Widespread Transmission of COVID-19 Occurred in Nursing Homes

April 8, 2021
April 8, 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 first 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.

Nursing Homes Are Virus Transmission Hotspots

When referencing nursing homes, it is important to consider more than long-term residents. In addition to a constant flow of shift-based workers, some of whom work at multiple facilities, where they could potentially catch an infection or transmit one, there can be a sizeable proportion of short-term residents who are in the facility for rehabilitation after surgery or another healthcare purpose. Even if families and other visitors are restricted or prohibited, this work environment is not a closed circle and involves a substantial flow of traffic in and out, with significant challenges for preventing infection transmission. According to Donald Taylor, public policy professor and Director, Social Science Research Center at Duke, “Given asymptomatic transmission of the disease, we probably will not be able to get control of this in nursing homes without asymptomatic testing. We don’t know what that protocol of testing… will look like, but we desperately need evidence. If we don’t manage to control the epidemic within nursing homes, we’re not going to control it in the United States.”

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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