Skilled Nursing Facilities Staff Research Articles

Results of a Feasibility Pilot Pragmatic Trial Implementing Palliative Care in Skilled Nursing Facilities.

Background: Seriously ill older adults are admitted for post-acute care in skilled nursing facilities (SNFs) for curative, rehabilitative treatments, yet experience high rates of re-hospitalization, and death. The primary palliative care in post-acute care (PPC-PAC) intervention is an evidence-based approach designed to help people with serious illness align treatment plans with goals of care, optimize quality of life, and improve satisfaction with their care. Objectives: To conduct a preliminary study and evaluate the feasibility of implementing the PPC-PAC intervention in the post-acute care SNF setting. Design: Two-group, multisite feasibility pilot pragmatic clinical trial with a non-equivalent design. Measurements: Primary outcome measures-eligibility, enrollment, and data collection rates; consultation satisfaction; and fidelity. Effectiveness outcome measure-quality of life using the Palliative Outcomes Scale version 2. Results: Close to 70% of those who were eligible and approached by the study team (45/65) enrolled in the trial throughout 12 SNFs in the Northeast and Mid-Atlantic United States. Thirty-five were enrolled from intervention sites; 10 were enrolled from control sites (usual care). Most participants (80%) expressed general satisfaction with PPC-PAC, and 90% of clinicians implemented the PPC-PAC intervention as intended. At 21 days follow-up, there were no significant differences in effectiveness outcomes. Conclusion: Implementation of the PPC-PAC intervention proved to be feasible and acceptable among older adults and clinicians. Future research should focus on testing the effectiveness of PPC-PAC and explore strategies for optimal intervention implementation and SNF staff engagement in the post-acute care setting.

Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.

To examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed throughout the pandemic in order to provide recommendations for policies and practices used to strengthen the SNF workforce moving forward. For this qualitative study, we engaged a purposive national sample of SNF leaders (n = 94) in one-on-one interviews between January 2021 and December 2022. Using purposive sampling (i.e., Centers for Medicare & Medicaid quality rating, region, ownership) to capture variation in SNF organizations, we conducted in-depth, semi-structured qualitative interviews, guided a priori by the Institute of Medicine's Model of Healthcare System Framework. Interviews were conducted via phone, audio-recorded, and transcribed. Rigorous rapid qualitative analysis was used to identify emergent themes, patterns, and relationships. SNF leaders consistently described staffing shortages spanning all job roles, including direct care (e.g., activities, nursing, social services), support services (e.g., laundry, food, environmental services), administrative staff, and leadership. Ascribed sources of shortages were multidimensional (e.g., competing salaries, family caregiving needs, burnout). The impact of shortages was felt by all staff that stayed. In addition to existing job duties, those remaining staff experienced re-distribution of essential day-to-day operational tasks (e.g., laundry) and allocation of new COVID-19 pandemic-related activities (e.g., screening). Cross-training was used to cover a wide range of job duties, including patient care. Policies are needed to support SNF staff across roles beyond direct care staff. These policies must address the system-wide drivers perpetuating staffing shortages (i.e., pay differentials, burnout) and leverage strategies (i.e., cross-training, job role flexibility) that emerged from the pandemic to ensure a sustainable SNF workforce that can meet patient needs.

Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER)

ObjectivesTo evaluate the impact of a mentoring program to encourage staff-delivered sleep-promoting strategies on sleep, function, depression, and anxiety among skilled nursing facility (SNF) residents. DesignModified stepped-wedge unit-level intervention. Setting and ParticipantsSeventy-two residents (mean age 75 ± 15 years; 61.5% female, 41% non-Hispanic white, 35% Black, 20% Hispanic, 3% Asian) of 2 New York City urban SNFs. MethodsExpert mentors provided SNF staff webinars, in-person workshops, and weekly sleep pearls via text messaging. Resident data were collected at baseline, post-intervention (V1), and 3-month follow-up (V2), including wrist actigraphy, resident behavioral observations, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) depression scale, Brief Anxiety and Depression Scale (BADS), Brief Cognitive Assessment Tool (BCAT), and select Minimum Data Set 3.0 (MDS 3.0) measures. Linear mixed models were fit for continuous outcomes and mixed-effects logistic models for binary outcomes. Outcomes were modeled as a function of time. Planned contrasts compared baseline to V1 and V2. ResultsThere was significant improvement in PSQI scores from baseline to V1 (P = .009), and from baseline to V2 (P = .008). Other significant changes between baseline and V1 included decreased depression (PHQ-9) (P = .028), increased daytime observed out of bed (P ≤ .001), and increased daytime observed being awake (P < .001). At V2 (vs baseline) being observed out of bed decreased (P < .001). Daytime sleeping by actigraphy increased from baseline to V1 (P = .004), but not V2. MDS 3.0 activities of daily living and pain showed improvements by the second quarter following implementation of SLUMBER (P's ≤ .034). There were no significant changes in BADS or BCAT between baseline and V1 or V2. Conclusions and ImplicationsSNF residents had improvements in sleep quality and depression with intervention, but improvements were not sustained at 3-month follow-up. The COVID-19 pandemic led to premature study termination, so full impacts remain unknown.

