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"We should value [nursing home staff] as the professionals they are and give them the tools and skills to provide the highest quality care possible."
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Giving Nursing Home Professionals the Skills and Support They Need in the COVID-19 Crisis

By Kedar Mate | Friday, October 23, 2020
Giving Nursing Home Professionals the Skills and Support They Need in the COVID-19 Crisis

During the first surge in the COVID-19 pandemic, many people I talked to in health care told me they had never worked harder at any other time in their careers. No one had ever seen anything like the high volume of patients, catastrophic losses, and sometimes terrifying uncertainties brought on by the novel coronavirus. In the face of such challenges, it was heartening to see the public displays of gratitude directed at hospital workers that seemed to be everywhere.

I don’t, however, recall seeing this same kind of appreciation directed toward nursing home professionals. I thought of this when we started the IHI COVID-19 Rapid Response Network for Nursing Homes in June of this year. With support from The John A. Hartford Foundation, the Network hosted 20-minute phone huddles every weekday to offer nursing home staff real-time, practical solutions to challenges caused or exacerbated by COVID-19.

The efforts our nursing home colleagues described during the huddles earned our deep respect. I remember one of the participating organizations told us that some of their certified nursing assistants (CNAs) and cleaning staff had chosen to live at the nursing home for the first several weeks of their surge rather than risk bringing the virus in from the community. They selflessly created a “bubble” with the residents, risking their own health, and sacrificing time with their families to protect the health and welfare of the residents.

Participants shared many other examples of astonishing commitment. If you don’t work in a nursing home, or know someone who does, you may not have heard these kinds of stories. During this pandemic, nursing home professionals have not received much gratitude for their efforts. Instead, many nursing home staff have been the objects of malice and malcontent. They were blamed for the spread of COVID-19 as if it were the fault of individuals and not the way we built our systems of long-term care over many decades that was at play. Media reports often call nursing homes COVID-19 “hot spots” without noting that the professionals who care for nursing home residents are among the most needed and at-risk essential workers. It’s been estimated that almost 77,000 nursing home residents and staff have died from COVID-19 in the US, representing nearly 40 percent of known COVID-19 deaths.

Millions of older adults are residents in nursing homes in the US. We entrust some of the most vulnerable people in our communities to their care. We should value those care providers as the professionals they are and give them the tools and skills to provide the highest quality care possible.

I hope the launch of a new national initiative will go a long way toward giving nursing home staff the kind of respect and support they need and deserve. The AHRQ ECHO National Nursing Home COVID-19 Action Network is a partnership between the US Agency for Healthcare Research and Quality (AHRQ), Project ECHO, and IHI. The network will provide free training and support to nursing homes across the US to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff from COVID-19.

IHI’s Role in the National Nursing Home COVID Action Network

The idea for a large-scale improvement network in support of nursing homes came from IHI’s work on improving care and outcomes for older adults. Since 2016, IHI has been working with the support of The John A. Hartford Foundation on an initiative called Age-Friendly Health Systems. Over the last several years, we concentrated our efforts first on hospitals and then ambulatory care centers. We had always imagined extending the Age-Friendly Health System concept to post-acute and long-term care settings, but the pandemic accelerated those efforts. We launched the Rapid Response Network for Nursing Homes virtual huddles to provide immediate daily support in mid-April and shared the latest information in a rapidly evolving COVID-19 policy environment.

The huddles became an incredibly powerful and engaging activity for the over 2,000 nursing home organizations that joined the network. Between 200-300 attendees participated every day, determined to learn how to provide better and safer care from expert faculty and their peers.

The experience helped us see the potential to challenge the prevailing narrative around nursing homes and their staff. Could we flip the script from one that was unfairly vilifying nursing home staff to one that celebrated the work of those that were banding together to improve their performance and care?

We also became determined to do more. Could we go from reaching 2,000 nursing homes to reaching every nursing home in the country? How could we connect every nursing home with the best available science? How could we equip them with the quality improvement (QI) tools to help them implement best practices reliably in every care setting? This led to a conversation with AHRQ and Project ECHO that evolved into the National Nursing Home COVID-19 Action Network.

IHI’s role in this Action Network is to help identify subject matter experts who understand the realities of facing off against a pandemic like this in the nursing home setting. We have built a 16-week curriculum to address key topics, including infection prevention and control, coronavirus testing strategies, use of PPE, and managing social isolation. In the future, the network will focus on new topics, including how to deliver vaccines safely to nursing home staff and residents.

In addition, IHI will link participants to QI coaches. Our goal is to anchor the Action Network in solid quality improvement guidance to help ensure reliable implementation of any best practice because, as the pandemic continues, new clinical and operational challenges will present themselves. One week’s priority may be around COVID testing; the next may focus on visitation policies.

A Renewable Improvement Resource

I believe that it can be a true game changer when people learn the techniques of improvement. It may appear purely technical, but it can become the energy to transform almost any circumstance. We’ve seen that nursing home staff want the tools to make changes in their work and their environment. They are eagerly seeking this kind of empowerment.

We look forward to working with CNAs, administrators, medical directors, therapists, and other nursing home professionals across the US – and we are now recruiting sites to join this Network. We hope the National Nursing Home COVID-19 Action Network can become a renewable resource because there will inevitably be future issues this group can work together to address. Our goal is to help them develop skills they can use long after the current pandemic is over.

Editor’s note: Look for more each month from IHI President and CEO Kedar Mate, MD, (@KedarMate) on improvement science, social justice, leadership, and improving health and health care worldwide.

You may also be interested in:

National Nursing Home COVID-19 Action Network details and registration

Free AHRQ ECHO National Nursing Home COVID-19 Action Network Pre-Launch Webinar on COVID-19: Realistic and Quality Approach to Cohorting, Cleaning and Disinfection

Driving the Urgent Need to Improve Nursing Home Care

Free Age-Friendly Health Systems resources

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