3 Questions for Katherine Almendinger, SM’10
Research Director, American Health Care Association
Katherine Almendinger, SM’10, heads the research team at the American Health Care Association, a trade association representing 14,000 skilled nursing facilities/nursing homes, assisted living centers, and intermediate care facilities. The AHCA’s COVID-19 response team provides communications, emergency response, education, and technical assistance to skilled nursing and assisted living facilities across the country.
How is your research team supporting members in the context of COVID-19?
All of our projects are focused largely on COVID now, from interpreting clinical guidance, to looking at survey changes, to trying to help coordinate with federal agencies and getting funding. We interface with our providers, but also with the CDC and CMS, with the White House, with FEMA—just trying to make sure that we can provide as much information to parties who need it as we can, especially since this is an unprecedented thing for most of our providers.
Something we’re working on now is looking at why infections happened. Survey and regulation are supposed to be encouraging certain behaviors, but if it’s something that a provider has no control over, then punishing them does absolutely nothing for keeping people safe and preventing the spread of COVID. We’re also trying to establish what’s true, and what’s helpful. For example, a piece in Kaiser Health News that was trying to draw correlations between CMS quality rankings and COVID cases, but if you use a larger sample than they looked at, the two are not actually related.
We have also been working to lobby Congress to include long-term-care facilities in the bills that they’re passing to cover the increased costs [of caring for COVID-19 patients], trying to get us prioritized in the testing queue. Trying to overturn state requirements to accept people from a hospital without testing. So, it’s a pretty broad spectrum.
Why is it so important to address COVID-19 in long-term-care facilities?
The average age of our residents ranges from the high seventies to mid-eighties, depending on the facility. Most people have multiple underlying comorbidities, so they’re the hardest-hit group if they are exposed to this virus. We’re providing care for the people who have the most significant consequences of getting infected.
Many people who arrive at hospitals needing to be on ventilators are coming from nursing homes. At the same time, we need to take people from hospitals, but if we bring people from hospitals who have COVID infections into the building, that produces additional people who need to go to the hospital. Hospitals and skilled nursing facilities need to be able to partner to manage the flow of patients back and forth.
How has AHCA recommended that nursing homes/skilled nursing facilities protect patients and staff? What is still needed?
It’s been a mix of cohorting, requesting testing, and then restricting interactions and making sure that facilities and staff follow protocols for infection prevention and control. We’ve been trying to focus on getting resources to help them identify individuals who have the infection quickly, whether or not they’re symptomatic, and cohort them away from others who are vulnerable to that infection.
There were orders to divert PPE to hospitals, and so a huge number of facilities have not been able to get protective equipment for their staff. We worked with the CDC to put together crisis management guidance on how to use and conserve PPE. Our members have struggled with shortages of staff because they don’t want to come in when there’s not PPE. We think that we have [now] been heard, that it’s vital that we have PPE, but then whether the supply chain can keep up is a question.
Right now, nursing facilities need help and support the way hospitals are being supported.