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Virtual Town Hall

COVID-19: Impact and Resources for Older Adults

At UNG’s Institute for Healthy Aging virtual town hall meeting in May 2020 , we heard from a panel of experts regarding the COVID-19’s ongoing and future impact on the senior community. Learn about valuable resources available to older adults and how to access them by watching the Virtual Town Hall.

Featured Speakers

Abby Cox: Director, Georgia Department of Human Services, Division of Aging Services
Pat Freeman: CEO, Legacy Link, the Northeast Georgia Mountains Area Agency on Aging
Pam Clayton: VP Quality Advancement & Regulatory Affairs, Georgia Healthcare Association

Georgia Health Care Association Town Hall FAQ

What is the status of the over 200+ long-term care facilities (in regions) across Georgia?

The safety and well-being of Georgia’s older adults as well as the staff who care for them is our highest priority. Providers remain vigilant with protective measures and monitoring for the presence of the virus to protect those we serve.

Do long-term care facility staff have adequate PPE across the state and is there a staffing shortage due to staff illness?

Personal protective equipment (PPE) has been a challenge since the onset of the pandemic and while some channels for procurement are beginning to open up, inventory and cost remain a significant issue. Staffing has been a challenge as providers follow screening and isolation recommendations for the health care setting.

How many older adults are in long-term settings (senior retirement communities, assisted living and intermediate care facilities)? What can you say to them to ease their fear of getting coronavirus?

We care for over 50,000 older adults in skilled nursing and assisted living centers across the state. Understandably, contracting the virus is a concern for most everyone. However, residents, families and other stakeholders can be assured that providers have taken this virus very seriously and we are providing updates multiple times per day to ensure access to the most current guidance to ensure protective measures are in place.

Last week an article in the AJC was titled: Staffing shortages threaten care at nursing homes, assisted living facilities – are there staffing issues and what is being done to address staffing concerns?

We are so proud of our caregivers and their dedication as they continue to show up has been inspiring but an adequate and competent workforce was a challenge for health care providers pre-COVID and the impact of this virus has amplified the challenge. We are fortunate the Governor and the Department of Community Health have worked with us to allow for a temporary nurse aide program, which has been a tremendous benefit.

As many Georgians were displaced from jobs in settings such as the hospitality industry, we have been able to welcome them into our centers and provide an online training and skills evaluation program. This has been an excellent opportunity for nursing students as well as classroom and clinical rotations were disrupted due to the virus.

An article in the AJC stated that 4,149 nursing home and assisted living residents have been infected and more than 659 have died, and almost 2000 long-term care workers have been infected. What is really going on in Long Term Care? How is it being addressed?

There is still much to learn about this virus but everyone recognized early on older adults and those with underlying chronic conditions were particularly vulnerable. Sadly, this has proven to be true and in our settings we serve older adults and most have two or more chronic conditions. Couple this with the lack of certain environmental controls and asymptomatic carriers and the risk of transmission increases.

As test capacity expands, we do anticipate we will continue to see confirmed diagnoses in our setting. It is important to note that some centers may reflect a higher incidence of COVID-19 because they may have designated COVID treatment units. The numbers we are tracking are cumulative; therefore, some residents who were COVID positive may no longer be in the center as they may have discharged to home or to a lower level care setting. Well over 1500 have recovered and I do think that is an important statistic to share.

What is known regarding number of cases, hospitalization, and deaths of older adults in Georgia?

Cumulatively, older adults in our setting represent about 12% of the state’s total number of confirmed cases. Unfortunately, as feared, the mortality rate is much higher for this population. However, it is important to note that while providers report the death of anyone that was confirmed to have COVID the cause of death may not actually be COVID.

The Department of Community Health has a public facing website that provides details on confirmed cases and outcomes for all skilled nursing facilities and assisted living and personal care homes with 25 or more beds.

What is being done to target keeping older Georgians safe and protect the vulnerable frail elderly?

Given the congregate nature of our setting and challenges associated with testing and PPE, providers have waged a valiant fight against this highly contagious virus and their efforts have been nothing short of heroic. But this is a unique virus.  

Early on, Georgia Health Care Association recommended that providers restrict visitation and implement screening even prior to the official recommendation from Centers for Medicare & Medicaid Services (CMS) or the Centers for Disease Control (CDC). This was followed by recommendations to limit group activities and communal dining.

Universal masking and other recommendations have been implemented as guidance is provided by the Department of Public Health, Centers for Disease Control or Centers for Medicare Services. We also feel better positioned as testing capacity increases.

Are current nursing home guidelines working? Are there updated guidelines going forward?

This has been a dynamic environment and initially guidance was changing daily if not multiple times per day. I think we will continue to learn more about the virus, how it behaves differently with different individuals and will respond accordingly.

The Georgia Health Care Association (GHCA) and the Georgia Center for Assisted Living (GCAL) created this COVID Resource page early on and this has been helpful to providers and other stakeholders as they can have ready access to current information and guidelines. Additionally, they do a webinar each Friday that is open to everyone and share information on changes in guidance or best practice and I think providers have found this to be very helpful.