BUILDING RESILIENCE IN SKILLED NURSING (BRISK): A CASE OF COMMUNITY-ENGAGED RESEARCH IN SKILLED NURSING FACILITIES

Abstract Older adults receiving post-acute rehabilitation care in a skilled nursing facility (SNF) commonly present with high physical, psychological, and social needs. Psychosocial stressors and associated consequences (e.g., poor transitions, re-hospitalizations) may be magnified among families with limited financial resources. The current study aimed to co-develop a dyadic psychological intervention tailored to meet the unique psychosocial needs of socioeconomically disadvantaged patients and their care-partners during the transition from SNF to home. In this presentation, we describe the process of partnering with SNFs and forming a community advisory board (CAB) to meet the objectives of the current study. First, we discuss practical and regulatory considerations related to identifying facility partners (e.g., facility chains, physician groups) and recruiting patient-care-partner dyads in partner facilities. Second, we highlight strategies to incentivize potential SNF partners as well as historically and systematically under-represented patient participants, including budgetary considerations, recruitment strategies, sustained contact after discharge, and clinical service provision. Third, we discuss the recruitment, formation, and role of a CAB with diverse perspectives, including patients, family care-partners, SNF staff, policy makers and advocates. Overall, this presentation will generate discussion on practical strategies for building and maintaining mutually beneficial research partnerships with SNFs and similar hard-to-reach healthcare settings (e.g., long-term care facilities, home health agencies).

Emergency department visits by older adults receiving postacute care in skilled nursing facilities.

Skilled nursing facilities (SNF) represent a common postdischarge destination for hospitalized older adults. The goals of SNF care include the completion of extended skilled nursing care and physical rehabilitation to enable patients to safely return home. However, nearly one in four older adults discharged to SNF are rehospitalized and one in five seek care in the emergency department (ED) but are discharged back to SNF. Our aim was to measure the national prevalence and costs to Medicare of ED visits by SNF patients. Of the 1,551,703 Medicare beneficiaries discharged to SNF in 2019, 16.3% had an ED visit within 14 days (n = 253,104). Of those ED visits, 25.5% resulted in a same-day discharge back to SNF (n = 64,472), costing Medicare $24.6 million. Novel care models that can leverage SNF staff and resources while providing rapid diagnostic services are urgently needed.

COVID-19 Vaccination Among Skilled Nursing Facility Staff: Challenges and Strategies Identified by Administrators

COVID-19 vaccinations are critical for mitigating outbreaks and reducing mortality for skilled nursing facility (SNF) residents and staff, yet uptake among SNF staff varies widely and remains suboptimal. Understanding which strategies are successful for promoting staff vaccination, and examining the relationship between vaccination policies and staff retention/turnover is key for identifying best practices. We conducted repeated interviews with SNF administrators at 3-month intervals between July 2020 and December 2021 (n = 156 interviews). We found that COVID-19 vaccines were initially met with both enthusiasm and skepticism by SNF staff. Administrators reported strategies to increase staff vaccine acceptance, including incentives, one-on-one education, and less stringent personal protective equipment requirements. Federal and state vaccination mandates further promoted vaccine uptake. This combination of mandates with prioritization of the vaccine by SNFs and their leadership was successful at increasing staff vaccination acceptance, which may be critical to increase staff booster uptake from its current suboptimal levels.

A Case Manager-Led Pneumonia Care Bundle in a Subacute Rehabilitation Facility.

