Make a List, Check It Twice

Mass. program models how to ease impact of COVID-19 on frail nursing home residents  

Big blue checkmark against a black background
Image: D3Damon/Getty Images

This article is part of Harvard Medical School’s continuing coverage of medicine, biomedical research, medical education and policy related to the SARS-CoV-2 pandemic and the disease COVID-19.

In April, Massachusetts nursing homes became hotspots for SARS-CoV-2 infections and associated deaths. In response, Governor Charlie Baker allocated $130 million in additional nursing home funding for two months. Funding was contingent on compliance with a new set of care criteria, which included mandatory testing of all residents and staff and a 28-point infection control checklist.

A study from researchers at Harvard Medical School and Hebrew SeniorLife, published in the Journal of the American Geriatrics Society, found that adherence to the state’s infection control processes, especially proper wearing of personal protective equipment (PPE) and cohorting strategies, such as grouping residents based on their risk of infection or whether they tested positive for COVID-19, was significantly associated with declines in weekly infection and mortality rates. 

Get more HMS news here

Lewis Lipsitz, HMS professor of medicine at Beth Israel Deaconess Medical Center and director of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, was the lead author on the report, which analyzed the process and outcome of Massachusetts’ novel state-wide SARS-CoV-2 infection control program developed to stem the rate of coronavirus infection among vulnerable nursing home populations. 

Items on the checklist included six core competencies related to cohorting of COVID-19 cases; the closing of congregate spaces; training and demonstrated proficiency in the donning and removal of PPE; the presence of appropriate infection control policies and the ability of staff to recognize and respond to the signs and symptoms of COVID-19. 

Within two days of the governor’s announcement, Hebrew SeniorLife and the Massachusetts Senior Care Association collaborated to rapidly organize a central command committee and five teams responsible for infection control consultation and training; PPE procurement; and staffing, testing and data management. 

Eighty nursing homes with previous infection control deficiencies and 43 additional facilities that failed an initial audit by the Massachusetts Executive Office of Health and Human Services were designated for on-site and virtual consultations, and all Massachusetts facilities were offered weekly webinars and answers to questions regarding infection control procedures. The Massachusetts Senior Care Association informed facilities of available resources for acquiring PPE and backup staff, and the Massachusetts National Guard was mobilized to provide universal testing.

Review and analysis of data collected from the program showed both resident and staff infection rates in special focus facilities rapidly declined to the same low level in both groups after facilities put recommended infection control interventions in place. For example, special focus resident infection rates declined from 10 percent on May 17 to close to none by July 5. 

“Massachusetts’ innovative program was unprecedented in this country,” said Lipsitz, who is also chief academic officer at Hebrew SeniorLife. “It helped long-term care providers increase their knowledge of, and access to, best infection control practices and reduce the risk of COVID-19 spread for both residents and staff.”

Louis Woolf, president and CEO of Hebrew SeniorLife said, “We hope to see this intervention replicated in other states, appropriately funded and sustained in all nursing homes, so that future waves of COVID-19, and other pandemics, can be prevented or mitigated.”

“This study shows the importance of prioritizing surveillance testing, funding for wages and PPE for nursing homes so that we can protect both our staff and our residents,” said Tara Gregorio, president of the Massachusetts Senior Care Association. “Until a vaccine is approved and available widely, these remain our best defenses against COVID-19.”

Adapted from a Hebrew SeniorLife news release.