US Pharm. 2020;45(5):31-34.

The COVID-19 pandemic has hit some nursing homes especially hard—including in the hotspot state of Michigan. Hundreds of deaths of residents in homes from Seattle to Boston have raised concerns about how well facilities are protecting the 1.3 million older Americans who live in them. Those concerns have prompted new federal and state requirements about testing and transparency.

New data suggest that at least in Michigan, nursing homes that responded to a survey were far better prepared for this pandemic than they were for the last one. The study includes responses from 130 nursing homes to a survey performed during the week that the state announced its first documented case of COVID-19, which shows that nearly all had a pandemic plan in place. That is compared with just over half of the 280 nursing homes that answered the same survey in 2007. Nearly all said they now have at least one staff member in charge of pandemic preparedness.

The findings are reported in the Journal of the American Geriatrics Society by a team from the University of Michigan that has studied and worked to improve nursing home infection prevention for years. Members of the team have several other recent publications with direct or indirect relevance to the COVID-19 pandemic, including putting forth recommendations for nursing homes and other housing facilities for older adults to use in planning how they will respond to pandemics such as COVID-19.

“Our nursing homes house some of the most vulnerable in our society,” said Lona Mody, MD, MSc, a geriatrician at Michigan Medicine, U-M’s academic medical center, and the VA Ann Arbor Healthcare System, who is senior author of both of the new publications. “This virus unfortunately is very contagious, the disease it causes has incredibly poor outcomes in older adults with comorbidities, and nursing homes are communal settings with shared spaces and resource limitations. This creates a perfect storm of sorts. Being novel, we learn as we go and have to learn really quickly.”

The new survey data show Michigan’s nursing homes have done a lot to prepare for pandemics since the last time the U-M team performed the survey. That previous survey was taken before the H1N1 influenza pandemic of 2009, but after the H5N1 pandemic of 2005 raised national awareness of the importance of pandemic preparedness, Dr. Mody and colleagues published pandemic preparedness guidance for nursing homes.

In mid-March, 85% of nursing homes said they had stockpiled supplies before COVID-19 hit, compared with 57% after the H5N1 pandemic. Most of those that had stockpiled supplies had focused on surgical masks, gloves, and hand sanitizer. Less than half had stockpiled N95 respirator masks, which are recommended by national and global health authorities for healthcare workers performing certain types of care on a COVID-19 patient.

Still, 42% of the nursing homes that answered a question about COVID-19-specific concerns said they were worried about running short of personal protective gear (PPE).

“Although the size and severity of COVID-19 outbreaks in some nursing homes have taken everyone by surprise, just as so much about this pandemic has, in general nursing homes knew exactly what their challenges were going to be in a pandemic—PPE shortages, staff shortages, and worries that they did not have the capacity to care for COVID patients after their hospital stay.”

Nearly all now said they had trained staff on how their facility would respond in a pandemic, up from 42% in 2007. But only one-third had conducted a pandemic drill. And Dr. Mody noted that nursing homes have a much higher rate of staff turnover than hospitals, which means that training on infection prevention and pandemic response has to be offered whenever a new person joins the organization.

Michigan’s nursing homes appear to have gotten better connected to the broader healthcare system in the past decade, with significantly more saying they now have communication lines established with local hospitals and public health departments.

Many also said they were drawing COVID-19 guidance not just from the CDC, but also from state and local health departments. Half also received guidance from their home’s corporate parent.

While half of the nursing homes surveyed this year said they expected significant staff shortages due to COVID-19, most of them said they had a plan to deal with that. Most planned to ask existing clinical staff to work more hours and to redeploy nonclinical staff. Two-thirds expected they would need to require staff to work overtime.

The survey also explored the potential for nursing homes to relieve the burden on hospitals. In all, 82% said they would be willing to take nonpandemic patients from overburdened hospitals now, compared with 53% in 2007. But the percent who said they would be able to accept patients with the pandemic disease stayed the same, at one-third of responding nursing homes.