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Recommendations for a Metropolitan COVID-19 Response—Special Area of Emphasis: Guidance on Protecting Individuals Residing in Long-Term Care Facilities

Recommendations for a Metropolitan COVID-19 Response—Special Area of EmphasisGuidance on Protecting Individuals Residing in Long-Term Care Facilities
Diane Meyer; Sarah LaFave; Allison A. Hart; Elena Martin; Jennifer Nuzzo
Date posted:
April 21, 2020
Publication type:
Johns Hopkins Bloomberg School of Public Health
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Long-term care facilities, including skilled nursing facilities, nursing homes, and assisted living facilities, house some of the nation’s most at-risk populations for morbidity and mortality related to COVID-19 infection. Residents of these facilities require frequent interactions with staff such as for assistance with personal care (i.e. feeding, bathing, dressing), which increases the risk for transmission of COVID-19. Additionally, residents often have underlying medical conditions that put them at increased risk for severe complications if they become infected (1).

These facilities are often under-resourced, hindering their ability to implement some of the critical measures necessary to prevent COVID-19 transmission. Outbreaks within these congregate residential settings can progress extremely quickly, resulting in a large number of cases in a short period of time, many of which may require transfer to an acute care facility. This surge can further stress local health systems that are often already functioning at full capacity. As of April 17, at least 7000 COVID-19 deaths have been linked to nursing homes, with over 36000 residents and employees infected (2).

The US Centers for Disease Control and Prevention (CDC), health professional organizations, and state and local health departments have developed strategies and guidelines for post-acute care settings to prevent COVID-19 transmission (3-9).

To support long-term care facilities in operationalizing these guidelines and accessing needed resources, local municipalities should establish a long-term care support team. Ideally, this team would be established prior to an epidemic, and then activated as needed. Such a team could be established under the auspices of the health department and staffed by members of the health department or by other agencies, organizations, or volunteers (e.g. Medical Reserve Corps, American Red Cross). Members of the long-term care support team should include clinicians, public health practitioners, local emergency response authorities, community organizations, and others with knowledge of long-term care facility operations. Refer to Box 1 for administrative activities that the team should implement once established. The recommendations below highlight the activities that the long-term care support team should perform to support long-term care facilities during their COVID-19 preparedness and response efforts.



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