February 10, 2021, Maggie Flynn, Skilled Nursing News - Good infection control standards are the same for skilled nursing facilities across the U.S. — both in the sense of federally mandated requirements and in the sense of the concrete conditions that are necessary to prevent the spread of contamination.
This was true even before a pandemic that shook the world in 2020, with ongoing shockwaves for the U.S. leading into 2021.
While the standards of good infection control are constant, the conditions in which SNF operators have to implement them — and the obstacles to that implementation — can vary wildly depending on their situation.
A small facility with fewer residents and staff, for instance, might find itself with a major COVID-19 outbreak and fewer resources at hand if it is located in a smaller, rural community — while a similarly sized facility in a more urban area, with connections to local hospitals, might be able to contain a similar outbreak through its ties to other providers.
A facility with easy-to-segment wings or floors could find success as a COVID-19 hub for referral partners, while another with a more open-floor plan might struggle to follow the social distancing and isolation protocols required by the pandemic.
The National Nursing Home COVID-19 Action Network (NNHCAN) was established in September 2020 with the goal of trying to level this playing field in terms of the standards themselves, by providing best practices for facilities through training provided by local hubs.
The network is a product of a partnership between the Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) and the University of New Mexico’s ECHO Institute in Albuquerque and the Institute for Healthcare Improvement (IHI) in Boston. The network was established through an AHRQ contract worth up to $237 million, part of the almost $5 billion Provider Relief Fund authorized earlier this year under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
When AHRQ embarked on discussions with the various groups and organizations that represent and support nursing homes, staff, medical directors and others, they heard two main requests. One was for continued financial support. The other was for knowledge — specifically making information easier to acquire.
“The knowledge and the information about COVID-19 was changing on an almost daily basis,” acting AHRQ director Dr. David Meyers told Skilled Nursing News. “And their focus was so much on caring for their residents, that it was hard to keep up with the changing information. So they pleaded with us and said: Could you make it simpler, so we could get the right information quickly, without having to run to 10 different websites or listen to many, many different phone calls?”
The goal ultimately was to draw information from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), he said.
It draws upon the ECHO — or Extension for Community Healthcare Outcomes, model, which was originally developed for primary care, Meyers told SNN. But the ECHO Institute had begun work with nursing homes recently in a project that represents “a massive expansion of what they were doing,” he said.
As of February 3, approximately 8,500 nursing homes are participating in the network, which has 99 training centers across 50 states. These centers operate multiple cohorts, which in turn each serve 25 to 35 nursing homes, on average, according to a spokesperson for the initiative. However, while 8,500 nursing homes have signed up for the network, not all of them have been placed in cohorts yet, she noted.
The first priority was to launch the program and make it available, Meyers said, with about 100 training centers coming online within two months.
“One of the things that excites me the most about this network is that what we’re doing is we’re pairing nursing homes with academic health centers or large hospitals in their areas, who are providing the training and support for them,” he told SNN. “And that’s creating local relationships that will, we hope, go beyond COVID — but also are important not just for COVID in the nursing home, but when patients have to transfer back and [forth], to building trust and understanding and relationships.”
Originally, the program enrollment period was expected to wrap up at the end of the 2020 calendar year, but because AHRQ and ECHO are still seeing interest from nursing homes — both through word of mouth and other means of outreach, such as training centers reaching out to local facilities — that timeline was extended, Meyers told SNN.
Currently AHRQ is recruiting to launch another 20 to 30 cohorts, or learning communities, so any nursing home interested could still sign up, he added.
Skilled Nursing News was able to listen in on one of the training sessions, offered by the Oklahoma Dementia Care Network, part of the University of Oklahoma. The topic was returning to work safely, but that formed only a portion of the session; much of the interaction, both in the chat section of the call and in conversation, consisted of sharing tips and best practices for addressing issues related to maintaining operations in the SNF setting while keeping staff and residents safe.
According to Meyers, this peer-to-peer aspect of the training was critical, given how isolating COVID-19 can be both for individuals and settings generally.
“The nursing home staff, in the day-in and day-out of the work they were doing, it was scary, and people were burning out, and they were feeling very isolated,” he said. “And the first feedback we got from the network was that being on these calls and hearing other nursing homes in their community, people having the same issues, made people feel they weren’t [alone].”
The network is trying to assess the impact of the infection control training course in terms of outcomes and effectiveness, but given the national COVID-19 emergency, coming up with metrics for that was “definitely a second-level priority,” Meyers said. The goal is to eventually assess the changes made and how successful they were, but that will come after the pandemic in a “summative evaluation.”
In the meantime, AHRQ is performing “formative evaluation,” where it holds calls with nursing homes — more than 250 a week — to assess whether the information presented was helpful, and whether it was useful. The curriculum and structure of the training can then be adjusted based on the feedback.
“One of the statistics I’ve gotten to watch is we ask them: Have you made a change? Has it been a big change or a small change?” Meyers told SNN. “And we’ve watched over the weeks, that number is now over 75%, close to 80% of [participating] nursing homes, that have said they’ve made a substantive change in how they’re delivering care for residents as a result of their participation.”