To evaluate the relationship between a case manager-led pneumonia care bundle at skilled nursing facilities (SNFs) and 30-day hospital readmissions for pneumonia. The primary practice settings included patients hospitalized with pneumonia at 2 community hospitals between October 2018 and June 2019 and who were subsequently transferred to an SNF. A retrospective cohort study was completed comparing patients in the preintervention cohort who received pneumonia standard of care versus patients in the postintervention cohort who received a case manager-led evidence-based pneumonia care bundle at an SNF. From October 2018 to June 2019, patients admitted with pneumonia to 2 community hospitals in Northwest New Jersey were enrolled in the preintervention cohort. Patients admitted with pneumonia from January 2020 to June 2021 were enrolled in the postintervention group. The primary outcome was to reduce 30-day readmission rates for all patients discharged from the hospital to an SNF with pneumonia. Ninety-nine patients were enrolled in the preintervention cohort and 34 patients were enrolled in the postinterventions cohort. Thirty-day readmission rates were lower in the postintervention cohort (24.2% vs. 17.7%). This reduction in readmission rates was clinically significant, demonstrating a 27% reduction for all patients discharged from the hospital to an SNF with pneumonia. Individualized pneumonia self-management education can be easily implemented in SNFs to improve quality-of-care outcomes for patients. Our health care system collaborates with several SNFs to decrease 30-day hospital readmission. The pneumonia care bundle includes specific measures to improve the transition of care for patients with pneumonia by decreasing the variability of patient care after discharge from the hospital to an SNF. It was hypothesized that to decrease readmissions from the SNFs, we needed to address the quality of care provided by the SNFs by using a 2-prong approach; education of SNF staff on the pneumonia care bundle, and in-person weekly follow-up visits in the SNF until discharge from the SNF to the patient's home.

Improving sleep using mentored behavioral and environmental restructuring (SLUMBER): A randomized stepped-wedge design trial to evaluate a comprehensive sleep intervention in skilled nursing facilities

IntroductionPoor sleep is ubiquitous in skilled nursing facilities (SNFs) and is associated with a myriad of negative symptoms. Non-pharmacological interventions can improve sleep, yet sustainability has not been demonstrated. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) trial will test whether a staff mentoring approach to address resident sleep issues positively impacts sleep quality and whether improved sleep benefits mood, cognitive performance, and activity engagement for residents living in SNFs. InterventionThis is a four-year hybrid type I effectiveness/implementation randomized stepped-wedge trial using a comprehensive sleep improvement program conducted in three urban SNFs. MethodsWe will provide SNF staff with sleep promotion strategies over a four-month intervention. Staff will have access to in-person workshops, webinars, weekly sleep pearls via text messaging, environmental data, and expert program mentors. We will consent residents for data collection (at baseline, end of intervention, and three- and six-months post-intervention) including resident observations, questionnaires, and wrist actigraphy (to objectively measure sleep). We will also use selected Minimum Data Set 3.0 (MDS) measures. ConclusionSLUMBER uses a unique strategy to iteratively improve sleep interventions through SNF staff buy-in, expert mentoring, and technological supports within a quality improvement framework. As a stepped-wedge trial, the initial SNF units provide opportunities for program improvement in subsequent units, accounting for variation across resident populations at different sites. Protocol limitations include strategies which may require substantial customization for greater spread. A comprehensive staff training program that addresses both sleep quality and related symptoms has the opportunity for considerable dissemination.Trial registration: USGOV Clinical Trials ID: NCT03327324

Pilot Trial of a Social Work Intervention to Provide Palliative Care for Adults with Cancer in Skilled Nursing Facilities.

