"We are Alone in This Battle": A Framework for a Coordinated Response to COVID-19 in Nursing Homes

Abstract

As of May 2020, nursing home residents account for a staggering one-third of the more than 80,000 deaths due to COVID-19 in the U.S. This pandemic has resulted in unprecedented threats to achieving and sustaining care quality even in the best nursing homes, requiring active engagement of nursing home leaders in developing solutions responsive to the unprecedented threats to quality standards of care delivery during the pandemic. This perspective offers a framework, designed with the input of nursing home leaders, to facilitate internal and external decision-making and collective action to address these threats. Policy options focus on assuring a shared understanding among nursing home leaders and government agencies of changes in the operational status of nursing homes throughout the crisis, improving access to additional essential resources needed to mitigate the crisis' impact, and promoting shared accountability for consistently achieving accepted standards in core quality domains.

Keywords: COVID-19; Nursing homes; QAPI; care quality; leadership.

Figure 1.

Operational Framework to Guide Decision Making During the COVID-19 Pandemic* Par Level = pre-determined quantity of a resource item that a nursing home should always have, PPE=personal protective equipment, RN=registered nurse, DOH=department of health, COVID=COVID-19 or coronavirus. *Adapted from the “Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2” (Berlinger et al., 2020).