Greg Arling and Priscilla Arling

The full report is available here:

Key points:

Prevalence of COVID-19 in Long-Term Care

• Minnesota’s COVID-19 cases began in early March 2020; the daily average of new cases peaked at 840 in mid-May, while new deaths peaked at 39 in early June. However, by July cases were on the rise again.
• According to cumulative totals on May 30, 2020, older people in long-term care facilities accounted for over four-fifths of total COVID-19 deaths: 56% of total deaths were in nursing facilities, 22% were in assisted living facilities, 3% were in memory centers, and only 19% were in community settings.
• The distribution of COVID-19 cases and deaths in long-term care facilities was highly skewed: some facilities had large numbers, but most facilities had only a few cases and deaths.
• COVID-19 cases and deaths, both overall and in long-term care, were concentrated in Minnesota’s major urban area (Twin Cities) containing the cities of Minneapolis and St. Paul.
• Racial and ethnic minorities in the Twin Cities had dramatically higher rates of COVID-19 cases overall than did whites. Yet, the prevalence of COVID-19 cases and deaths in Twin City nursing facilities did not differ by their percentage of minority group residents.

Minnesota’s Response

• The Minnesota Department of Health (MDH) has adopted a Five-Point Battle Plan for Prevention and Support of COVID-19 in Long-Term Care. The Plan’s goals are to ensure long-term care facilities can safely accept and care for residents discharged from the hospital; reduce COVID-19 transmission among residents and staff; quickly identify facilities needing special support; and help facilities plan for and manage COVID-19 infections.
• An MDH case manager works with each facility that has a COVID-19 case to assist in implementing infection control and managing care.
• The MDH has supplied facilities with a comprehensive COVID-19 Toolkit, with guidelines for contact tracing, risk assessment, protective equipment, testing, cohorting, and family visits.
• The state and Federal governments have provided expedited and advance payments to nursing and other long-term care facilities for emergency expenses incurred because of COVID-19.
• The state appropriated $150 million for health care response expenses in health and long-term care.

Programmatic and Structural Challenges

• Minnesota faces continued policy and programmatic challenges in long-term care, particularly if COVID-19 cases surge in the fall or winter.  The challenges include: ensuring access to testing, PPE, and infection control support; addressing staff shortages; balancing social distancing policies with patient rights and family visitation; and returning to “normal” once the COVID-19 pandemic subsides.
• The state also faces fundamental structural challenges in long-term care including: chronic staffing shortages due to low wages, inadequate sick leave or health insurance, and unfavorable working conditions; racial disparities; problems in care transitions to and from hospitals; increasing resident acuity without accompanying increases in skilled nursing and medical care capacity; and financial instability from occupancy declines combined with strained Medicaid budgets.