How nursing homes can prepare for the next pandemic

Two experts gave the healthcare system a "D" grade overall for nursing homes' performance during the COVID-19 pandemic, and offered ways nursing homes can better react to the next one, The New York Times reported Aug. 19.

More than 60,000 nursing home and long-term care facility residents died in the first five months from COVID-19. However, fewer than 1 in 5 residents received antiviral treatments from May 2021 to December 2022, the report said.

Brian McGarry, PhD, a health economist at the University of Rochester (N.Y.), and David Grabowski, PhD, a healthcare policy researcher at Boston-based Harvard Medical School, both gave the healthcare system its "D" grade due to a number of factors.

"I kept waiting for the cavalry to come, and it really hasn't, even today," Dr. Grabowski said. "At no time during the pandemic did we prioritize nursing homes." 

The poor grade was given due to these factors:

  • During the pandemic, more than 167,000 residents and at least 3,100 staff members died, Medicare reported.

  • A study published in JAMA found only one-quarter of infected residents received antivirals and 40 percent of nursing homes reported no antiviral use at all.

  • In early 2022, Medicare reported 87 percent of residents and 83 percent of employees had been vaccinated, but boosters have fallen off. Only 62 percent of residents per facility and 26 percent of staff are up to date on COVID-19 vaccines.

  • Early federal efforts prioritized hospitals, leaving nursing homes without critical equipment.

  • Fewer than one-fifth of nursing homes had the recommended turnaround of less than 24 hours for testing kits, which negated the value of the test, according to an expert.

Dr. McGarry and Dr. Grabowski offered a few areas for nursing homes to focus on in preparation for future pandemics:

  • Use more antivirals and use them more quickly.

  • Lockdowns, although reasonable, went on too long. "In retrospect, it caused a lot of harm," Karl Steinberg, MD, a medical director at three nursing homes in Southern California and former president of AMDA, the medical association representing providers in long-term care, said in the report. "We saw so much failure to thrive, people losing weight, delirium, rapid onset of dementia. And it was usually the staff who were bringing in COVID-19 anyway."

  • Continue to increase staffing levels at facilities.

  • Improve ventilation systems and divide buildings into smaller units with consistently assigned staff. 

All the change would require more investment from Medicaid and other federal programs, but "with more money would come increased federal oversight, which the industry rarely welcomes," the report said.


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