institutional Review Board (IRB) approval in January 2022. After we receive IRB approval, we will conduct a pilot study using the draft survey instrument. \
Results Reforms we expect to hear about from our research: • Changes to physical design and operating models to accommodate need for patient isolation, distancing, creation of pods, staff safety, and infection control • Integration of new models of care such as Green House Model • Expansion of telehealth and tele-visitation as well as home-based care options • New communication and reporting mechanisms • Programs to address staff burnout • Improved collaboration with hospitals and government agencies
Future Work We plan to use survey results to prepare both a Resource Guide on reforms planned for nursing homes post-Covid as well as a paper for publication on key strategies nursing homes are planning to use to reimagine their organization, service and delivery structures. Our hope is that the information collected from the survey and interviews will be useful to nursing home leaders in preparation for future pandemics and in establishing policies that will raise the level and standard of care being provided in New York State nursing homes. Given that we expect to uncover significant concerns about staff and leadership burnout in nursing homes, we also expect to propose future studies that build on previous work, to further address this critical issue. Additionally, since we expect to learn about the adoption of new models of care through our survey, we also expect to propose further studies that build on previous work, to explore the costeffectiveness of such innovations.
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