[MUSIC] Hello, my name is Morgan Katz, and I'm going to be talking to you today about how COVID-19 has posed a special risk to assisted living communities. Nursing homes and assisted living communities have been absolutely devastated by this pandemic. To put this in perspective, based on the current data we have available, approximately 45% of the deaths in the US are from residents living in nursing homes or assisted living facilities. These residents only account for less than 1% of the population. On top of this, many residents have been isolated to their rooms or homes for the past several months, some unable to see their family members or caregivers since early March 2020. There are several reasons why this pandemic has hit long term care facilities so hard. Residents that live or work in assisted living communities may be at particular risk for infection as well as more severe outcomes for several reasons. First, most residents living in this community are older and have comorbidities that put them at risk for more severe disease. They often require hands-on care, which means close personal contact with another individual. These are potential opportunities for exposure for the disease due to the inability to physically distance. Along with exposure to the staff, any individuals living in a group living setting with group activities and group dining have more exposure to others than individuals living in a single family home. This type of setting makes physical distancing a challenge, particularly in memory care or dementia units, when residents are not able to understand the need to physically separate. We use the term physical distancing here because this is an important aspect of how we address this virus and prevent transmission. While physical distance or separation by at least six feet is an important feature of reducing potential spread, this does not mean that individuals need to socially distance from others. That is, it is more important now than ever to find ways to socially connect and keep residents connected with their loved ones while still maintaining physical distance. Isolation and quarantine in congregate living settings has been an incredible challenge throughout the course of this pandemic. While physical distancing is one of the most important features of proper infection prevention of SARS-CoV-2, there are many challenges maintaining physical distance in this population. First, in general, the physical design is set up for group living. This may include shared living situations with roommates, and often includes group activity rooms in order to promote shared experiences and interaction. Second, the population is often hard to maintain physical distance, including isolating and quarantining individuals inside their room. Or requiring consistent and proper mask use due to cognitive disabilities, which may affect their understanding of the need for these practices. Particularly early in the pandemic, resources were also a major issue. Access to personal protective equipment was a significant challenge for healthcare providers across the country. Ensuring that staff had up to date infection prevention education has also been a major challenge. Staffing shortages have made it difficult to provide the on site guidance that is needed during a pandemic. On top of the various infection prevention challenges with isolation and quarantine, social isolation has mentally been incredibly difficult for both residents and staff in assisted living communities. As you know, visitation has been limited since early March 2020 in all of these communities, and most group activities, including shared dining, has been canceled. This prolonged social isolation can take a serious toll in this community, particularly in adults living with dementia. Prior to the pandemic, there have been issues with maintaining consistent and reliable infection prevention practices in the long term care setting. These communities have essentially been expected to operate with the infection prevention practices of a hospital, even though the population and physical setup often does not allow for this. Assisted living communities are an individual's home. Because of this desire to maintain a home-like environment for residents, communities often do not use the infection prevention methods that are helpful and necessary in the acute care setting. For example, signage documenting the appropriate transmission based precautions to where, when entering a resident's room who may have an infection, is often ambiguous or completely absent. There's limited access to hand sanitizer because mounting a hand sanitizer machine outside each patient's room may make it look more like a healthcare facility. There are also challenges with requiring consistent mask use, particularly if residents are ambulating around what they see as their home. Hand hygiene has been noted to be a challenge in observations of care in long term care facilities. This is often due to lack of education and lack of access to sinks or hand sanitizer. In general, there's also a lack of funding or support for infection prevention education as well. While some type of infection prevention programs became a requirement for nursing homes under the Obama administration, this is so largely overlooked in long term care. And often gets added on as a task to a staff member who already has many other responsibilities. Finally, high staff turnover and limited staffing is an issue throughout long term care settings, which makes any infection prevention education very difficult to sustain. Some groups of people are more likely to have severe disease if they get infected. These include older adults greater than 65 years of age, with increasing severity as age increases. People who are obese or people with other existing medical conditions, including diabetes, hypertension, lung disease, liver disease, kidney disease, or a weakened immune system. COVID-19, as most of you are aware, can have high mortality rates, particularly in older adults, but how does this disease kill? First, if the lungs aren't able to recover, if the virus damages the lungs too much and the patient is unable to breathe on their own, then that's one way that someone can die from COVID-19. Another way is through lack of oxygen. If the lungs aren't functioning properly, then you can't get enough oxygen in your body and that can damage many of your other organ systems. And you need all of these to function in order to survive. So damage to those organs can put you at increased risk for a heart attack or kidney failure, strokes, or other blood clotting disorders that can all cause death from COVID-19. Some people may be at higher risk for death than others. It depends generally on your health before you get sick and also access to care. So if someone gets sick with COVID-19 but is unable to seek care early in the illness, then they're at a higher risk for death. It's important for people who develop severe disease to be able to get the supportive care they need quickly. This includes an increased need for close monitoring for those diagnosed with COVID-19 in the assisted living setting. Death from COVID-19 is rare among young and healthy people, but it can happen. Death among older adults who have COVID-19 is much more common and it increases with age. 2 to 5% of people who are infected with COVID-19 age 65 to 75 years will likely die from COVID-19 in the United States. That risk increases to 4 to 10% among those infected age 75 to 85, and is over 10% in people age more than 85 years old. This is why it's so important to help keep people in these higher age groups safe from infection. It's very important that we do everything we can to try to limit transmission to people who are in these high risk age categories. [MUSIC]
