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. 2021 May 19:9:661042.
doi: 10.3389/fpubh.2021.661042. eCollection 2021.

Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned

Sarah Dys  1   2 , Jaclyn Winfree  2 , Paula Carder  1   2 , Sheryl Zimmerman  3 , Kali S Thomas  4   5
Affiliations

Coronavirus Disease 2019 Regulatory Response in United States-Assisted Living Communities: Lessons Learned

Sarah Dys et al. Front Public Health. .

Abstract

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research (n = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.

Keywords: long-term care; multilevel; public policy; regulatory response; socioecologic model; thematic analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Levels of COVID-19 policy response related to Al.
See this image and copyright information in PMC

References

    1. Kaiser Family Foundation . State COVID-19 Data and Policy Actions (2021). Available online at: https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data... (accessed January 26, 2021).
    1. Comas-Herrera A, Zalakaín J, Lemmon E, Litwin C, Hsu AT, Schmidt AE, et al. Mortality Associated with COVID-19 in Care Homes: International Evidence. International Long-Term Care Policy Network (2020). p. 30. Available online at: https://ltccovid.org/wp-content/uploads/2020/10/Mortality-associated-wit... (accessed January 26, 2021).
    1. Harris-Kojetin LD, Sengupta M, Lendon J, Valverde RH, Caffrey C. Long-term care providers and services users in the United States, 2015-2016. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics Report No. 2019–1427 (2019). Available online at: https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf (accessed January 15, 2021).
    1. Carder PC, O'Keeffe J, O'Keeffe C. Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition. RTI International. (2015). Available online at: https://aspe.hhs.gov/execsum/compendium-residential-care-and-assisted-li... (accessed January 16, 2021)
    1. Yi SH, See I, Kent AG, Vlachos N, Whitworth JC, Xu K, et al. Characterization of COVID-19 in assisted living facilities−39 states. MMWR Morb Mortal Wkly. (2020) 69:46. 10.15585/mmwr.mm6946a3 - DOI - PMC - PubMed

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