A panel of long-term care experts led a discussion on the lessons learned from the COVID-19 pandemic at the 2023 Illinois State of Reform Health Policy Conference earlier this month.
Last year, the Biden administration issued guidance on federal regulatory requirements for nursing homes that addressed resident health and safety. The initiatives establish minimum staffing requirements, promote single-occupancy rooms, and attach funding to quality metrics.
Marianne Marcocig, vice president of Pavilion Healthcare, said one lesson included better managing the isolation of residents in a facility designed and built for communal living, not a public health emergency.
“A lot of times [residents] were put in a private room because they were at risk for infection, they had the infection, or they were being monitored for the infection. In a two-week period, the only person they saw was their nurse [or certified nurse assistant] and that is not ideal, obviously. We weren’t staffed for that. We weren’t prepared for that in any way, shape, or form.
I think we learned a lot of lessons. I’m hoping that we’ll never have to go to that extreme because the psychosocial needs of the residents really suffered. The facilities just [were] not built to be that—they’re called private rooms. Structurally, they’re just not designed that way.”
— Marianne Marcocig, vice president, Pavilion Healthcare
One of the main lessons for Michelle Stuercke, chief clinical officer at Innovative Health, was the opportunity to improve communication and coordination between state and federal public health entities and stakeholders on administering the different levels of care during an emergency.
She said the regulatory environment was not set up to care for people with severe mental illness in a communal environment.
“We talk about things like health equity, and health inclusion. We need to realize that many of these individuals with severe mental illness have lived in an environment of fight or flight. So when something happens their first defense mechanism is to fight—whether that’s verbally or physically—to get out of their situation.
As a facility, you’re working with people with severe mental illness, you’re trying to help them find different coping mechanisms and different ways to go about managing their behavior, but it’s a process.”
— Michelle Stuercke, chief clinical officer, Innovative Health
Marcocig said the nursing home industry has done a poor job of educating caregivers and staff on how to manage certain behaviors among the elderly that stem from either a behavioral health condition, side effects of medication, or both.
Federal regulators have been examining problematic diagnoses related to the inappropriate use of antipsychotic drugs. While medication-assisted treatment (MAT) for substance use disorder remains the work of drug treatment facilities, Stuercke believes a MAT program could be administered within nursing homes throughout the state if policies can ensure that medications are safely delivered through nursing home pharmacies.
“We need more mental health professionals, more social workers on our staff to deal with different types of behaviors—adjustment disorder and community living skills—things that we never thought of in a traditional nursing home.
Changing staffing ratios to look at those types of positions and maybe not be so heavy on the nursing side of it. [Staffing] is something we need to look at.”
— Stuercke
The first reported death from COVID in the US happened at a nursing home facility in Kirkland, Wash., in early 2020. Soon after, nursing home resident deaths around the country were surging.
Of the 36,870 deaths from COVID-19 in Illinois, 31,824 (86 percent) were older than 60. And the older residents got, the more at risk they were to die from the virus—a risk that is lower today due to vaccination. Around 95 percent of Illinoisans 65 and older have received at least one vaccine dose, and 91 percent of them have completed the primary series.
Maintaining adequate and skilled staffing remains the primary challenge, according to both administrators.
“Getting our facilities back on track from a staffing perspective, making sure we’re taking care of our residents, and dealing with new residents [and the different types of specialties] that are coming to us. And preparing our staff so we continue to be successful providing post-acute care.”
— Marcocig