This paper reviews the infection control and prevention measures taken in assisted living facilities in New York State in response to the COVID-19 pandemic from March 2020 through December 2022.
It is known that the COVID-19 pandemic disproportionately affected residents in assisted living facilities. We previously reported an early rise in death rates in two assisted living facilities in March and April 2020 along with a high rate of asymptomatic SARS-CoV-2 infection (1). In our new paper we examine the public health response to COVID-19 in assisted living facilities through guidance documents and advisory letters from the New York State Department of Health (NYSDOH).
Read the Article
A review in October 2020 of 39 states in the US found that the death rate in assisted living facilities due to SARS-CoV-2 was almost ten-fold the rate in the general population overall (2). Residents in assisted living facilities tend to be older adults and often have multiple medical conditions which put them at risk for COVID-19. COVID-19 infection also has the potential for asymptomatic transmission. Furthermore, assisted living facilities are known to facilitate group activities such as communal dining and are often sought after by residents for this reason. These risk factors of age and medical comorbidities of the residents, the social nature of the institutions, and the asymptomatic transmission of COVID-19 posed a challenge to controlling COVID-19 within the environment of assisted living facilities.
The NYSDOH continuously took action to control and prevent the spread of COVID-19 within assisted living facilities. The purpose of our work in “Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022” was to document these actions to be used as a resource for future reference.
NYSDOH issued guidance documents and “dear administrator letters” to communicate state-mandated changes in procedures for assisted living facilities during the COVID-19 pandemic. These documents were collected, organized, and synthesized to create a timeline of the dates the guidance was issued, along with the dates the US Food and Drug Administration (FDA) approved diagnostic tests and vaccines. The timeline reports data from the beginning of the pandemic in March 2020 through to December 2022.
The guidance issued by the NYSDOH provided specific measures that assisted living facilities were to take to control and prevent infection in residents and staff. Initially, this included use of face masks, cancellation of communal dining and group activities, testing of assisted living staff, symptom screening, isolation, quarantine, and visitation guidance. The FDA authorization of COVID-19 mRNA vaccines in December 2020 led to new guidance for residents and staff to be vaccinated. Use of masks and social distancing policies stayed in place while issues of vaccine hesitancy were addressed. The appearance of variant strains of SARS-CoV-2 led to breakthrough infections and prompted requirements for COVID-19 booster vaccination.
Implementing these measures required an enormous amount of support, both physically by staff, and financially to acquire the appropriate supplies. This came at a time when assisted living facilities were facing staff-shortages themselves as staff members contracted COVID-19. The events that ensued show that controlling the COVID-19 pandemic in assisted living facilities required a layered approach including physical distancing, use of personal-protective equipment, and medical and social interventions.
One major consequence of these infection control measures was the isolation assisted living facility residents experienced, both from each other and from their families. The NYSDOH issued a list of best practices to keep residents’ families involved during the pandemic including scheduling regular video calls and attending virtual facility-wide meetings. Residents also used video calls for telehealth visits with their provider and hospitals as needed for medical care.
We hope that publishing a chronological review of the measures taken by assisted living facilities during the COVID-19 pandemic may serve as a resource for future reference. Readers can learn more at the NYS-DOH website and CDC.gov about current COVID-19 infection control and prevention.
References
- Montecalvo MA, Amler S, Cudjoe TKM, Smittle L, D’Ascanio A, Huang A, Recchia R, Hewlett D. SARS-CoV-2 in assisted living: Mortality and asymptomatic infection. J Natl Med Assoc. 2022 Apr;114(2):167-170. doi: 10.1016/j.jnma.2021.12.012. Epub 2022 Jan 3. PMID: 35131082; PMCID: PMC8720532.
- SH, See I, Kent AG, et al. Characterization of COVID-19 in assisted living facilities- 39 states, October 2020. Morb Mortal Wkly Rep 2020;69(46): 1730-1735
Co-authors
Dr. Dial Hewlett is the medical director of the Division of Disease Control and deputy to the commissioner of health at the Westchester County Department of Health.
Karen Davda is the senior program coordinator in the Bureau of Communicable Disease Control at the New York State Department of Health.
Dr. Marisa A. Montecalvo is an infectious disease physician affiliated with the New York State Department of Health and director of Health Services at New York Medical College.
About the Author
- Antonella D’Ascanio is a third-year medical school student at New York Medical College in Valhalla, NY. She has a strong interest in public health, particularly for older adults. She was pleased to have the opportunity to work with the New York State Department of Health to assemble a timeline of the public health response guidelines to the COVID-19 pandemic.
Latest entries