Background: Hospitalized patients with cancer and their caregivers discharged to skilled nursing facilities (SNFs) have unmet palliative care needs. Objective: To determine feasibility and acceptability of Assessing and Listening to Individual Goals and Needs (ALIGN), a palliative care social worker (PCSW) intervention, for older adults and their caregivers in SNFs. Design: Single-arm, single-site pilot study. Predefined feasibility goals were >70% intervention completion and study retention rates (postintervention outcomes completed at one week). Setting/Subjects: Twenty-three patients with cancer and their 21 caregivers discharged to 12 SNFs posthospitalization. Measurements: Primary outcomes were feasibility and acceptability. Exploratory patient and caregiver-reported outcomes, including goals of care were collected at baseline and one week postintervention. Health care utilization, mortality, and hospice utilization was collected at the six-month follow-up. Results: Of 73 patients screened, 35 (48%) were eligible and 23 (66%) patients and 21 caregivers enrolled. Eighteen (78%) patients completed the intervention and 10 (44%) patients and 13 (62%) caregivers provided follow-up outcomes. Average age of patients was 73, and 19 (83%) had stage III or IV cancer. Average age of caregivers was 55. Eight (44%) patients' preferences changed to prefer less aggressive care. Nineteen (83%) patients died during or shortly after intervention completion. Qualitative feedback from participant and SNF staff interviews supported high acceptability. PCSW involvement increased illness understanding and patient engagement with advance care planning. SNF staff valued increased palliative support. Conclusions: Intervention completion was >70%, however, not study retention due to higher-than-expected mortality. Future study should account for high mortality and examine whether ALIGN can better prepare surrogate decision makers and enhance the ability of SNFs to address changing goals of care. Clinical Trial Registration Number NCT04882111.

Unique Care Needs of People with Dementia and Their Caregivers during Transitions from Skilled Nursing Facilities to Home and Assisted Living: A Qualitative Study.

The purpose of the study was to describe unique care needs of people with dementia (PWD) and their caregivers during transitions from skilled nursing facilities (SNF) to home. A qualitative study using focus groups, semistructured interviews, and descriptive qualitative analysis. The study was set in one state, in 4 SNFs where staff had experience using a standardized transitional care protocol. The sample included 22 SNF staff, 4 home health nurses, 10 older adults with dementia, and their 10 family caregivers of whom 39 participated in focus groups and/or interviews. Data collection included 4 focus groups with SNF staff and semistructured interviews with home health nurses, SNF staff, PWD, and their family caregivers. Standardized focus group and interview guides were used to elicit participant perceptions of transitional care. We used the framework analytic approach to qualitative analysis. A steering committee participated in interpretation of findings. Participants described 4 unique care needs: (1) PWD and caregivers may not be ready to fully engage in dementia care planning while in the SNF, (2) caregivers are not prepared to manage dementia symptoms at home, (3) SNF staff have difficulty connecting PWD and caregivers to community supports, and (4) caregivers receive little support to address their own needs. Based on findings, recommendations are offered for adapting transitional care to address the needs of PWD and their caregivers. Further research is needed (1) to confirm these findings in larger, more diverse samples and (2) to adapt and test interventions to support successful community discharge of PWD and their caregivers.

Implementing Infection Prevention and Control (IPC) Practices Including COVID-19 Mitigation Strategies in a Skilled Nursing Facility

BackgroundThe All Facilities Letter (AFL) issued by the California Department of Public Health (CDPH) on November 9, 2020, informed all skilled nursing facilities (SNFs) of the passage of AB 2644 (Chapter 287, Statutes of 2020). This AFL requires SNFs to have a full-time, dedicated infection preventionist (IP), a plan for infection prevention, quality control, and annual infection prevention and control training for all healthcare personnel (HCP). Healthcare facilities are ideal settings for transmitting infections to residents, healthcare workers, their families, and communities.Therefore, the objective was to assess compliance with infection prevention and control and standardized practices in Hand Hygiene, Personal Protective Equipment (PPE) donning and doffing, and Catheter-Associated Urinary Tract Infection (CAUTI) prevention bundle.MethodsHand Hygiene, PPE, and CAUTI competencies were developed to increase awareness and compliance with standardized practices. Hand Hygiene and CAUTI champions representing every shift in the unit were created to lead SNF staff in observing IPC practices. A direct observation tool was utilized to gather data, and just in time, feedback was provided to staff when opportunities in non-compliance were identified.ResultsThe compliance rate in Hand Hygiene, PPE, and CAUTI prevention in 11 months increased from 69 % to 99 %.ConclusionsInfection Prevention and Control practices are the most critical element in reducing healthcare-associated infection among residents and staff. Implementing IPC practices increased compliance in Hand Hygiene, PPE, and CAUTI prevention bundle. Comprehension of fundamental IPC practices is critical to health care systems, especially during a pandemic.

