Working in a nursing home is difficult – many are understandably burned out. Since January 2020, roughly 236,000 caregivers have left the profession behind. That’s 15% of the total nursing home workforce. This year alone, more than 400 certified US nursing homes are on the brink of shutting down, double the closure rate before the pandemic began. Most facilities are operating at a loss, and without help, a quarter of the country’s skilled nursing facilities will close by 2025. As the country’s population continues to age, this trend is especially concerning.
The Need for Infection Control
How did nursing homes land in such dire straits? The answer lies in infection control, or lack thereof. The problem predates the pandemic, but COVID-19 exposed the issue to the public. COVID-19 killed nearly 136,000 nursing home residents and more than 2,000 workers. While they make up under 1% of the US population, nursing home residents accounted for 1 in 5 of the country’s COVID-19 related deaths. Low income seniors were hospitalized for the disease at 4 times the rate of other Medicare beneficiaries.
These statistics paint a dark picture. Before the pandemic, other diseases led to similar outcomes. Prior to COVID-19’s arrival, 380,000 nursing home residents died annually from infections like influenza and urinary tract infections. 40% of nursing homes were cited for poor infection control practices. In fact, infection control was the most commonly cited deficiency on state surveys.
Nursing Homes Need Help
Why are infection control practices so bad in nursing homes? Part of the problem is design. In 2021, only 30% of nursing homes had hand sanitizer located outside the resident’s room while 45% only had dispensers inside the room. This exposes elderly residents with weaker immune systems to outside germs. Another problem is equipment. The pandemic made the general public aware of just how powerful personal protective equipment (PPE) can be in stemming infection. Yet during the first 2 years of the pandemic, 80% of nurses experienced PPE shortages. 2 in 3 felt unsafe reusing PPE when recommended to. Even when they had the recommended N-55 masks, most nurses never had their masks fit tested.
Most critically, the fault line in infection control is facility practices. Throughout the pandemic, nursing leaders have found communicating and implementing new policies to be among the top challenges they faced. Even when they knew what they needed to do to stop an infection, procedures weren’t always followed. In a 2021 survey of nursing homes, shared equipment was disinfected between residents 42% of the time. Nurses aren’t lapsing out of malice; rather, they’re faltering in the face of high stress and increased workloads. Staff shortages heap extra burdens onto the staff that remain. When the pressure mounts, remembering steps as simple as washing hands can become difficult. Unfortunately, these slips can have deadly consequences for the residents who rely on nurses for care.
Distributing new infection control practices and guidelines in print or online is not effective. Change begins with boots on the ground, in-person support. Give nursing homes a new start.