Throughout the COVID-19 pandemic, the virus has spread through nursing homes at an alarming rate, infecting and killing thousands of residents and making infection control efforts a priority within the post-acute setting.
The elderly — particularly those living with underlying health conditions — are disproportionately affected by COVID-19, and are the most vulnerable to severe complications or death. CarePort data, which is consistent with other reports, confirms this.
In addition, according to a CarePort analysis of 63,000 long-term care residents in nursing homes in April 2020, nursing home residents with dementia were 1.7 times more likely to die from COVID-19 than residents without this diagnosis — even after adjusting for age.
While residents with dementia accounted for 52% of COVID-19 cases, they constituted 72% of all COVID-19 deaths in the nursing home setting. This finding is consistent with other models that predict mortality in nursing homes, where dementia is a common underlying condition.
While dementia is often viewed as a cognitive impairment by the general public, advanced dementia — which may be more prevalent in nursing homes — affects multiple organ systems and therefore may be more complex when facing an illness such as COVID-19. Further study is warranted to explain the association between dementia and COVID-19 mortality, and additional analysis around COVID-19 risk inside nursing home walls is necessary to better identify who specifically is dying from the virus and to improve COVID-19 prevention and management measures.
COVID-19 prevention and management strategies are especially challenging in memory care units, where residents with cognitive impairment may have difficulty following protocol such as social distancing, washing hands and avoiding touching their face. Further, unfamiliar processes or changes to routine may lead to fear and anxiety, which is why the CDC and Infection Prevention and Control (IPC) recommend maintaining a patient’s routine, a dedicated memory care unit personnel and structured activities along with infection control. Post-acute providers with memory care units are also advised to follow interim IPC recommendations, developed specifically for presumed or confirmed COVID-19 cases within memory care units.
Nearly two-thirds of all U.S. nursing home residents have some type of cognitive impairment such as Alzheimer’s disease or dementia, making it critical that long-term post-acute care facilities continue to prioritize infection control, and focus their efforts on triaging COVID-19 patients — with special considerations for those with cognitive impairment due to dementia or Alzheimer’s.
Tom Martin is the director of post-acute care analytics at CarePort Health. He has led several data analytics teams providing insight to healthcare providers trying to improve quality of care for their post-acute care patients. He holds an M.S. in Resources Economics with a concentration in econometrics from the University of Massachusetts Amherst. As director of post-acute care analytics at CarePort, Tom studies how the ever-changing PAC regulatory and payment landscape is impacting care delivery and how acute and post-acute providers can leverage their data to improve patient care.