Blog: Potential COVID-19 Impact Greater on Rural and Single Provider Long Term Care-1256717949

Potential COVID-19 Impact Greater on Rural and Single Provider Long Term Care

May 14, 2021
May 14, 2021

Few people, especially those within healthcare, are unaware that the COVID-19 pandemic has hit the nursing home and long-term care areas of the care continuum harder than anywhere else. The skilled nursing environment has, unfortunately, become a place where COVID-19 is easily transferred between patients, residents, family members, and staff, necessitating lockdowns, the prohibition of visitors, and elimination of resident gatherings. While some measures have been successful in preventing additional widespread infection and loss of life, there are inherent challenges for this care environment in the face of a pandemic. According to a recent media briefing about nursing facilities and the COVID-19 pandemic, Duke University eldercare experts emphasized that "Nursing homes will continue to be COVID-19 hotspots until state and federal officials can institute sweeping testing of asymptomatic patients and workers."

This blog post is the sixth in our series based on the HealthStream article, 10 Considerations for COVID-19 and Long-Term Care, which examines specific considerations and recommendations to improve the prospects for people living in this long term care, offered by three Duke experts in the eldercare and public policy space.


There appears to be a correlation between serious outbreaks of COVID-19 and location in rural areas, as well as the size of a facility and its affiliation with larger health systems. Independent nursing facilities that are not part of larger organizations may typically have problems with baseline quality. COVID-19 may potentially exacerbate existing structural deficits and connect with the need to implement more stringent infection controls. Many care facilities in this situation are already challenged by thin staffing levels, making the need for asymptomatic testing even more critical. Testing itself can be difficult—getting results returned can take so long that they are no longer helpful for a rural facility in its efforts to prevent the spread of infection.

About the Experts

Nathan Boucher is an Assistant Research Professor in the Sanford School of Public Policy at Duke. He studies patients' and caregivers' experiences and expectations of health care delivery during advanced illness and near the end of life.

Eleanor Schildwachter McConnell is an Associate Professor at the Duke University School of Nursing. She studies factors that influence functional decline in very frail older adults. Her research has been funded by the National Institute of Nursing Research and the Department of Veterans Affairs.

Donald Taylor is a Professor of Public Policy who researches aging and comparative health systems, including Medicare, long-term care, and health policy. Taylor also directs Duke's Social Science Research Center.

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