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Infection Control

Preventing COVID-19 in Assisted Living Facilities—A Balancing Act

Educational Objective
To understand how to prevent COVID-19 outbreaks in assisted living facilities

1 Credit CME

JAMA Internal Medicine

Published Online: May 21, 2020

Invited Commentary

Article Information and Disclosures

Grace Y. Jenq, MD¹;

John P. Mills, MD²;

Preeti N. Malani, MD, MSJ³

Author Affiliations

¹Department of Internal Medicine, University of Michigan, Ann Arbor
²Division of Geriatrics and Palliative Medicine, University of Michigan, Ann Arbor
³Division of Infectious Diseases, University of Michigan, Ann Arbor

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Since the initial cases of coronavirus disease 2019 (COVID-19) were identified in the US, the unique vulnerability of older adults has been painfully demonstrated with several nursing home–associated outbreaks.¹ The public health response, though entirely appropriate to halt transmission and save lives, requires draconian limits on movement and visitation.

As a consequence, similar interventions have been put into place in other residential communities, such as assisted living facilities. As the name implies, assisted living facilities provide older adults with a range of assistance for activities of daily living. Nearly 1 million older adults live in an estimated 25 000 assisted living facilities in the US, most with impairments in cognition or mobility.

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Article Information

Corresponding Author: Preeti N. Malani, MD, MSJ, F4135 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109 (pmalani@umich.edu)

Published Online: May 21, 2020. doi:10.1001/jamainternmed.2020.2224

Conflict of Interest Disclosures: None reported.

References

McMichael TM , Currie DW , Clark S , et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington [published online March 27, 2020]. N Engl J Med. doi:10.1056/NEJMoa2005412 PubMed Google Scholar

Roxby AC , Greninger AL , Hatfield KM, , et al. Outbreak investigation of COVID-19 among residents and staff of an independent and assisted living community for older adults in Seattle, Washington [published online May 21, 2020]. JAMA Int Med. doi:10.1001/jamainternmed.2020.2233 Google Scholar

Kimball A , Hatfield KM , Arons M , et al; Public Health – Seattle & King County; CDC COVID-19 Investigation Team. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-381. doi:10.15585/mmwr.mm6913e1 PubMed Google Scholar Crossref

Bai Y , Yao L , Wei T , et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406-1407. doi:10.1001/jama.2020.2565 PubMed Google Scholar Crossref

Tong ZD , Tang A , Li KF , et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis. 2020;26(5):1052-1054. doi:10.3201/eid2605.200198 PubMed Google Scholar Crossref

Centers for Disease Control and Prevention. Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html. Accessed on April 24, 2020.

Coronavirus Disease 2019: Considerations for Assisted Living Facilities. Centers for Disease Control and Prevention. Updated April 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/assisted-living.html.Accessed on April 24, 2020.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.