Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, GAPNA President-Elect Jennifer Kim, DNP, GNP-BC, GS-C, FNAP, FAANP, reviews 3 studies on disaster response in long-term care settings and home-based primary care.

A proactive nursing home risk stratification model for disaster response: lessons learned from COVID-19 to optimize resource allocation

J Am Med Dir Assoc. 2021;22(9):1831-1839.e1. doi:10.1016/j.jamda.2021.07.007

Summary: Researchers used the COVID-19 pandemic as an example in developing a risk stratification system to ensure adequate allocation of resources to nursing homes during disaster preparation and management. The system risk-stratifies nursing homes using 4 domains: risk of intrusion, capability for outbreak containment, failure in organizational capability, and failure in the availability of community and health care supports. Current level of community transmission and geographic location of nursing homes and services should also be considered in the risk stratification, according to the study authors.1


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Commentary by Dr Kim: The COVID-19 pandemic has disproportionately affected older adults living in long-term care facilities. This population accounts for approximately one-third of all COVID-related deaths in the US.

Although its implementation was well-intentioned, the year-long isolation and restrictive visitation policies that were incorporated by most long-term care facilities have resulted in an increased prevalence of loneliness, isolation, and worsening cognition.  

Natural disasters have also threatened the health and well-being of older adults living in long-term care facilities in recent years; more than 2600 federally-declared disasters have occurred since 2000.2 Climate change has elevated the risk of more natural disasters in the near future.

The bulk of efforts to protect this vulnerable population during these public health and natural disaster crises have been reactive, and have highlighted a need for a coordinated emergency management system that incorporates leadership at the local, state, and federal level.

This risk stratification model is unique in that it uses a proactive approach that can be scaled and adapted for use within long-term care facilities faced with varying emergency response needs.

A unique disaster response in aged residential dementia care: can the experience inform future care models?

J Clin Nurs. 2021 May 26. doi.org/10.1111/jocn.15862

Summary: Eight staff members who chose to live on-site at a level 3 dementia care unit in New Zealand during the COVID-19 lockdown were interviewed about their experience and their perceptions of how living on-site affected residents well-being.3

Commentary by Dr Kim: Winston Churchill is credited with saying “Never let a good crisis go to waste” at the end of World War II. The COVID-19 pandemic has caused tremendous physical, mental, and emotional suffering of older adults across the globe, especially frail older adults with dementia in communal living settings.

The inadvertent benefits of this unique disaster response remind us of the importance of the nurse-patient relationship.

Staff members who voluntarily chose to live with residents at this aged residential care (ARC) facility during New Zealand’s COVID-19 lockdown witnessed the impact of person-centered care on their professional development, their enhanced sense of community, and improved resident outcomes.

Although the concept of person-centered care has long been valued, it is often eclipsed by common challenges in long-term care, including staffing shortages, government regulations, and increased acuity of care. Becoming acquainted with resident behavior patterns and preferences is often a luxury, yet it grants the nurse better insight into a resident’s needs and may therefore improve resident care.

Staff members in this qualitative study described improvements in residents’ behavior during the lockdown, noting that they were “more settled,” “less aggressive,” and “happier.” There were fewer falls and residents’ use of psychotropic medications decreased.

Although this is a small study that occurred outside of the US, the results fortify the body of literature that supports person-centered care as a central tenet of dementia care.

“Helping fill that gap:” a qualitative study of aging in place after disaster through the lens of home-based care providers

BMC Geriatr. 2021;21(1):235. doi:10.1186/s12877-021-02159-0

Summary: Focus groups were conducted with home-based care providers (n=25) who provided in-home care during Hurricane Irma and Hurricane Harvey. They expressed challenges faced by older adults during these disasters, including maintaining continuity of care, encouraging individual preparedness, and accessing complex governmental support.4

Commentary by Dr Kim: There has been a resurgence of home-based primary care (HBPC) in the US within recent years. This health care delivery model fills a critical access gap as it provides high-quality health care for patients who often have functional and cognitive impairments and little social support, all of which impair their abilities to seek medical care outside of their homes.

Timely and comprehensive HBPC may prevent worsening chronic health conditions that often result in costly emergency department visits and hospitalizations.

An emphasis on aging in place has occurred in tandem with the growth and expansion of HBPC. More than half of all Medicaid long-term care spending is on home- and community-based services (HCBS). Recipients of HCBS avoid institutional care through the provision of similar cost-effective services provided within their home or community.

Nurse practitioners provide more home-based primary care than any other provider type and their contributions to this field of health care continue to grow.

This study provides valuable insight into older adults’ needs during and after a natural disaster and emphasizes the need for emergency preparedness on a personal, interpersonal, community, societal, and policy level. Advanced practice providers delivering home-based care are well-positioned to provide leadership in emergency preparedness efforts.

References

1. Ibrahim JE, Atkins G. A proactive nursing home risk stratification model for disaster response: lessons learned from COVID-19 to optimize resource allocation. J Am Med Dir Assoc. 2021;22(9):1831-1839.e1. doi:10.1016/j.jamda.2021.07.007

2. Federal Emergency Management Agency. Disaster Declarations 2019. Accessed 10/15/2021. Available from: https://www.fema.gov/disaster/https://fema.gov/disaster

3. Moir C, Lesa R, Richie L. A unique disaster response in aged residential dementia care: can the experience inform future care models? J Clin Nurs. 2021 May 26. doi: 10.1111/jocn.15862

4. Bell SA, Krinke LA, Dickey S, De Vries RG. “Helping fill that gap:” A qualitative study of aging in place after disaster through the lens of home-based care providers. BMC Geriatr. 2021;21(1):235. doi:10.1186/s12877-021-02159-0