A new policy brief from the American Geriatrics Society offers a roadmap to help guide federal, state and local governments addressing COVID-19 concerns in often-overlooked assisted living communities, reinforcing industry calls for more resources.

The brief outlines recommendations to empower healthcare workers on the frontlines of COVID-19 care based on the latest research and guidance, including the need for personal protective equipment, access to testing, public health support for infection control and workforce training. 

“We hope this brief can help policymakers, advocates and clinicians look at, but also beyond, the circumstances we can control — and those we can’t — to prioritize the innovation, collaboration and compassion that can put key patients and public health first,” AGS President-Elect Annie Medina-Walpole said in a statement. “That’s a cardinal direction for planning in crisis and in calm, regardless of where we may live as we age.”

The AGS points out that given the wide variety of structure and staffing at assisted living communities, most do not have the resources to respond to COVID-19 compared with some other settings. For example, unlike nursing homes, there are no requirements for staffing healthcare professionals and no standard requirements for infection control. Although some elements of nursing home guidance could be adopted by assisted living, many operators struggle to implement best practices in the absence of more targeted recommendations, the brief states.

“As the priority for PPE and funding is given to frontline medical staff caring for COVID-19 patients, support for direct care workers outside the hospital has been insufficient,” the brief states. “Assisted living facilities do not have the capacity or resources to implement full CDC guidance issued for medical facilities when there is a recognized pandemic.”

Pointing to research and recommendations from the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention and other key agencies, the AGS recommends focusing on the following areas to make a difference:

  • Defense Production Act: Assisted living communities, residential care facilities for the elderly, continuing care retirement communities, nursing homes and home health care agencies must be included as priorities when estimating what is needed for the country’s coordinated response to COVID-19. This includes PPE, testing equipment and related laboratory supplies, and supplies for symptom management and end-of-life care.
  • COVID-19 testing and contact tracing: These will be vital once restrictions begin to loosen to offer the best chance for identifying asymptomatic COVID-19 carriers, as well as confirming those showing symptoms.
  • Safe transitions of COVID-19 residents: The first and best option for people who test positive is to quarantine in their places of residence unless hospital care is necessary. Transfer of symptomatic or known COVID-19-positive residents should be guided by a clinician and the resident’s primary care provider to manage care in place, if possible. COVID-19-positive assisted living residents discharged from hospitals or skilled nursing facilities should not return unless the assisted living community can safely isolate that individual and adequate infection control protocols and PPE for staff and community members are in place.
  • Infection control: State, county and local health departments should engage with assisted living communities to advance infection control practices by providing technical assistance for screening, testing for residents and staff, guidance on advanced hygiene practice, support of physical distancing, staff training on proper use of PPE and symptom recognition, and training and resources for care planning for symptomatic residents. 
  • Workforce: Workforce needs should be addressed through pay scales, reimbursement rates and state regulations for assisted living communities. AGS advocates for congressional support of paid family, medical and sick leave for the entire healthcare workforce, as well as for enhancing COVID-19 screening and training. COVID-19, the brief states, “exacerbated existing gaps in expertise and systemic weaknesses in healthcare service delivery for older Americans.” The AGS also urged Congress to provide educational and grant opportunities for direct care workers who play a critical role in assisted living.