Lessons Learned When Discharging Older Adults to Skilled Nursing Facilities

Background: When patients transition from an inpatient hospital stay to a skilled nursing facility (SNF), the information that is sent with them is essential to proper care in the facility. Methods: Records of hospital-to-SNF transfer were reviewed for opportunities for improvement in providing accurate or complete information. SNF staff were asked about their experiences caring for these patients and the effects that the inadequate documentation had on the patient’s medical care. Results: Four cases were identified that exhibit key errors that make the transition from the inpatient setting to the SNF setting difficult and potentially unsafe for patients and providers. These included: (1) inaccurate medication reconciliation on discharge, (2) incomplete medication instructions on discharge, (3) lack of information about the inpatient course and diagnoses and (4) missing instructions for follow-up care and procedures. Conclusions: Education for hospital-based providers has the potential to decrease the risks associated with transitioning patients from inpatient to SNF care settings. Structural and systemic changes could reduce the role of human error in this process and decrease the time requirements on overburdened hospital staff.

Strategies to Promote Staff and Resident Flu and COVID-19 Vaccination in Skilled Nursing Facilities

Influenza (flu) and COVID-19 vaccination of both residents and staff are critical components of infection prevention in skilled nursing facilities (SNFs). Our study sought to identify and characterize strategies that SNF staff are using to promote vaccination. Twenty-six semi-structured, qualitative interviews were conducted with administrators, directors of nursing, infection preventionists, and Minimum Data Set (MDS) coordinators at 13 SNFs across the country. Interview transcripts were analyzed using a content analysis approach and a detailed audit trail was maintained. Skilled nursing facility staff described varying approaches to promote flu vaccination in their facilities. These ranged from small-scale efforts, such as displaying informational posters and providing candy at flu clinics, to more hands-on strategies including holding health fairs and educational question and answer sessions and having one-on-one discussions. A few facilities reported having a formal “vaccine champion,” usually the infection preventionist, who was responsible for influenza vaccine promotion and education efforts. Use of incentives to promote flu vaccination also varied across facilities prior to the COVID-19 pandemic. Some used no incentives, while others provided bonuses to staff who were vaccinated or allowed staff who had received the flu vaccine to avoid wearing a face mask for the duration of the flu season. While many strategies and incentives had been in place prior to COVID-19 and did not change as a result of the pandemic, participants described concerns about the continued effectiveness of the masking incentive strategy, given that masks are expected to be a requirement of SNF staff for the foreseeable future. Participants reported similar approaches to educate about and promote COVID-19 vaccination for residents and staff. With regard to education, staff discussed both widespread, general education strategies as well as targeted, individual approaches. Where COVID-19 vaccination was not mandatory, it was incentivized for staff by reduced testing requirements and for residents by reduced restrictions on activities and visitation. A wide range of strategies to promote flu and COVID-19 vaccination were reported. Future efforts to promote vaccination, informed in part by our findings here, will be critical to avoid the potential burden of influenza and COVID-19 co-circulation.

Evaluating the Findings of the IMPACT-C Randomized Clinical Trial to Improve COVID-19 Vaccine Coverage in Skilled Nursing Facilities

Identifying successful strategies to increase COVID-19 vaccination among skilled nursing facility (SNF) residents and staff is integral to preventing future outbreaks in a continually overwhelmed system. To determine whether a multicomponent vaccine campaign would increase vaccine rates among SNF residents and staff. This was a cluster randomized trial with a rapid timeline (December 2020-March 2021) coinciding with the Pharmacy Partnership Program (PPP). It included 133 SNFs in 4 health care systems across 16 states: 63 and 70 facilities in the intervention and control arms, respectively, and participants included 7496 long-stay residents (>100 days) and 17 963 staff. Multicomponent interventions were introduced at the facility level that included: (1) educational material and electronic messaging for staff; (2) town hall meetings with frontline staff (nurses, nurse aides, dietary, housekeeping); (3) messaging from community leaders; (4) gifts (eg, T-shirts) with socially concerned messaging; (5) use of a specialist to facilitate consent with residents' proxies; and (6) funds for additional COVID-19 testing of staff/residents. The primary outcomes of this study were the proportion of residents (from electronic medical records) and staff (from facility logs) who received a COVID-19 vaccine (any), examined as 2 separate outcomes. Mixed-effects generalized linear models with a binomial distribution were used to compare outcomes between arms, using intent-to-treat approach. Race was examined as an effect modifier in the resident outcome model. Most facilities were for-profit (95; 71.4%), and 1973 (26.3%) of residents were Black. Among residents, 82.5% (95% CI, 81.2%-83.7%) were vaccinated in the intervention arm, compared with 79.8% (95% CI, 78.5%-81.0%) in the usual care arm (marginal difference 0.8%; 95% CI, -1.9% to 3.7%). Among staff, 49.5% (95% CI, 48.4%-50.6%) were vaccinated in the intervention arm, compared with 47.9% (95% CI, 46.9%-48.9%) in usual care arm (marginal difference: -0.4%; 95% CI, -4.2% to 3.1%). There was no association of race with the outcome among residents. A multicomponent vaccine campaign did not have a significant effect on vaccination rates among SNF residents or staff. Among residents, vaccination rates were high. However, half the staff remained unvaccinated despite these efforts. Vaccination campaigns to target SNF staff will likely need to use additional approaches. ClinicalTrials.gov Identifier: NCT04732819.

