Assisted living should be included in solution to COVID-19 crisis in long-term care

For all of its tragic outcomes, COVID-19 “presents an opportunity to do things differently and looking more systematically at large-scale solutions to care for older adults,” Christopher Laxton, executive director of AMDA – The Society for Post-Acute and Long-Term Care Medicine, tells McKnight’s Senior Living.

Laxton is one of the authors of a special article in the July issue of JAMDA, in which AMDA leaders lay out actions related to policy, collaboration, individualization, leadership and reorganization to “prevent sinking back into the complacency and habits of our pre-COVID-19 lives.”

“If we miss that challenge, we’ll have missed a huge opportunity to make things better,” Laxton said. “Our challenge is to use this to rise to the occasion to make things better from a policy point of view.”

One challenge is convincing policymakers to look at the assisted living population the same way they look at the nursing home or skilled nursing population, he said. The populations are comparable, in terms of age and underlying conditions that would contribute to the severity of illness.

Policymakers, Laxton said, should be looking at the entire population as a group and not separating them out as the regulatory framework or the walls of the institutions they are in. The ability to control the spread of the virus, he added, can’t be done by identifying the most at-risk by the walls of the facility in which they live. One could argue that assisted living residents are more at risk, Laxton said, because they are more dependent on care, can come in and out of a facility, and there is less control over who they can see.

The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are nearing 100% reporting of nursing home data on COVID-19 cases and fatalities in the National Health Statistics module, he added, but those numbers are lacking for assisted living, which is not a federally regulated setting.

“That doesn’t mean the data aren’t important,” Laxton said. “If you really want an understanding of how in this population both are impacted by illness and death, you need to know what’s going on in assisted living as much as in nursing homes.” 

Laxton and his co-authors referenced the rapid-fire pace of action, including “national and state policy changes, some well-informed and helpful, others disastrously off the mark.” They also stressed the pandemic exposed “how fundamentally broken our approach to providing care and support to our nation’s older adults has become.”

Among their recommendations for solving the COVID-19 crisis in post-acute and long-term care is including PALTC expertise in policy making decisions, normalizing collaboration across healthcare sectors, abandoning a one-size-fits-all solution, and implementing proactive and supportive federal policy leadership.