Editorial Offers Practical Recommendations for the Care of Older Individuals at Highest Risk from COVID-19

BACKGROUND:
For long-term care providers, the rise of COVID-19 (coronavirus) into a global pandemic conjures the specter of the rapid escalation of care for concurrently infected frail older adults living together in long-term care facilities. Recently, a nursing home in Washington state reported multiple deaths from COVID-19 with many more residents under observation. The evolving pandemic has resulted in multiple recorded US deaths from the virus, as well as transmission of the virus to US healthcare workers. The Washington State case study should serve as a proverbial "canary in the coal mine" and focus attention and preparedness efforts on long-term care facilities, where the risk of COVID-19 transmission in the coming months may be high. Adding to this healthcare challenge, long-term care residents often have medical conditions associated with an increased risk of morbidity and mortality from COVID-19. Further, even as the overall case fatality rate drops for people who are infected with the virus, the risk of death among older adults may be 10-fold higher than for younger individuals.

RECOMMENDATIONS:

• Appropriate preparedness includes five key elements: 1) Reduce morbidity and mortality among those infected; 2) Minimize transmission; 3) Ensure protection of healthcare workers; 4) Maintain healthcare system functioning, and 5) Maintain communication with worried residents and family members.
• AMDA, The Society for Post-Acute and Long-Term Care Medicine, has recently published interim recommendations for healthcare providers in long-term care facilities. The documents offer guidance and address frequently asked questions on how post-acute and long-term care facilities should prepare for and manage individuals with suspected COVID-19.
• Airborne disease protocols should be activated and put into action. Plans previously developed for pandemic influenza can be re-purposed for COVID-19, including the respiratory outbreak preparedness checklist previously developed by the CDC.
• Once COVID-19 has begun to spread within a community, additional efforts to reduce the introduction of the virus into the long-term care facility can include limiting visitors. Also, staff could be screened upon entry for fever or respiratory symptoms.
• Environmental services should be engaged to perform at least daily cleaning with Environmental Protection Agency (EPA) registered hospital-grade disinfectants, particularly in high-traffic areas (e.g., dining halls, treatment areas, living spaces, etc.).

IMPLICATIONS:

• Training staff and visitors on how to minimize their risk for picking up COVID-19 in the community and in long-term care facilities, and transmitting it to others, will remain the most important tools to stop the spread of the virus. Executing a communication strategy that keeps residents, family members, and the public informed also will be critical during this rapidly evolving crisis.

AUTHOR/FUNDING INFORMATION:
Drs. Dosa, LaPlante, and Gravenstein are part of HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence, RI.

Dosa D, Jump R, LaPlante K, and Gravenstein S. Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk. Journal of the American Medical Directors Association. Editorial. March 13, 2020; Epub ahead of print.