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Program Reduces Long-Term Care Covid-19 Outbreaks

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(congerdesign, Pixabay)

18 June 2020. A collaborative program between an academic medical center and long-term care homes for older residents helps reduce Covid-19 infection outbreaks and deaths. The program at University of Virginia Health System in Charlottesville is described in a paper accepted for publication in the Journal of the American Medical Directors Association.

Nursing homes and long-term care facilities are particularly hard hit by the Covid-19 pandemic. Residents of these homes are often older individuals with chronic medical conditions requiring more intensive care, and living in close quarters, making them more susceptible for transmitting the SARS-CoV-2 virus. Statistics reported by the Kaiser Family Foundation, show as of 11 June, some 46,000 of the nearly 118,000 deaths from Covid-19 in the U.S. — almost four in 10 — occurred at long-term care facilities.

The program is a collaboration between academic experts and medical practitioners at University of Virginia Health and long-term care facilities, led by geriatrician Laurie Archbald-Pannone. “We call the program GERI-Pal, meaning Geriatric Engagement and Resource Integration for Post-Acute and Long-Term Care Facilities,” says Archbald-Pannone in a university statement, “and it has been a great opportunity to bring together hospital and community-based resources to assist our local facilities in preventing and responding to Covid-19 outbreaks.”

GERI-Pal is based on a general medical collaboration model called Project Echo, short for extension for community healthcare outcomes, designed to provide more access to the expertise of medical specialists and researchers for local medical practitioners, particularly those in rural areas. This expanded access to expertise is expected to help local clinicians better deal with complex medical conditions, such as HIV, tuberculosis, and chronic pain, and more recently Covid-19 infections.

Using the Project Echo model, GERI-Pal makes available a number of experts and specialists at University of Virginia Health: geriatrician, pulmonologist, nurse practitioner, clinical nurse leader, and nurse educator. These specialists provide training to long-term care colleagues and guidance on Covid-19 testing and treatment. Experts on infection control also help colleagues at these facilities establish procedures for protecting residents, as well as staffing needs and access to personal protective equipment. A separate nursing liaison offers a single point of contact to the medical center for each participating long-term care facility.

In addition, GERI-Pal uses telemedicine, making it possible for long-term care staff to consult with experts on pulmonary, critical care, geriatric, and palliative medicine at University of Virginia Health on testing, treating, and monitoring residents for Covid-19. The telemedicine experts also help long-term care practitioners transfer residents to and from University of Virginia Health if needed. In addition, volunteer medical students at University of Virginia speak with long-term care residents to help break down their isolation during ordered stay-at-home periods.

The university offered the Project Echo part of GERI-Pal to 77 long-term care facilities, of which 35 are taking part. Other aspects of GERI-Pal, however, are used by between 2 and 13 homes. The team reports that two of the three facilities taking part in the full GERI-Pal infection protection program experienced no sustained Covid-19 transmission or outbreak. Where two separate Covid-19 outbreaks occurred, the mortality rates were 12 and 19 percent respectively, lower than the 28 percent reported early in the pandemic at a long-term care facility in Washington State.

“Developing this program has been a wonderful collaboration amongst many sites of care and types of care providers,” notes Archbald-Pannone, adding “Many of the systems we’ve put in place and lessons we have learned will be of value to improve care beyond even Covid-19.”

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