COVID-19 in Assisted Living Facilities

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The focus of media on COVID-19 has largely focused on hospitals initially, then nursing homes.   A very thought-provoking read in the November 20, 2020 edition of Morbidity and Mortality Weekly Report (MMWR) – CDC provides us with a look at how Assisted Living Facilities are faring during this public health emergency.  I’ve excerpted some of the key findings from this report below; I’ve also taken the liberty of bolding important data.  Review the entire article including the tables and footnotes for additional information.

“The coronavirus disease 2019 (COVID-19) pandemic has highlighted the vulnerability of residents and staff members in long-term care facilities (LTCFs).  Although skilled nursing facilities (SNFs) certified by the Centers for Medicare & Medicaid Services (CMS) have federal COVID-19 reporting requirements, national surveillance data are less readily available for other types of LTCFs, such as assisted living facilities (ALFs) and those providing similar residential care. However, many state and territorial health departments publicly report COVID-19 surveillance data across various types of LTCFs.  These data were systematically retrieved from health department websites to characterize COVID-19 cases and deaths in ALF residents and staff members.  Limited ALF COVID-19 data were available for 39 states, although reporting varied.  By October 15, 2020, among 28,623 ALFs, 6,440 (22%) had at least one COVID-19 case among residents or staff members. Among the states with available data, the proportion of COVID-19 cases that were fatal was 21.2% for ALF residents, 0.3% for ALF staff members, and 2.5% overall for the general population of these states.  To prevent the introduction and spread of SARS-CoV-2, the virus that causes COVID-19, in their facilities, ALFs should 1) identify a point of contact at the local health department; 2) educate residents, families, and staff members about COVID-19; 3) have a plan for visitor and staff member restrictions; 4) encourage social (physical) distancing and the use of masks, as appropriate; 5) implement recommended infection prevention and control practices and provide access to supplies; 6) rapidly identify and properly respond to suspected or confirmed COVID-19 cases in residents and staff members; and 7) conduct surveillance of COVID-19 cases and deaths, facility staffing, and supply information.

LTCFs comprise a broad range of nursing and residential care facilities that provide varying degrees of health and social services. LTCFs include ALFs and similar residential care facilities, SNFs and other nursing homes, and residential facilities for persons with intellectual and developmental disabilities. As of 2016, the 28,900 U.S. ALFs accounted for approximately 44% of the nation’s LTCFs and had 811,500 residents and 298,800 full-time equivalent care staff members.  Resident care in ALFs is focused on activities of daily living, such as bathing and toileting, and assisting with skills needed for independent living, such as medication management and housekeeping.  As of 2016, 52% of ALF residents were aged ≥85 years, 30% were aged 75–84 years, 71% were female, 81% were non-Hispanic White, and 17% had Medicaid as payer for services.

By November 6, 2020, approximately 569,000–616,000 COVID-19 cases and 91,500 deaths were reported among LTCF residents and staff members in the United States, accounting for 6% of total state COVID-19 cases and 39% of deaths.  Although U.S. LTCF outbreaks have been extensively described, they have primarily focused on SNFs.  Less has been published on the occurrence of COVID-19 in ALFs.  National characterization of COVID-19 in ALFs is challenging because these facilities do not have a federal COVID-19 reporting requirement, unlike CMS-certified SNFs. However, many state and territorial health departments collect and publicly report COVID-19 data across various types of LTCFs as part of their surveillance activities.

Note the recommendations in the 2nd paragraph of this blog, behind the bolded verbiage.

Assisted Living Facilities are part of the post-acute continuum of care and certainly deserve as much attention, intervention and mitigation as do LTCFs and acute care hospitals.  We’re all in this together.