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Nursing Homes and Future Pandemics

July 1, 2020

For over 20 years, the nursing home industry has been implementing a culture change.

The traditional “medical model” of institutionalized care tends to focus on the physical and biological aspects of specific diseases and conditions. However, the industry has largely moved to a model that focuses on individualized care to improve the quality of life for residents while maintaining a high quality of care. This is accomplished by creating a more home-like environment and fostering companionship and relationships that help to eliminate the loneliness, helplessness, and boredom experienced by many individuals. In large part, long-term care providers (e.g., nursing homes, skilled nursing facilities, rest homes) have achieved these goals by providing greater resident choice and person-centered care to maintain residents’ dignity, among many other positive changes.

During a pandemic such as COVID-19, approaches that more closely resemble the medical model are essential when caring for the physical health of the resident. For example, extreme procedures to control the spread of infection such as strict guidelines around visitation must be followed. But we also must consider the resident’s psychosocial health, especially given the potential for feelings of isolation due to the lack of in-person contact with family and friends. As we observe the widespread outbreak of COVID-19, we have to ensure that the lessons we learn as COVID-19 unfolds help to inform a person-centered care  model so that such practices are not diminished, but enhanced.

Person-Centered Care and Infection Control

First, we have to acknowledge how COVID-19 impacted nursing home populations. For example, Massachusetts adults over the age of 80 were not more likely to contract the disease, but they were disproportionality more likely to die from it than any other age group. A large proportion of these deaths were in long-term care facilities. Massachusetts is not alone – similar statistics are found world-wide. Elsewhere in the United States, as of June 2020, there have been 107,389 confirmed COVID-19 cases in nursing homes, accounting for 29,497 resident deaths. As of May, one-third of COVID-related deaths were among nursing home residents or workers.

However, the data do not suggest that a person-centered care model was more perilous for residents, and research shows that facilities that have a strong foundation in person-centered care can reduce loneliness and improve mental health. The role of emotional well-being in healthcare, especially for nursing home residents, cannot be overstated. With CMS’ decision in March to restrict nursing home visits from family, friends and outsiders, residents not only faced concerns of infectious disease, but how to manage feelings of isolation and loneliness from the loss of visits from loved ones. This was especially difficult for residents with dementia and their families. By providing consistent assignments—which refers to having the same caregivers caring for the same residents for the majority of the time—staff come to know their residents well. Consistent assignment promotes a nurturing, trusting relationship that can respond more effectively to a resident’s demeanor and identify loneliness, boredom, and anxiety, not to mention early changes in his or her physical health.

These, we believe, are key protective factors that protect some residents from COVID-19. Why? These relationships lead to frequent, critical communication among residents, families, and staff within the facility—elements that have bolstered the ability of facilities to respond to this pandemic. For example, having one caregiver providing care to a small group of residents can help to mitigate the spread of infection to other residents while ensuring residents feel emotionally connected.

Because older adults are at greater risk of severe impacts, it is imperative that facilities revisit how the person-centered care model can be integrated with a medical model to strengthen the response to a pandemic. The opportunity now is to take what we have learned from COVID-19—facility by facility—and use that knowledge to enhance the medical response in long-term care facilities while continuing to evolve person-centered care. Doing so will enable facilities to provide care that is supportive and meaningful while adhering to strict infection control guidelines.

Has your facility benefitted from using person- centered care approaches during COVID-19? We’d love to hear your stories and share them (anonymously) in a subsequent blog. Email us.

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