Covid-19 changed everything for nursing homes. There was a very high fatality rate of senior citizens in nursing homes nationwide, bringing in greater scrutiny of federal regulators on how the industry will operate in the future.
Nursing homes are seen as the next level of long-term, residential, maintenance care for patients who are otherwise stable but in poor or declining health and unable to fully care for themselves. Elderly and disabled patients are cared for constantly by medical staff working around the clock. Generally speaking, these facilities are supposed to provide a standard of care outlined in the licensing requirements demanded by each state’s department of health and by industry-wide standards. One of these requirements is ‘infection control’. As we’ve been hearing for almost a year, this standard has not been followed by an alarming number across the country, resulting not only in an increased number of infections but also in a disproportionate number of deaths.
Regulatory controls are expected to become considerably stricter, with an increased focus on the provisions of the Nursing Home Transparency and Improvement Act, the Elder Justice Act and the Patient Safety and Abuse Prevention Act, all adopted as part of the ACA.
What are some of the measures nursing homes can take to avoid future disasters?
Hygiene and environmental disinfection
Daily controls through proper hygiene include personal protection, cleaning, disinfection, separating at-risk patients and assigning specific staff members to work on the same patients for an entire week or month, while other patients are cared for by different nurses. In addition, reducing visits in and out of the facility and checking the temperature of staff and residents several times a day are other important control measures. All patients should be kept informed of their condition, treatment and risk factors, and be trained to monitor themselves for any changes. Once personal protection measures are needed, patients and personnel should be shown how to use masks and other devices, and the staff needs to ensure the measures are reinforced daily.
These are relatively inexpensive devices that can monitor not just blood pressure or glucose levels, but also the oxygen saturation in the blood. While some are used by fitness enthusiasts and personal health-minded people, many of them are used by medical professionals and recommended to patients. While a watch cannot provide any cure or help other than a warning, it has been very helpful in detecting early deterioration in blood oxygen levels in people infected with Covid-19.
Some patients who could not be admitted into hospitals were given pulse oximeters to use at home in order to monitor their blood oxygen level. Oximeters give a reading where the O2-saturation levels are shown as a percentage, with anything below 90% being a sign that something could have worsened. While not fool-proof, this method of early detection has been useful for at-risk individuals to know when to contact a doctor or go to the hospital. Providing watches that perform this function to nursing home residents or ensuring they own and wear one all the time may be a valuable strategy financially and medically, particularly if such devices send data over the facility’s wi-fi network for centralized visibility. There might be insurance companies willing to accept a proposal to pay for such devices if it means less medical costs to cover later.
Adoption of AI
AI has transformed from a term favored by sci-fi writers and movie directors to describe a worldwide machine apocalypse in mankind’s future to a technology term that many industries use to denote advanced capabilities of highly-developed computers and software techniques.
In healthcare, hospitals and other stakeholders are increasingly used to the idea of leveraging AI to improve medical care, billing, staff and resource management, and much more. Its predictive capabilities coupled with practical real-time performance, advanced visualizations, and detailed built-in knowledge can offer never-before-seen changes in the healthcare environment.
In nursing homes, AI can be used for speech-driven documentation where nurses and doctors can record their visit in real time. The patient’s file is updated immediately, facilitating communication and decision-making. The search features allow physicians to extract the status of a disease or treatment, dosage schedules, side effects, and more. AI systems for healthcare facilities are HIPAA compliant, requiring authentication and validation for anyone who uses the system.
Some AI solutions are more practical than others, and some are more affordable than others. However, they each undoubtedly improve the logistics of patient care in any healthcare facility with needs that match the features provided by that particular AI system.
Patient portals and social media
Memory and cognitive issues are associated not just with specific various conditions but also with old age itself. For any nursing home employee, being able to communicate clearly, in both directions, with the elderly person under their care is essential. . For that and many reasons, having an IT-proficient employee or an IT specialist by trade among the staff is a necessity, in order to research, propose, install, and use beneficial information technology solutions for the specific needs of a healthcare facility and all its stakeholders.
Creating a patient portal can bridge the gap between the health care staff and the residents, and between the staff, residents and their families. A patient can always access the portal and post items of interest, while the staff and family members can track behavior and detect problems ahead of time, including the patient’s physical condition and their mental state, as well.
Social media is also important because patients can share things as they occur, that they might otherwise forget before the next nurse or doctor visit. The patient can post updates about their progress and about matters of concern, such as recurrent pain or wheezing, depressive states, dizziness.
Care first, Profits secondary
There has been concern about the increased involvement of investment companies in nursing home management and ownership. Private equity firms have been buying nursing homes for years, using them as sources of revenue with little or no concern for the patients residing there.
A New York Times article describes ‘how private investment companies have made it very difficult for plaintiffs to succeed in court and for regulators to levy chainwide fines by creating complex corporate structures that obscure who controls their nursing homes’. In spite of numerous regulatory efforts and lawsuits filed by patients and families of patients, many of these nursing homes don’t rectify their problems and continue getting away with substandard care.
‘More than one-third of deaths in the US are linked to nursing homes’ announced another article from the New York Times, updated in January of 2021. The top 5 nursing homes with the most deaths, whether owned either by private firms or the local authorities, had received numerous warnings and citations over the years for non-compliance and were given abysmal ratings, some of them as low as L or K. The L rating indicates that there’s ‘immediate jeopardy to resident health and safety’ and that the ‘deficiency is widespread’. The letter K stands for ‘immediate jeopardy to resident health and safety’ and that the ‘deficiency is part of a pattern’.
The Covid-19 disaster had been a long time coming, and the management and medical staff of these nursing homes bear the primary responsibility for so many deaths. The public outrage is predicted to last long enough to produce significant changes in compliance laws and oversight by regulatory agencies. As far as the general public is concerned, the reputation of a nursing home will be paramount in determining whether a family selects it as a new home for their beloved relative or not.