Caring for Older People Amid the COVID-19 Crisis

By Matt Gontarchick

On May 21, the Senate Special Committee on Aging held a hearing entitled, “Caring for Seniors Amid the COVID-19 Crisis” during which members and witnesses discussed the pandemic’s impact on long-term care facilities as well as recommendations to improve safety for residents, nursing home workers, and their families.

Chairwoman Susan Collins (R-ME) noted in her opening statement that the COVID-19 pandemic has been especially deadly for individuals over 65, explaining that seniors comprise two out of five hospitalizations and eight out of 10 deaths related to the virus. As a result, she urged her fellow committee members to ensure long-term care facilities have access to tests, and she called on members to take into account how nursing homes can acquire future tests and vaccines.

Ranking Member Bob Casey (D-PA) cited similar statistics on the pandemic’s disproportionate impact on older Americans. While nursing homes residents account for only 0.15 percent of the population, the he pointed out that they also represent one-third of COVID-19 deaths. This fact was repeated several times during the hearing by other members and witnesses.

Casey also discussed providing additional relief for nursing homes via the HEROES Act (H.R. 6800), which the Democrat-controlled House advanced on May 15. Some of the bill’s provisions he highlighted would require nursing homes to collect data on the prevalence of COVID-19 and provide more funding for community-based services.

According to Mark Mulligan, MD, Director, New York University Grossman School of Medicine, seniors are at greater risk for coronavirus-related complications due to relatively weaker immune systems and the prevalence of chronic diseases. In order to effectively combat the virus, Dr. Mulligan explained that effective medical countermeasures are needed, such as treatments and vaccines. While seniors will be included in efficacy trials for vaccines, he noted that the elderly typically do not respond to vaccines as well as younger people. That said, in the absence of a vaccine, Dr. Mulligan explained that our most effective weapon against the virus is non-pharmacological interventions, such as social distancing. As the pandemic continues, he suggested that social distancing policies be tailored to seniors to account for differences in biology.

Tamara Konetzka, PhD, Professor Health Services Research, University of Chicago, began her opening remarks by sharing her research findings on the impact of COVID-19 on seniors. First, she identified a strong relationship between race the and provability of COVID-19 cases and deaths. Second, Dr. Konetzka found no meaningful relationship between nursing home quality and the probability of at least one COVID-19 case or death. Third, she found no meaningful difference between for-profit and non-profit nursing homes and the probability of COVID-19. As a result, Dr. Konetzka and her team concluded that nursing homes are primarily a reflection of the neighborhoods in which they are located.

To improve nursing home safety amid the pandemic, Dr. Konetzka offered three recommendations. First, she stated that nursing homes need an influx of funding and technology to achieve adequate levels of staffing, personal protective equipment (PPE), and testing. Second, Dr. Konetzka urged lawmakers to enhance the ability of Medicaid beneficiaries to receive care at home instead of in institutional facilities. Third, she called for enhanced requirements around data collection and transparency.

According to Steven Landers, MD, MPH, President and CEO, Visiting Nurse Association Health Group, the pandemic’s effects on nursing homes and hospitals underscore the importance of strong home care system. To achieve this, he called on the committee members to ensure home health workers can remain safe by allowing access to PPE at a reasonable price. For example, Dr. Landers said his organization is paying seven to 10 times the normal price for masks, face shield, and other equipment.

Landers additionally spoke about telehealth’s potential to innovate home health care. To increase its adoption, he recommended that home health agencies be reimbursed for using telehealth, and he called on the emergency waiver that allows physicians and other providers to perform home health face-to-face encounters via telehealth be extended permanently.

Matt Gontarchick is Associate, Chamber Hill Strategies, in Washington, D.C.