RAND Corporation Report: COVID Lessons Long-Term Care Facilities

RAND Corporation Report: COVID Lessons Long-Term Care Facilities

Elderly people in nursing homes with an elevated risk for COVID-19 are also vulnerable to isolation and neglect. A 2022 report released by the RAND Corporation suggests that lockdown measures in nursing home facilities, while well-intended, may have caused significant harm to residents and their families.

The Impact of COVID-19 on Nursing Homes

Staff shortages in nursing homes were a problem pre-pandemic: between 2017 and 2018, over half of nursing homes met expected staff levels 20% or less of the time.

The COVID-19 pandemic exacerbated the problem, with many nursing home staff quitting due to burnout, lack of personal protective equipment, and low pay. A significant number also contracted COVID-19 and could not safely return to work.

While gathering restrictions and social distancing requirements were intended to stop the spread of the virus, they also prevented families from visiting their loved ones.

Many families could not check on their elderly loved ones, recognize signs of untreated illness, or provide the extra care that was unavailable due to staff shortages. This social isolation, the RAND report says, led to increased physical, mental, and cognitive health problems in nursing home residents.

Isolation and Neglect of Nursing Home Residents

According to the RAND Corporation report, the no-visitors policy in many nursing homes harmed the overall health of nursing home residents, with some studies finding a heightened risk of dementia and cognitive decline.

One study, which reported higher use of benzodiazepine and antipsychotic medications in nursing homes during lockdowns, coincided with anecdotes about worsening medical care.

Covid-induced staffing shortages often resulted in residents not receiving the necessary care, leading to preventable illnesses. In extreme cases, residents were left on the premises with limited certified staff available, forcing abrupt evacuations to other facilities. Covid-positive residents and those waiting for test results were admitted to hospitals, increasing their isolation due to the strict protocols.

Family members are a significant source of both social interaction and healthcare. However, lockdown measures prevented them from entering the facility at all. Many were unable to monitor their loved one’s health, provide care, or protect them from preventable death.

Psychological Effects of Isolation on Nursing Home Residents

These nursing home lockdowns had harrowing effects on elderly residents across the nation. Many residents suffered psychological challenges due to Covid-19 policies that isolated them from loved ones and disrupted their normal schedules.

A 2020 report found that the pandemic and subsequent lockdowns caused residents to feel anxiousness, loneliness, hopelessness, and depression. Many residents suffered from loneliness due to restrictive policies that prevented them from seeing their families and engaging with other residents.

These people showed higher instances of high blood pressure, anxiety, depression, and suicidal thoughts, which lead to loss of enjoyment of life and higher mortality rates.

In 2020, the Journal of the American Medical Association (JAMA) released an article that stated isolation proved deadly for many long-term care facility patients. According to JAMA, residents suffering from isolation stopped eating, gave up on living, and passed away when they couldn’t see their families.

Physical Effects of Covid-19 Isolation on Nursing Home Residents

The prolonged isolation residents suffered due to Covid-19 policies had devastating physical effects. Instances of staffing shortages lead directly to neglect and mistreatment; however, psychological loneliness and isolation also harm residents’ physical health.

An AARP article from 2020 details the damaging effects that loneliness and social isolation have on nursing home residents. Residents who suffer from these issues have a greater risk of mortality from all causes. Loneliness and isolation are associated with a 32% increase of stroke, a 50% increase in the risk of developing dementia, and a 40% increased risk of heart failure.

Long-Term Care Facility Policy Changes Post Covid-19

According to the RAND study, decision-makers for long-term care facilities must change policies surrounding events like the Covid-19 pandemic to prevent harm to residents.

RAND suggests that administrators and federal and state governments enact policies that treat residents as people with autonomy over their lives. These policies should respect residents’ decision-making processes and consider social isolation’s implications on their well-being.

As of 2022, the federal government and California have made strides toward improved visitation policies for nursing home residents. Nursing home reforms signed by President Biden increased transparency for residents and their families, providing them with additional rights during decision-making processes.

The reforms also set new nursing home staffing requirements to prevent neglect due to caregiver shortages and enhanced accountability and oversight for nursing homes across the country.

California has also made changes to laws regarding nursing home operations. California Assembly Bill 1502 was signed into law in September 2022, which addresses the state’s nursing home licensing procedures and establishes standards that make it more difficult for unqualified administrators and companies to obtain a license.

California Assembly Bill 849, which was approved in October of 2021, came as a direct result of Covid-19 policies. The bill enhances protections for residents’ rights regarding their well-being by holding nursing homes accountable for negligent or abusive actions.

The law allows residents to file a civil claim against facilities or staff that violate their California Patients’ Bill of Rights or federally mandated rights. It also requires facilities to pay up to $500 per right violation.

California’s Department of Public Health (CDPH) offers helpful resources for residents and their families to inform them of their rights under California Law. Residents and their families can easily access CDPH resources, such as a patient rights fact sheet that outlines residents’ rights regarding:

  • Visitors
  • Choosing how to spend their time
  • Living accommodations
  • Quality care
  • Medical treatment
  • Freedom from physical or medical restraints
  • Freedom from abuse
  • Transfer and discharge

While nursing home reforms must continue to make changes based on residents’ needs, the movement toward more patient-centric policies is promising. If you or a loved one has suffered from neglect or psychological damages due to Covid-19 policies, contact the CDPH to learn your rights and legal options.