School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States.
Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, United States.
Front Public Health. 2021 May 19;9:661042. doi: 10.3389/fpubh.2021.661042. eCollection 2021.
Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 older adults live in AL. To identify COVID-19 issues specific to AL, stakeholders with expertise in AL operations, policy, practice, and research ( = 42) were recruited to participate in remote interviews between July and September 2020. Using a thematic analysis, we derived the following overarching themes: (1) Policymakers are disconnected from and lack an understanding of the AL context; (2) AL administrators were left to coordinate, communicate, and implement constantly changing guidelines with little support; (3) AL organizations faced limited knowledge of and disparate access to funding and resources; (4) state-level regulatory requirements conflicted with COVID-19 guidelines resulting in uncertainty about which rules to follow; and (5) AL operators struggled to balance public health priorities with promoting their residents' quality of life and well-being. To develop evidence-informed policy and avoid unintended consequences, AL operators, direct care workers, residents, and clinicians practicing in these settings should have opportunities to provide feedback throughout the policy development process, both state and national.
2019 年冠状病毒病（COVID-19）对居民、他们的家人、工作人员和集体护理机构的经营者造成了不成比例的影响。辅助生活（AL）是一种为需要支持性护理但不需要持续护理的老年人提供的长期护理机构，强调护理提供的社会模式。由于 AL 是一种长期护理机构，它有时与养老院一起在与 COVID-19 相关的讨论中被提及，但没有认识到其不同的护理实践会带来与 COVID-19 相关的独特挑战；因此，它在很大程度上被排除在 COVID-19 讨论之外，尽管大约有 81.2 万老年人居住在 AL 中。为了确定特定于 AL 的 COVID-19 问题，我们招募了在 AL 运营、政策、实践和研究方面具有专业知识的利益相关者（=42 人）参与 2020 年 7 月至 9 月的远程访谈。我们使用主题分析得出了以下总体主题：（1）决策者与 AL 环境脱节，缺乏了解；（2）AL 管理人员不得不协调、沟通和实施不断变化的指导方针，几乎没有得到支持；（3）AL 组织对资金和资源的了解有限，获取渠道也不一致；（4）州级监管要求与 COVID-19 指南相冲突，导致不确定应遵循哪些规则；（5）AL 运营商在平衡公共卫生优先事项与促进居民的生活质量和福祉方面面临困难。为了制定循证政策并避免意外后果，应让 AL 运营商、直接护理人员、居民和在这些环境中执业的临床医生有机会在整个政策制定过程中提供反馈，包括州和国家层面。
