Li Yue, Maeng Daniel, Lee H Benjamin, Jia Yusheng, Cai Xueya
Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY, USA.
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
J Appl Gerontol. 2025 Jan 5:7334648241309764. doi: 10.1177/07334648241309764.
During 2020-21, states established essential caregiver (EC) programs which allowed nursing home residents to receive in-person supports during the COVID-19 pandemic. This study presents comparative data on the designs of these programs. We conducted on-line searches for federal and states' nursing home visitation and reopening guidelines published in 2020-22. We also compared differences between states with and without an EC program in COVID-19 infection and death rates among nursing home residents or the general population, nursing home staff shortage rates, and rankings on restrictiveness of social distancing policies. Among states with an EC program, we summarized key program characteristics. Twenty states established nursing home EC program from late 2020 to early 2021. Compared to states without an EC program, states with the program had slightly higher COVID-19 infection rate but slightly lower COVID-19 death rate, similar nurse staffing and nursing aids shortage rates in nursing homes, and somewhat lower rankings on the restrictiveness of social distancing measures. Compared to CMS guidelines that banned indoor visits to nursing homes under defined circumstances from March 2020 to November 2021, state EC programs were much less restrictive in specifying caregiver visits, for example, visits were allowed when county COVID-19 positivity rate>10% (18 programs), when the resident was not vaccinated (20 programs), or when the nursing home was in a COVID-19 outbreak (13 programs). However, state EC programs might still prohibit EC visits in certain situations, such as when the resident was in transmission-based precautions (13 programs), that is, when the resident had a confirmed COVID-19 infection, had COVID-19 symptoms although not yet confirmed, or was in observation for developing COVID-19 infection in the 14 days of nursing home (re)admission. States with and without a nursing home EC program did not differ appreciably in COVID-19 infection and death rates, or staffing shortage rates in nursing homes, although states with an EC program might have slightly less restrictive social distancing policies. State EC programs varied substantially in key designs. Comparative evaluations are needed to understand the effectiveness of these programs.
在2020 - 2021年期间，各州设立了基本照护者（EC）项目，该项目允许养老院居民在新冠疫情期间获得面对面的支持。本研究展示了这些项目设计的对比数据。我们对2020 - 2022年发布的联邦和各州养老院探访及重新开放指南进行了在线搜索。我们还比较了有无EC项目的州在养老院居民或普通人群的新冠感染率和死亡率、养老院工作人员短缺率以及社交距离政策限制程度排名方面的差异。在有EC项目的州中，我们总结了关键的项目特征。20个州在2020年末至2021年初设立了养老院EC项目。与没有EC项目的州相比，有该项目的州新冠感染率略高，但新冠死亡率略低，养老院护士配备和护理辅助人员短缺率相似，且社交距离措施限制程度的排名略低。与2020年3月至2021年11月期间在特定情况下禁止室内探访养老院的医疗保险和医疗补助服务中心（CMS）指南相比，各州的EC项目在规定照护者探访方面限制要少得多，例如，当县新冠病毒阳性率>10%时允许探访（18个项目），当居民未接种疫苗时允许探访（20个项目），或当养老院发生新冠疫情时允许探访（13个项目）。然而，各州的EC项目在某些情况下仍可能禁止照护者探访，比如当居民处于基于传播的预防措施中时（13个项目），即当居民新冠病毒感染确诊、有新冠症状但尚未确诊，或在养老院（重新）入院14天内正在接受新冠感染观察时。有无养老院EC项目的州在新冠感染率和死亡率或养老院人员短缺率方面没有明显差异，不过有EC项目的州社交距离政策的限制可能略少。各州的EC项目在关键设计上差异很大。需要进行比较评估以了解这些项目的有效性。
