1. Ehrlich, Haley BS
  2. McKenney, Mark MD, MBA, FACS
  3. Elkbuli, Adel MD, MPH

Article Content

According to the Centers for Disease Control and Prevention (CDC), in 2016, there were 15,600 nursing homes (NHs) in the United States for more than 1.3 million elderly patients (CDC, 2016). The number of elderly patients in NHs is expected to have increased since 2016 due to the aging of the population (U.S. Census Bureau, 2019). Of the 73 million Baby Boomers, 10,000 per day turn 65 years old, with 52 million past this age threshold in 2018 (U.S. Census Bureau, 2019). As a result, more of our population will be entering into long-term care facilities (LTCFs), the site of many COVID-19 outbreaks (McMichael et al., 2020).


This portion of the U.S. population is the most vulnerable to COVID 19 (CDC, 2020a). The mortality rate for the elderly population is the highest, with 80% of COVID-19 deaths occurring in those older than 65 years (CDC, 2020a). Although infection is one of the major causes of hospitalization and mortality in the elderly population, there exist set guidelines for infection prevention and control (IPC) for LTCFs (Travers et al., 2015, p. 359). Travers et al. found that there were barriers for LTCF staff to properly implement IPC policies including staff shortages, high staff turnover, lack of accountability, and immense workloads (Travers et al., 2015, p. 359). The lack of staff has been well-documented, particularly the shortage of registered nurses (Harrington & Edelman, 2018). The recent trend is for LTCFs to send their patients to hospitals for a lack of resources and capability to deliver care for their residents. This, in turn, overwhelms the hospital systems, which are experiencing staffing shortages (CDC, 2020b). The patient to provider ratio is overly high in LTCFs. This lack of staff is the source of many problems within LTCFs; it is also a factor that provoked their lack of preparedness against COVID-19 (Harrington & Edelman, 2018; McMichael et al., 2020; Travers et al., 2015, p. 359). Prior to the outbreak of COVID-19, the environment for many in LTCFs included subpar standards in IPC provided by the sparse health care staff. This, combined with the elderly person's vulnerability to infections, provided COVID 19 with opportunities. In King County in Washington State, within a matter of 3 weeks of the first confirmed case of COVID 19 in an LTCF, 167 more confirmed cases followed of which 101 were LTCF residents, 30 of whom died (McMichael et al., 2020). As a result, the CDC implemented temporary guidelines for LTCFs in order to take extra precautions (CDC, 2020b). Although these guidelines are somewhat similar to the original guidelines previously in place, it still does not solve the issue; who is going to carry out these guidelines? Currently, LTCFs, like much of our health care system, are weakened by staffing shortages (Haddad, 2020). The previous IPC guidelines often had limited adherence from many LTCFs due to staffing shortages and other barriers (Harrington & Edelman, 2018; Travers et al., 2015, p. 359). Without the resolution of this deficit, other solutions will be lessened in their effectiveness.


Currently, LTCFs are being advised by the American Geriatrics Society (AGS) to comply with the federal, state, and CDC recommendations (AGS, 2020). In addition, the AGS acknowledges the personal protective equipment (PPE) shortage and that without the proper PPE in LTCFs, more COVID-19 outbreaks will occur, with high mortality among the residents (AGS, 2020). Other precautions that LTCFs should undertake include temporary discontinuation of group activities and the barring of visitors (AGS, 2020; CDC, 2020b). Patient safety measures have been outlined for transportation to and from the hospital, patient-staff interactions, and patient-patient interactions. The present goal for LTCFs is focused on precautionary measures against COVID-19. Although these efforts are vital for the current state of affairs, long-term repairs are required to resolve the gaps in preparedness and care of our growing elderly population. This crisis highlights a considerable need to mend a broken system that, for too long, has been in a state of disarray.


Upon reviewing the changes that must be made about caring for our elderly population, the first consideration must be the resolution of agism. Agism has a profound effect on our elderly population, from devaluating perceptions to discrediting working in LTCFs (Brooke & Jackson, 2020). Altering the negative views of our elderly population to positive outlooks can decrease the effects of agism by humanizing our elders and combating the shortage of caregivers (Brooke & Jackson, 2020). During this time of disruption, it is worthwhile to explore the use of technology in filling gaps of care. Telemedicine is an increasingly popular approach to maintaining patient care without the risk of exposure to infection (Coombes & Gregory, 2019; Elkbuli, Ehrlich, & McKenney, 2020). This method of patient care should be implemented in LTCFs to help alleviate some of the burden on the strained staff and maintain proper care during the COVID19 pandemic. Addressing the staffing shortage remains the most effective course of action in mending our LTCFs in the long term. This proactive measure is also the most effective approach to improving implementation of IPC policies, thus better preparing LTCFs for future needs and pandemics (Harrington & Edelman, 2018). The ratio of staff to elderly patients will worsen as our Baby Boomer population ages if it continues to remain inadequately addressed.




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