Supporting our nursing homes during the COVID-19 pandemic

Residents in nursing homes and other senior living facilities are at high risk of COVID-19 infection. Elderly patients may have subtle symptoms, and staff often have none at all. The combination of close living quarters and the need for multiple daily healthcare interactions can cause undetected disease to spread rapidly and widely.

Even the highest quality facilities are being overrun. As staff fall ill, it becomes difficult to care for patients. Personal protective equipment is in short supply, and remaining employees often have to cover for their now quarantined colleagues. COVID-19 infected residents are sick and need additional help with activities of daily living (toileting, bathing, eating, etc.). This puts incredible strain on front-line caregivers and management teams, who are working heroically, often at great personal risk.

Nursing homes require support from health departments, regional health systems, and the community. Thus far, that support has been inconsistent and uneven. Some hospitals and county public health officials have been very involved from the beginning, collaborating on logistics, testing, and staff. Other nursing homes are largely left on their own. The response seems to hinge less on a uniform protocolized standard and more on the strength of individual medical and public health leaders.

The care of frail seniors is difficult in normal times-it is now exceptionally challenging. We are not going to control COVID-19 without a comprehensive, resource-rich response. The following four elements must be in place to control disease while we wait for a vaccine and improved treatment options:

1. Facilitate testing of all residents and staff in every senior congregant living center in the state. This will allow for the rapid identification and isolation of infected residents and healthcare workers, curbing the spread of disease. Accountability should reside with local and state health departments (they should provide testing and equipment). Repeat periodic screening of staff will also be required, and as testing becomes widely available, this responsibility can be transitioned back to the facility.
2. Prioritize PPE for healthcare workers in nursing homes. Hospitals have received the majority of supplies. We need to work harder to source and supply PPE in senior care facilities. Accountability should also reside with local and state health departments until the supply chain is stabilized.
3. Deploy regional "strike teams" to manage outbreaks. Teams should be composed of front-line staff, infection control specialists, and logistics support personnel. The goal would be to rapidly test all staff/patients, set up strict medical and infection control protocols, and provide ongoing support until the crisis is over.
4. Support nursing homes with infection control strategies. Every facility needs a dedicated infection control specialist who is in regular communication with local health departments. The goal would be to rapidly disseminate new guidelines, help maintain isolation, educate staff on proper infection control principles, and coordinate surveillance testing.

It is not too late to change the outcome in our nursing homes. Lives can be saved, but we need to act now.

Adam Wolk, MD is an internal medicine clinician located in Chapel Hill.