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Responding to COVID-19 in Long-Term Care: A Public Health Nursing Approach

Michele Burke*

COVID-19 disproportionately impacts older adults and those with underlying medical conditions; advanced age, physical frailty, and medical comorbidities place them at particularly high risk for adverse consequences of COVID-19. Patients living in congregate long-term care settings are also at substantial risk of transmission due to a combination of medical, social, and environmental vulnerabilities. They require close and prolonged contact with caregivers who assist with activities of daily living. Many suffer from cognitive impairments that interfere with universal masking and social distancing. Moreover, healthcare staff in these settings are likely to be low-wage workers, new immigrants, with limited English proficiency and health literacy. They are more likely to live in overcrowded settings and work several jobs across multiple facilities. All of these resident and staff level factors combine to potentiate the risk of infection in these settings. Alameda County Public Health Department, in its efforts to prevent, contain, and mitigate the spread of COVID-19 in these challenging environments, established a COVID-19 Long-Term Care Facility (LTCF) Outbreak Team comprised of public health nurses drawn from across the public health workforce. Applying a public health framework, these LTCF Outbreak Nurse Investigators worked intensively with a wide variety of high risk long-term care settings to implement effective mitigation and early intervention strategies in order to prevent the most consequences of COVID-19.Responding to COVID-19 in Long-Term Care