There are so many topics I hope to address during my tenure as the 2020–2021 president of the American Geriatrics Society (AGS)—but, candidly, it is hard to imagine writing anything in 2020 without first addressing COVID-19. By the time this article reaches you, I hope—as do all our nurses, pharmacists, physician assistants, physicians, social workers, and so many other inter-professional colleagues—the light at the end of this proverbial tunnel will be in sight. As we look toward a less distant horizon, though, I am reminded that we need to keep the past and present ever close. This pandemic has changed so much for our country and our world, often in sad ways but always, I hope, in ways that ultimately can teach us more about the care we provide and how it must evolve to meet older people where they are.
As we have already learned, outbreaks across the spaces and places where our expertise is needed are a foreseeable consequence of a viral pandemic, even with experts working as valiantly as they have. Our efforts at the AGS have been focused on triaging immediate concerns, but also envisioning a future when we are better prepared to meet older adults' needs in times of crisis and calm. One of the updates that has me proudest, for example, is a policy brief we published outlining core priorities for nursing home care during COVID-19 (AGS, 2020).
Short- and long-term, we hope this brief can help policymakers, advocates, and clinicians look at but also beyond the circumstances we can control—and those we can't—in pandemics to prioritize the innovation, collaboration, and compassion that can put patients and public health first. That's a cardinal direction for planning in crisis and in calm, for nursing home residents but also for us all as we age.
In the policy brief published earlier this spring in our namesake journal, the AGS offered a roadmap to guide federal, state, and local governments addressing COVID-19 concerns for a critical—and critically impacted—group: older adults in nursing homes and long-term care (AGS, 2020). The brief outlined recommendations based on the latest research and guidance, encompassing actions on resource needs, patient transfers, priorities for public health, and opportunities to better empower health workers on the frontlines of COVID-19 care.
More than 15,000 nursing homes care for the oldest and most chronically ill Americans, who are among the most susceptible to COVID-19 and its complications (AGS, 2020). In reviewing existing research and recommendations, the AGS suggested orienting expertise toward several focal points where tangible action can make a difference (and where lessons learned often extend well beyond any particular virus or outbreak):
The AGS called for quick action to increase production and distribution of important supplies. These supplies included personal protective equipment and COVID-19 tests, but also supplies for symptom management and end-of-life care (AGS, 2020).
The AGS reinforced the importance of carefully considering transfers between nursing homes, hospitals, and other care settings. AGS experts noted, for example, that individuals who test positive for COVID-19 should not be discharged to a nursing home unless the facility can safely and effectively isolate the patient and implement adequate infection control for staff and residents. The AGS also urged the Centers for Disease Control and Prevention to develop guidance regarding transfers to emergency departments, where direction is still needed (and will be key to preparing for future challenges) (AGS, 2020).
According to AGS experts, more must be done to integrate key players in public health. These include geriatrics and palliative care experts with the requisite skills in advanced illness care, but also nursing home administrators and those with experience in local coordination and data analysis. Importantly, that analysis must include information from nursing homes—a key to confronting COVID-19 in communities across the United States but also to better understanding the impact of pandemics on some of the hardest hit communities and cohorts (AGS, 2020).
The AGS reinforced the importance of supporting health professionals, our nation's frontline defense for treating and preventing the spread of COVID-19 and other viral pandemics. The AGS encouraged Congress to advance paid family, medical, and sick leave for the whole health workforce, while also enhancing COVID-19 screening and training to protect staff availability (AGS, 2020). This is one long-range solution where action is absolutely vital: We need policy mechanisms that protect and support our health workforce and the infrastructure that can bolster our important expertise.
Finally, as part of ongoing efforts to protect America's economy, the AGS reminded legislators to consider the value of supportive tax relief and payment opportunities targeting long-term care. For example, the Centers for Medicare & Medicaid Services should continue to ensure payment to nursing homes can meet the costs of enhanced precautions, just as Congress should also structure tax relief to support nursing home employers and nurses, therapists, and direct care workers who care for older adults (AGS, 2020).
The AGS policy brief remains available with free access from the Journal of the American Geriatrics Society, which also issued its own call for COVID-19 scholarship in the days, weeks, and months following the viral outbreak (AGS, 2020). AGS updates, including work on clinical practice, public policy, and public and professional education, have been posted to the Society's COVID-19 information hub at https://www.americangeriatrics.org/covid19.
I know these tools were a valuable addition to the field at the peak of the COVID-19 crisis—and we certainly thank our expert members, leaders, and staff for all their hard work. I also know, however, that these resources will continue to be valuable tools as we analyze what has happened, what could have been done differently, and where we can help the whole of health care better prepare for future challenges. There can be little doubt that our country is aging—just as there can be little doubt that pandemics will continue to strain health systems. But, by learning from our past, I am confident we can build momentum for a world structured around high-quality, person-centered care for us all. That's what geriatrics has always been about.
Annie Medina-Walpole, MD, AGSF
President, American Geriatrics Society
- American Geriatrics Society. (2020). American Geriatrics Society (AGS) policy brief: COVID-19 and nursing homes. Journal of the American Geriatrics Society. Advance online publication. doi:10.1111/jgs.16477 [CrossRef]