Nursing Homes and Assisted Living under Heightened Scrutiny

The explosive number of fatal Covid19 cases reported in America’s senior living facilities is giving pause to those concerned about the issue. In an independent examination, the Associated Press finds two weeks ago there were 450 deaths, and this week 4,485 residents of nursing homes and assisted living facilities have passed. At least five facilities in the Houston area have cases. Texas Health and Human Services says 16% of the state’s nursing homes have reported cases.

We can expect changes, as Covid19 has changed almost everything it has touched. One of those may be a reconsideration of the wisdom of housing large groups of vulnerable populations in close quarters. “Congregate living for older adults affects risk,” says Dr. Carmel Dyer, executive director of the Consortium on Aging at The University of Texas Health Science Center at Houston and executive vice chair of the Department of Internal Medicine at McGovern Medical School at UTHealth and one of the nation’s leading gerontologists. She says facilities that operate like dorm rooms increase the risk of contracting the highly contagious virus and says scaled down versions are preferable.

Loe Hornbuckle is applying that smaller model at his Sage Oak Boutique Assisted Living and Memory Care facility in North Texas where there are only eight residents per house. He says residents have the option of self-isolating in their room, if they choose, but even if everyone comes to the dining room for a meal it’s never more than ten people. He says their boutique model is proving to be considerably better than many others for the current pandemic. “Smaller groups are better than larger groups,” Hornbuckle advises, highlighting that smaller groups require smaller staffs, which again minimizes chances for contamination to occur. “That extra element of our boutique model really does provide some additional defense against having the virus come in the door.”

How seniors are seen by medical staff may also change going forward, Dr. Dyer saying legal limitations on tele-medicine have been eased, making it possible for patients to get quick answers to the myriad of health questions that arise in the course of normal elderly life beyond Covid. More widely available tele-health opportunities will be critical, she says, especially for staff looking for a quick professional opinion.

In long term planning, gerontologists and palliative care physicians will need to be included in the policy decision making of how the nation addresses future senior living care facilities, suggests Dr. Dyer.

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