Lessons Learned: COVID and Long-Term Care Facilities

Michelle Ubben

The COVID-19 pandemic is a crisis that spared no one, leaving hospitals scrambling to find PPE, respirators and adequate staff, schools pivoting to deliver quality education virtually and restaurants turning to delivery and pickup options when in-person dining was cut in half or shuttered altogether.

But no sector has borne the brunt of this crisis like the nursing home and long-term care profession.

From the very beginning, when the first U.S. outbreak was reported in a nursing home in Kirkland, Washington, the long-term care profession has been the fulcrum of this crisis. By May, 28,000 nursing home residents and staff had died of COVID nationwide, and to date nursing homes account for 35 percent of the nation’s deaths.

The factors that made the long-term care profession especially vulnerable were largely beyond its control: Nursing homes, already working with their communities’ most vulnerable, serve a population that proved to be uniquely susceptible to the virus. Although technically health care facilities, nursing homes lacked many of the specialized resources required to treat COVID patients, things like rooms with negative airflow, sufficient PPE and ventilators—and the staff trained in how to use them.

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As a consequence, nursing homes with COVID outbreaks by and large had to transfer sick patients en masse to hospitals. This led to a perception by some that they were simply dumping their problem on an already burdened part of the healthcare system.

Faulty perceptions plagued the profession in other ways, too. Based on an October survey conducted in Florida, 2020’s hyper-partisan political environment also colored how people viewed nursing homes’ handling of the crisis, with Democrats delivering much lower grades.

Although determinations to lock down or reopen nursing homes were executive decisions imposed on facilities by the government, the nursing homes themselves bore the wrath of many family members and the public.

So, what are the crisis lessons to be gleaned from the decidedly unenviable position that nursing homes found themselves in during the pandemic?

First and foremost, be nimble. This was—and remains—a public health crisis without a playbook. Knowledge of how the virus was transmitted, what would effectively stop the spread, how long it could live on surfaces, and other critical information was simply lacking in the early days of the crisis and evolved from day to day. Like other parts of the health care sector, the long-term care profession had to closely monitor guidance from public health officials for direction, and had to train and retrain staff to observe new and unfamiliar safety protocols. Not knowing how to beat back the virus on day one was excusable, but learning quickly and holding staff accountable for new, higher standards of hygiene was expected.

Second, be transparent. Duck and cover is a common response to crisis under the best of circumstances. When the consequences are being numbered in body bags and stored in refrigerated mortuary trucks, the instinct to circle the wagons can be profound. In this case, when some state authorities also were reluctant to release data that put states in a bad light, there was added incentive to go mum. But trust and credibility are byproducts of telling the truth and sharing information in a crisis, even when the numbers look bad. Nursing homes that kept family members and in some cases the media informed in real time were seen as reliable information sources. Although HIPAA regulations prevent naming individuals with COVID, sharing the numbers of residents and staff testing positive, hospitalizations, and, tragically, deaths is permissible and necessary to build trust.

Third, follow through. For family members with a loved one in a nursing home, COVID has produced almost unbearable anxiety and helplessness. They’ve had no choice but to rely on the nursing facility to take the right steps to keep their loved one safe. So promise-keeping becomes ultra-critical. A fundamental tactic of crisis management is to shift focus from the problem to the solution. In this case, when the announced solutions are routine staff testing, contact tracing, consistent mask wearing, frequent hand washing and other hygiene protocols, it’s imperative that facility leaders follow through and make sure those procedures are followed.

Fourth, be human. In the past year, nursing homes have had to deal with some of the most unthinkably painful human experiences, including staff members holding up a phone so family members who weren’t allowed to be in the room could say goodbye to dying parents. They have had to meet the needs of frail elders for love and social interaction, while also taking precautions to stop the spread of this disease. At the same time, many nursing home professionals also had to cope with the death of coworkers. Their outcomes haven’t been perfect, but their efforts have been nothing short of heroic. COVID doesn’t just present a threat to health but a challenge to the soul. Nursing home management that led with a human face rather than a corporate one got points for their humanity in the throes of this crisis.

Finally, tell your story. Although the last chapter has yet to be written, the long-term care profession already has a positive story to tell. Upwards of 93 percent of nursing homes have the ability to test their entire staff, and they’ve decreased the lag time in waiting for results from 3.8 days in August to 2.1 days in November. That aggressive testing is paying off, with a dramatic reduction in deaths from COVID in nursing homes as a percentage of COVID cases—down from 42.9 percent on May 24 to 25.7 percent on November 15.

That doesn’t mean it’s all rosy for long-term care, nor should the profession pretend it is. The percentage of nursing homes reporting a shortage in any of their staff (nursing, clinical, aides or other) has risen from 20.4 percent in late May to 22.4 percent in mid-November. Nursing home populations were declining even before COVID, straining budgets—which were then raided further to pay for PPE, testing and unexpected staff needs.

Nursing home funding from both Medicare and Medicaid have been declining, making it increasingly hard to maintain quality standards, even without the exponential added strain of a pandemic. Part of telling the profession’s story must be sharing both how it rose to the occasion of COVID and what policy changes and investment are needed for the industry to meet the needs of an aging America into the future.

Given the positive prospects for a vaccine, we’ll likely move beyond the pandemic in 2021, but the lessons learned along the way, especially by those in the crosshairs of the crisis, like the long-term care profession, should be studied and embraced by all.

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Michelle Ubben is Partner and President at Sachs Media.