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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

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
1.
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/NEJMoa2005412PubMedGoogle Scholar
2.
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.2020.2233Google Scholar
3.
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.mm6913e1PubMedGoogle ScholarCrossref
4.
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.2020.2565PubMedGoogle ScholarCrossref
5.
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/eid2605.200198PubMedGoogle ScholarCrossref
6.
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.
7.
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.
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