Older adults and individuals with underlying, serious medical conditions are at higher risk of morbidity and mortality related to COVID-19. In particular, residents of long-term care nursing facilities (NFs), skilled nursing and rehabilitation settings (SNFs), and assisted living residences (ALRs) may be at higher risk. IHI has compiled a list of national resources that provide updated information on COVID-19 and older adults.
Resources to Support Nursing Home Staffing
Staffing During the COVID-19 Pandemic: A Guide for Nursing Home Leaders: A resource guide written by and for directors of nursing, administrators, and other nursing home leaders that outlines steps to reduce or eliminate urgent staff shortages, particularly shortages of direct care workers
- Resources for Point of Care Staff: A Summary: This document includes links and brief descriptions for resources that support ongoing COVID-19 identification and treatment; post-vaccination practices; emotional and organizational support; ongoing compliance and testing; communication and leadership; and stopping the spread for clinical and operational and all staff.
Resources to Support Discussions about Vaccine Hesitancy in Nursing Homes
Resources to Support Age-Friendly Health Systems
Asking and Acting on What Matters to Older Adults
The COVID-19 pandemic has heightened awareness of the importance of advance care planning, as well as the need to ask and act on What Matters to each older adult. This is particularly important for individuals living in nursing homes, skilled nursing and rehabilitation facilities, or assisted living residences — settings that increase the risk of person-to-person COVID-19 transmission among residents and staff, and of serious illness related to COVID-19 infection.
Since residents may become ill over hours or days, it is vital to have their wishes documented prior to them becoming unable to express their own goals and preferences. These conversations can be stressful and challenging under any circumstances. Advance care planning may be especially difficult if it must be done over the telephone, by computer, or when the health professional is wearing full personal protective equipment (PPE) including a mask.
IHI recognizes that many health systems have requested guidance on how to facilitate these discussions. Below are some resources that may be helpful in guiding health care professionals through conversations with residents, family members, care partners, teams, and communities.
Policy and Updates
Resources for Physicians, Nurses, and Other Health Care Professionals
For a cultivated list of resources for hospital and health system leaders and health care providers, visit the
main COVID-19 Guidance and Resources web page.
Resources for Post-Acute and Long-Term Care/Health System Administrators and Leaders
- Centers for Disease Control and Prevention (CDC):
Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (information compiled by CMS, but not intended as guidance from CMS, to assist nursing homes in meeting residents' needs
LeadingAge: Coronavirus Resources
American Health Care Association: How You Can Help Prevent the Spread of Coronavirus (COVID-19) in Long-Term Care Facilities
John A. Hartford Foundation: COVID-19 Resources for Older Adults, Family Caregivers, and Health Care Providers
American Geriatrics Society (AGS) COVID-19 Resources
Eldercare Locator: Resources to help older adults locate community-based resources (e.g., food and shelter, services from AAA or AAADs)
- University of Maryland School of Pharmacy:
Optimizing Medication Management During the COVID-19 Pandemic: Implementation Guide for Post-Acute and Long-Term Care (national recommendations for medication management in skilled nursing, rehabilitation, and nursing facilities produced by a task force of geriatric physicians, nurses, and pharmacists)
- Health Affairs Blog (May 12, 2020):
Importance of Nursing Home Transparency and Oversight, Even in the Midst of a Pandemic
Agency for Healthcare Research and Quality PSNet: COVID-19 and Safety of Older Adults (useful guidance on safety of older adults living in nursing facilities and assisted living residences, in particular)
- Centers for Medicare & Medicaid Services (CMS) Guidance:
CMS Memo QSO-21-19-NH: Interim Final Rule: COVID-19 Vaccine Immunization Requirements for Residents and Staff (May 11, 2021)
CMS Memo QSO-20-39-NH: Nursing Home Visitation — COVID-19 (REVISED April 27, 2021)
CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID19 Focused Survey Tool (REVISED April 27, 2021)
CMS Memo QSO-20-31-All: COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control Deficiencies, and Quality Improvement Activities in Nursing Homes (June 1, 2020)
Guidance for Hospital to Post-Acute or Long-Term Care Transfer During the COVID-19 Pandemic
Post-acute and long-term care settings have expressed concern about admitting or readmitting people who have been in the hospital and potentially exposed to COVID-19 or have become COVID-19 positive. In some cases, post-acute and long-term care settings may not believe that they have adequate PPE or environmental safeguards to provide safe care and protect health care and other workers. In other cases, they may be concerned about staff shortages or inadequate staff training.
Several states have published new guidance around hospital to post-acute or long-term care transfers. Please consult your state's department of public health website for the most current state-specific information since this information changes frequently.
Resources on Telehealth