Remote support for families and caregivers during transitions from skilled nursing facilities to home

Remote support for families and caregivers during transitions from skilled nursing facilities to home

Leadership among Director of Social Work at Skilled Nursing Facilities (SNFs)

Skilled Nursing Facilities (SNFs) provide ongoing care to the seniors and chronically ill. To maximize the quality of this care, SNF staff must be trained to respond to patient care crises and communicate across departments. Although researchers have studied the leadership styles, strategies, and interactions of facility administrators and nursing directors, little was known about the leadership styles and strategies imployed by the director of social worker (DSW). The aim of this phenomenological study was to explore how DSW influenced leadership policies, prepared subordinated for crisis intervention and management, perceived that social workers influenced patient care decisions, and believed that communication amongst SNF staff about patient care could be improved. The conceptual framework was based on the multilevel leadership model construct, the situational leadership model construct, and the complex adaptive leadership model construct. Participants included a purposive sample of 10 DSW working in a large, corporate SNFs in Virginia. Data were collected via in person, semi structured interviews consisting of open-ended questions. Data were analyzed via Hycner's phenomenological approach. Findings from this investigation helped clarify roles and responsibilities of DSW, thereby improving the leadership they provide to subordinate social workers. Findings may be used to improved communication across professionals within SNFs and in their role in patient decisions.

Challenges and Strategies to Maintain Fidelity to the MIRROR-TCM Intervention During the COVID-19 Pandemic

Randomized clinical trials (RCTs) have demonstrated that the multicomponent Transitional Care Model (TCM), an advanced practice registered nurse-led, team-based, care management strategy improves outcomes for older adults transitioning from hospital to home. However, healthcare systems’ adoption of the model has been limited. A multi-system, replication RCT (MIRROR-TCM) enrolling older adults hospitalized with heart failure, chronic obstructive pulmonary disease or pneumonia began in February 2020 just as the outbreak of COVID-19 in the U.S. dramatically changed the healthcare and research landscape. The goal of this qualitative descriptive study is to explore the impact of COVID-19 on fidelity to the TCM intervention during this clinical trial. Using directed content analysis, recorded monthly meetings with health system leaders and staff were coded to identify challenges and strategies to maintaining fidelity to the intervention in the context of the pandemic. Analyses showed that COVID-19 impacted all 10 TCM components. The components with the most challenges were delivering services from hospital-to-home due to quarantining, restrictive facility policies, lack of personal protective equipment and limited telehealth availability; coordinating care due reduced availability of services, and screening at risk individuals because of fewer eligible patients. Strategies for addressing challenges included: exploring alternatives (e.g., increasing reliance on telehealth, expanding study eligibility), building and engaging networks (e.g., direct outreach to skilled nursing facility staff) and anticipating needs (e.g., preparing for shorter hospital stays). Findings highlight the importance of monitoring the contextual challenges to implementing an evidence-based intervention and actively engaging partners in identifying strategies to achieve fidelity.

1207. Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County’s Response, California 2020-2021

