Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned.

Sarah Dys,Kali S Thomas,Jaclyn Winfree,Paula Carder,Sheryl Zimmerman

doi:10.3389/fpubh.2021.661042

Abstract

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.

Highlights

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected older adult residents of long-term care settings, who comprise 1% of the United States (U.S.) population but nearly 40% of COVID-19-related deaths [1]
We identified the following themes related to COVID-19 policy response in Assisted living (AL): [1] Policymakers are disconnected from and lack an understanding of the AL context; [2] AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; [3] AL organizations faced disparate access to funding and resources; [4] State-level regulatory requirements conflicted with COVID19 guidelines resulting in uncertainty about which rules to follow; and [5] AL operators had to negotiate a balance of public health priorities with promoting their residents’ quality of life and wellbeing
The COVID-19 pandemic underscored the importance of understanding meaningful differences among long-term care settings; the need to centralize and collaborate to communicate changing recommendations and guidelines; that access to resources and funding affects adherence to guidelines, regulatory representation, and contradictions; and the need to balance public health response with residents’ overall quality of life

Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected older adult residents of long-term care settings, who comprise 1% of the United States (U.S.) population but nearly 40% of COVID-19-related deaths [1]. As of September 2020, of the estimated 82,105 COVID-19-related deaths in long-term care settings, 30% were linked to AL residents [2]. Another recent study reported that one in five AL residents who tested positive for COVID-19 died, compared with a rate of 1 in 40 in the general U.S population [3]. We learned from the lived experience of various stakeholders how the COVID-19 policy response materialized in and affected AL settings across the U.S

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Conclusion