When will be able to see our mom again? There has been no visitation since early March, she doesn’t have a smart-phone or a computer. We need to see her!

We recognize the changes brought on by this pandemic are unprecedented and we grieve for the residents and families who long to see each other. Centers have worked really hard to create opportunities for interaction and I am pleased that CMS implemented an expedited grant application process that allows skilled nursing centers to apply for funds to purchase technological supports that will facilitate virtual visitation and interaction.

Many centers have already acted on this and hopefully will able to purchase additional equipment soon. CMS has recently released guidance on considerations for re-opening long-term care centers and we will be working with appropriate agencies to evaluate specific plans for Georgia. 

How can we balance nursing home/assisted living safety with helping elders feel connected with their families and friends?

I think the struggle to achieve this balance is going to be with us for some time as we try to keep everyone safe yet meet their holistic needs. We are a high touch profession and this has been a significant shift for everyone, especially the residents and direct caregivers. I have been amazed by some of the creative things they have done to help residents feel safe and connected. I really hope communities at large will continue to engage and be creative in how they offer support.

What are the plans for allowing family to have face to face contact with their loved ones?

CMS has just released guidance on re-opening of centers and the plan will vary by center based upon their specific incidence rate and other factors such as case status in the local community, staffing and access to testing, ability to follow social distancing measures, for example use of face coverings, local hospital capacity and PPE. We will be working with other stakeholders to promote a coordinated and thoughtful plan.

Are the facilities getting what they need such as PPE for the staff and residents?

The ability to procure PPE has improved but remains an issue. You may have heard the federal government committed to disbursing a week’s allocation to all skilled nursing centers across the nation in the month of May and another week’s worth in June. This is helpful but some centers are using in a day what they may have historically used in a month so you can appreciate they supply and demand challenge.

My mother is 97 and in an Assisted Living Factuality. Prior to the facility being closed to visitors on March 15, she was in great health - going to the dining room for lunch and dinner, playing games in the dining room all day. Now she spends the day in her room and only occasionally gets out for 15 minutes with a mask on. And not allowed visitors. How are facilities guarding the mental health of residents?

As I have said, caring for the whole person is the goal of staff every day. They are accomplishing this through many creative outlets and the access to mental health services through telehealth is a vital tool. I do think it is positive that staff are keenly focused on monitoring residents for any change right now and this can be helpful in quickly identifying changes in mood or behaviors allowing for early intervention.

I do encourage family members to actively engage staff in sharing ideas of things that might be meaningful for their family during this period of a more socially isolated environment.

Are facilities testing everyone (residents, staff) – and how often?

At this time, testing is strongly encouraged but we are also cognizant of resident’s right to make an informed choice and we are balancing these rights with public safety.

We are currently working with appropriate agencies on a robust resident and staff testing initiative that will continue over the next couple of weeks. Presently, over 65% of skilled nursing residents have been tested at least once.

I read that there is little virus transmission when people are outside – is there any thought being given to allowing residents to have visitors outside on the facility’s properties?

Outdoor visitation is not expressly prohibited where social distancing measures can be strictly adhered to. Of course there are a lot of considerations that go along with that such as space configuration and visitation logistics. These discussions are encouraged at the local level where all factors can be appropriately considered.

We worry about our parent’s mental health. The facility they are in is closed and we haven’t seen them in two months. They say that all they are doing is watching TV. The residents need some type of "escape" from this lockdown. What are facilities doing to keep people active, and why are they allowing people to stay in their rooms all day.

There is no question the precautions that have been recommended for our setting in the interest of protecting the residents’ health has been hard for everyone. I think we see the debate around risk versus benefit of various recommendations associated with the virus and public health being played out across the nation. I am pleased that providers have embraced the challenge of thinking about how to support resident’s in a different way and we often see evidence of this in pictures and the sharing of great ideas.

Again, we encourage family members and communities to engage in unique ways to meet their social and emotional needs and definitely to share specifics they think would be meaningful to their loved ones.

Are mental health professionals should be available to all residents?

Onsite essential services have continued throughout the pandemic and fortunately access to mental health services through telehealth has increased due to waivers put into place as a result of the public health emergency.

We go to church up here online – can facilities have some type of religious services available for their residents to participate in?

Church or religious services have continued to be offered in a variety of ways at the different centers. This may be virtually or in some cases churches have offered a drive through or parking lot type service that residents could observe from a distance.

Is there a plan among your constituents to address social isolation in long term care facilities? What issues of social isolation are being discussed and how are they being address? Or responded to?

I think we are all acutely aware of the potential adverse effects of this pandemic on both residents and staff and mitigation strategies are definitely a part of the ongoing conversation. We continue to offer a lot of virtual resources and have several mechanisms that allow providers to share strategies that are working for them. It certainly takes a village but I do think awareness is a huge part of the battle and the need to combat the effects of isolation has everyone’s attention.

