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Nursing Home Care in Crisis in the Wake of COVID-19

Educational Objective
To understand the crisis Nursing Home Care is facing in the wake of COVID-19
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic has devastated US nursing homes. Thousands of facilities nationwide have reported cases of COVID-19 among residents and staff.1 Although less than 0.5% of the total US population (approximately 1.5 million people) live in nursing homes, nursing home residents have accounted for approximately 25% of the documented deaths due to COVID-19. Some states (such as Massachusetts and Pennsylvania) and some European countries (such as France and Ireland) have reported that residents of nursing homes account for 50% of the deaths.1 Virtually all nursing homes are in full lockdown mode with residents unable to see their families or participate in communal meals or activities. Many staff are concerned they will contract the virus, and severe staff shortages exist because many workers are unable or unwilling to work in conditions characterized by insufficient testing and personal protective equipment (PPE).

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: David C. Grabowski, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (grabowski@hcp.med.harvard.edu).

Published Online: May 22, 2020. doi:10.1001/jama.2020.8524

Conflict of Interest Disclosures: Dr Grabowski reported receiving research support from the National Institute on Aging, the Agency for Healthcare Research and Quality, the Arnold Foundation, and the Warren Alpert Foundation; serving on a scientific advisory committee for and receiving personal fees from naviHealth; receiving personal fees from the Medicare Payment Advisory Commission, Vivacitas, CareLinx, Compass Lexecon, Abt Associates, Analysis Group, and the Research Triangle Institute. Dr Mor reported receiving research support from the National Institute on Aging, the VA Health Services Research and Development Service, and the Seqeris Corporation via Insight Therapeutics Inc; and chairing a scientific advisory board for and receiving personal fees from naviHealth.

References
1.
Chidambaram  P . Kaiser Family Foundation Issue Brief: state reporting of cases and deaths due to COVID-19 in long-term care facilities. Accessed April 26, 2020. https://www.kff.org/medicaid/issue-brief/state-reporting-of-cases-and-deaths-due-to-covid-19-in-long-term-care-facilities/
2.
Grabowski  DC . 2019 Senate finance committee hearing: not forgotten: protecting Americans from abuse and neglect in nursing homes. Accessed January 19, 2020. https://www.finance.senate.gov/imo/media/doc/Grabowski%20Senate%20Finance%20testimony%20FINAL.pdf
3.
Grabowski  DC , Joynt Maddox  KE .  Postacute care preparedness for COVID-19: thinking ahead.   JAMA. Published online March 25, 2020. doi:10.1001/jama.2020.4686 PubMedGoogle Scholar
4.
Mor  V , Rahman  M , McHugh  J .  Accountability of hospitals for Medicare beneficiaries’ postacute care discharge disposition.   JAMA Intern Med. 2016;176(1):119-121. doi:10.1001/jamainternmed.2015.6508PubMedGoogle ScholarCrossref
5.
Barnett  ML , Mehrotra  A , Grabowski  DC .  Postacute care—the piggy bank for savings in alternative payment models?   N Engl J Med. 2019;381(4):302-303. doi:10.1056/NEJMp1901896PubMedGoogle ScholarCrossref
6.
Teno  JM , Gozalo  PL , Trivedi  AN , Mitchell  SL , Bunker  JN , Mor  V .  Temporal trends in the numbers of skilled nursing facility specialists from 2007 through 2014.   JAMA Intern Med. 2017;177(9):1376-1378. doi:10.1001/jamainternmed.2017.2136PubMedGoogle ScholarCrossref
7.
McCarthy  EP , Ogarek  JA , Loomer  L ,  et al.  Hospital transfer rates among US nursing home residents with advanced illness before and after initiatives to reduce hospitalizations.   JAMA Intern Med. 2019;180(3):385-394. doi:10.1001/jamainternmed.2019.6130PubMedGoogle ScholarCrossref
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