Improving the Reponse to COVID-19 in Long-Term Care Settings

The coronavirus (COVID-19) pandemic continues to create additional challenges for people living with Alzheimer's and all dementia, their families and caregivers. Long-term care settings are experiencing these challenges in particular. The Alzheimer's Association and AIM is urging state and federal policymakers to implement new policy solutions which will address the immediate and long-term issues impacting care facilities during the COVID-19 pandemic.

Across the country these facilities, their staff, and their residents are experiencing a crisis due to a lack of transparency, an inability to access the necessary testing, inaccurate reporting and more. According to some estimates, more than 27,000 residents and workers have died from the coronavirus at nursing homes and other long-term care communities.

Download the Policy Recommendations

We urge policymakers to implement these recommendations to protect people living with Alzheimer’s and all dementia in long-term care settings during the COVID-19 pandemic. Download.


Our nation has not done enough to support these communities. The Alzheimer’s Association has outlined policy recommendations to address the COVID-19 crisis in long-term and community-based care settings.

Testing

Each nursing home and assisted living community must have the onsite capability to verify that all residents, staff and visitors are free of COVID-19 infection, whether or not they are symptomatic. In short, access to testing should be the “White House Standard.” Government support is needed to ensure accelerated production and delivery of testing, with rapid turnaround testing staffed by trained personnel.

  • Establish and implement a protocol to use testing to verify, as a baseline, that residents and staff of each facility are free of infection.
  • As an essential component of establishing a baseline assessment, immediately prioritize access to testing supplies for nursing homes and assisted living communities and require that all residents and staff be tested.
  • Purchase, deliver and provide training in the proper use of commercially available, rapid point of care COVID-19 testing.
  • Thereafter, implement daily testing for all new individuals who come onsite, and retesting for returning individuals who enter the facility, in accordance with local guidance.

Reporting

All cases of COVID-19 at nursing homes and assisted living communities need to be reported immediately and accurately. Additionally, these reports should be updated upon remission, death, transfer or other appropriate status update. With all appropriate privacy safeguards for individuals, this reported data should be freely and immediately accessible to all down to the facility level.

  • Require all nursing homes and assisted living communities to report positive diagnoses to public health authorities immediately (never later than same day), update previously reported cases upon significant changes in status, and proactively notify family and/or designated persons of changes.
  • Protect the privacy of individuals, but do not tolerate this as an excuse to delay implementation of this expectation. These issues can be reasonably addressed.
  • Create a central, publicly accessible web platform that is searchable down to the facility level to make deidentified data available immediately upon reporting. No lag between reporting and publication is needed or tolerable.

COVID-19, Alzheimer's and Dementia: Support

As the COVID-19 pandemic continues to pose additional challenges for people living with dementia, and those providing care, the Alzheimer’s Association is here to help. For additional support and tools to help ensure your health and the health of those you love during the crisis, visit alz.org/covid19help.


Surge activation

As “hot spots” occur, they must be dealt with urgently and effectively. Any reported cases should trigger careful, ongoing monitoring and, if conditions warrant, “strike teams” will be employed to the facility to provide needed support until the outbreak is appropriately contained and eliminated.

  • Designate state Long-Term Care Ombudsman and state and federal CMS Surveyors as “essential,” ensure they have priority access to personal protective equipment (PPE), and authorize them to visit long-term care communities.
  • Establish a protocol for what steps nursing homes and assisted living communities must take once a resident or staff member tests positive for COVID-19 and require that this protocol is implemented by the care provider.
  • Require nursing homes and assisted living communities to implement a care coordination protocol that ensures a smooth transition between care settings if a resident must be moved to another care setting.
  • Activate statewide strike teams to help nursing homes and assisted living communities that are identified as “hot spots” and in need of additional support.

Providing support

All nursing homes and assisted living communities must have full access to all needed PPE, testing equipment, training and external support to keep them COVID-19 free.

  • Immediately prioritize access to PPE for all staff in nursing homes and assisted living communities. These facilities should be given access to an adequate, ongoing supply.
  • Require dissemination of essential dementia care standards to aid provisional staff in the delivery of person-centered dementia care.
  • Require the use of personal information forms for each resident to allow all staff to quickly identify essential information about the person to help maintain a stable and comforting environment.
  • Require nursing homes and assisted living communities to address social isolation and ensure people with dementia are able to communicate with designated family/friends.
  • Direct the state department of health to establish and administer a Statewide Long-Term Care Emergency Response Task Force to coordinate with all key stakeholders to identify pressing issues and implement solutions.