I recently read that ½ of our coronavirus deaths are connected to nursing homes, assisted living facilities, and other long-term care facilities. What is being done to reduce the risk of the coronavirus getting into the facility?

Unfortunately, mortality rates are higher in older adults with underlying chronic conditions. We continue to encourage adherence to every protective measure to the greatest possible extent that is recommended by DPH, CDC and other agencies.

Our shelter-in-place order ended April 30, except for "medically fragile and elderly Georgians," who generally must stay home until June 12. Does this mean that the long term care facilities will stay closed to visitors until June 12?

We do anticipate restrictions will be in place until June 12 but we will be critically reviewing CMS’s recommendations relative to easing restrictions and will continue to engage with appropriate agencies to inform planning and actions. I know we are all anxious to resume some sort of normalcy but do not want to act precipitously and risk minimizing the positive impact of the many sacrifices that have been made up to this point.

My father had a stroke and his doctor wants to send him to a rehab facility? Is that safe? Can I take him home to my house and get him therapy at home? He can’t walk and can barely speak.

These decisions are obviously specific to the individual patient circumstances and the recommendations of their physician but inpatient rehab or outpatient rehab may be a safe option. I can assure you the providers take their responsibility to make safe admission decisions very seriously and admission decisions are made based upon the center’s ability to meet the resident or patient’s comprehensive needs including any isolation precautions that may be warranted.

The CDC now recommends that everyone wear cloth facemasks – my mother told me that she hasn’t been given one that she can put on when the staff come into her room. Shouldn’t she be given one?

At a minimum, cloth face masks should be worn when a resident leaves their room. Obviously these recommendations are different for anyone presumed to be COVID positive. Many communities have donated face masks and I am sure that would be welcome at most centers.

Are long term care staff tested for covid-19 every time they come into the building?

No, testing capacity nor turnaround of test results has permitted this frequency of testing. However, strict screening criteria is followed prior to beginning shift or assignment.

The assisted living my mother lives in brings the residents into the hall in front of their doors to play bingo. Is this safe?

Decisions on activities of this nature are best made at the local level where there is awareness of the incidence of covid within the center as well as within the community at large. I would think it is possible to practice social distancing measures and enjoy an activity of this type in certain assisted living settings.

Are the number of people with coronavirus increasing or decreasing in nursing homes?

We are tracking cumulative incidence of COVID and as expected, as test capacity increases we are seeing these numbers increase.

What is the COVID-19 Temporary Nurse Aide Training Program? Why was it instituted? Are the nurses’ aides capable to do the necessary work?

The temporary nurse aide program is an online training program that is followed by skills evaluation and supervised training. The program was made possible by Georgia through the waiver process permitted by the declared public health emergency. State test sites were closed due to the public health emergency and this prevented certified nursing students to complete the state requirements for certification.

This provided a wonderful pathway to allow these individuals to be able to work and fortified our workforce. The online training is based upon existing standards of training and is an excellent program that equips employees to competently fulfill their job responsibilities.

Why is the National Guard going into nursing homes? What are they doing there?

Governor Kemp deployed the national guard to assist with environmental cleaning and to deploy resources needed for testing. This augmented efforts at the center level as environmental staff have been affected by isolation precautions in some cases. We appreciate everyone’s willingness to think differently about how we can ensure needs are met during these challenging times. I think many of the residents have enjoyed seeing the service men and women so that has been an added benefit.

I’ve heard that people that have been hospitalized with Covid-19 being discharged to nursing homes? How can that be safe?

The Department of Public Health and other stakeholders have emphasized that a patient’s COVID status should not be the primary determinant of an admission decision; rather, the centers ability to meet the patient’s comprehensive needs which may include isolation precautions. In most cases, rather a test has been conducted or not, centers are treating new admissions as a presumptive positive and placing them in isolation for a period of time to decrease the risk of transmission.

What is currently being done to define procedures and processes for keeping long term care facilities safe?

Centers were required to have an emergency plan in place that addressed emerging infections prior to this pandemic. Plans are being adapted as we learn new information and guidance is provided by various agencies such as Department of Public Health (DPH) and CDC. This will be ongoing as we continue to understand more about this virus.

Given the current no-visitation state for long term care facilities, what is being discussed regarding allowing visitors/families to visit?

CMS just released guidance yesterday related to planning for ease of restrictions in the long-term care setting. Many factors will need to be considered and this will need to be a thoughtful and collaborative process.

How are residents being kept active physically and mentally while being isolated?

These efforts look different center to center. We have heard of centers doing things like overhead trivia for staff and residents and of course therapists and restorative aides are providing care in the resident’s room. CMS hosts a call with what they refer to as the frontline and they invite providers to share successful strategies for resident engagement and stimulation

Need More Information?

Contact Pamela Elfenbien, Director of the Institute for Healthy Aging
Phone: 678-717-3688

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