BackgroundThe coronavirus-19 disease (COVID-19) outbreak has had a particularly devasting effect on skilled nursing facility (SNF) residents and healthcare workers (HCWs). While representing only 11% of COVID-19 cases, the residents accounted for 43% of deaths in the United States. MethodsWe report a retrospective review of the support provided by our local health department (LHD) to long-term care facilities in response to the COVID-19 pandemic. This group comprised of staff from healthcare-associated infections (HAI); the Medical Operations Center (MOC); Testing, Tracing, and Treatment (T3); and the Healthcare Provider Status Taskforce (Table 1 outlines their functions). The HAI team with the State Public Health Department provided infection prevention and control (IPC) outbreak investigation, education, recommendations, and ongoing access to technical assistance. The T3 team focused on rapid response testing and tracing; the HPSTF team collected data and issued questionnaires; the MOC responded to staffing and PPE requests; and the Long-Term Care Facility sector presented routine telebriefings to update the facilities on public health guidance, share resources, and answer questions during and in between briefings. Table 1. Sectors and Function of Response Teams to COVID-19 ResultsFrom March 2020 through May 2021, there were 504 outbreaks in LTCFs; the HAI team performed 281 outbreak investigations (Figure 1). In the same period, 308,264 molecular tests were performed using various platforms; laboratory services were outsourced during peak testing requests (Figure 2); “strike teams were deployed to facilitate testing on 404 occasions. Self-reported fully vaccination rate for SNF staff was 73% (March 2021) and 76% for residents (April 2021). There were 568 staff requested; total orders for PPE were 4,839 and 16,892,823 PPE items were fulfilled (Figure 3). In addition to knowledge gaps in IPC, other challenges included shifting IPC guidance, PPE shortages, timeliness of test results that impacted cohorting, community acquisition of disease with transmission to residents, interfacility spread among staff, staffing shortages, and vaccine hesitancy issues. Figure 1. Number of Outbreaks and Number of Outbreak Investigations Figure 2. Number of Tests Performed by the Public Health Laboratory and the Number of Visits by “Strike Teams” Figure 3. Personal Protective Equipment Fulfillment during COVID-19 PandemicConclusionThe management of the recent COVID-19 outbreaks required a multi-pronged approach. Lessons learned are applicable to other highly transmissible infectious diseases. Disclosures All Authors: No reported disclosures

Adverse Events and Their Contributors Among Older Adults During Skilled Nursing Stays for Rehabilitation: A Scoping Review.

PurposeTo identify factors that contribute to adverse events among older adults during short stays at skilled nursing facilities (SNFs) for rehabilitation (ie, up to 100 resident days). Adults aged 65 years and older are at serious risk for adverse events throughout their continuum of care. Over 33% of older adults admitted to SNFs experienced an adverse event (eg, falls) within the first 35 days of their stay.DesignA scoping review.Setting and ParticipantsOlder adults admitted for short stays in SNFs.MethodsEligibility criteria were peer-reviewed original articles published between 1 January 2015 and 30 May 2021, written in English, and containing any of the following key terms and synonyms: “skilled nursing facilities”, “adverse events”, and “older adults”. These terms were searched in PubMed, MEDLINE, CINAHL, EBSCOHost, and the ProQuest Nursing and Allied Health Database. We summarized the findings using the Joanna Briggs Institute and PRISMA-ScR reporting guidelines. We also used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavioral change as a framework to guide the content, thematic, and descriptive analyses of the results.ResultsEleven articles were included in this scoping review. Intrinsic and extrinsic contributors to adverse events (ie, falls, medication errors, pressure ulcers, and acute infections) varied for each COM-B domain. The most frequently mentioned capacity-related intrinsic contributors to adverse events were frailty and reduced muscle strength due to advancing age. Inappropriate medication usage and polypharmacy were the most common capacity-related extrinsic factors. Opportunity-related extrinsic factors contributing to adverse events included environmental hazards, poor communication among SNF staff, lack of individualized resident safety plans, and overall poor care quality owing to racial bias and organizational and administrative issues.ConclusionThese findings shed light on areas that warrant further research and may aid in developing interventional strategies for adverse events during short SNF stays.

Implementing transitional care in skilled nursing facilities: Evaluation of a learning collaborative

Proctor's Framework for Implementation Research describes the role of implementation strategies and outcomes in the pathway from evidence-based interventions to service and client outcomes. This report describes the evaluation of a learning collaborative to implement a transitional care intervention in skilled nursing facilities (SNF). The collaborative protocol included implementation strategies to promote uptake of a transitional care intervention in SNFs. Using RE-AIM to evaluate outcomes, the main findings were intervention reach to 550 SNF patients, adoption in three of four SNFs that expressed interest in participation, and high fidelity to the implementation strategies. Fidelity to the transitional care intervention was moderate to high; SNF staff provided the five key components of the transitional care intervention for 64–93% of eligible patients. The evaluation was completed during the COVID-19 pandemic, which suggests the protocol was valued by staff and feasible to use amid serious internal and external challenges.