Article by Barnett and Grabowski as an Insight in JAMA highlighting the vulnerability of nursing homes to infection. It reports on the initial infection in a nursing home in Kirkland, Washington, connected with 30 deaths from COVID-19 (1 in 4 residents). After dozens of staff became ill, a crisis team was sent in.
The article highlights the vulnerability of nursing homes to COVID-19 (and other infections) due to:
- high levels of chronic illness and impairment
- people living in very close proximity, which makes it challenging to quarantine residents once they are sick
- caregivers moving from room to room
- many staff do are not entitled to paid sick leave, so they may continue to work even while experiencing symptoms
These problems are compounded by the impact of infection and quarantine on staff availability, in the context of:
- existing difficulties in recruitment in this sector due to low pay and demanding work environment
- high cost of temporary agency staff
- potential employees unlikely to want to work in homes with ongoing outbreaks
The paper identifies the following prevention measures, with a call to ensure that some of economic resources mobilized to tackle the COVID-19 impacts are used for:
- Proactive staff education regarding hand washing
- Personal protection equipment (PPE)
- Nonpunitive sick leave policies
- Telemedicine to extend clinician workforce
- Moving those with suspected infections to separate rooms
- Investment in equipment and training to use technology to maintain contact between residents and their friends and family
The article concludes by emphasizing the role of nursing homes as a critical safety net for frail older adults, with a reminder that around half of people aged 65 or more will use a nursing home at some point in their lives.
Original paper: https://jamanetwork.com/channels/health-forum/fullarticle/2763666