By Tom Gresham
In the assisted living industry, communities are always ready for flu season. However, the flu is only one of an assortment of infectious diseases that represent a severe risk to the members of their communities. For that reason, providers place an emphasis on infection prevention and control efforts throughout the year to stay on top of the latest threats and to always provide the safest possible environment for residents, team members and visitors.
“It’s a matter of maintaining our diligence and recognizing that our residents are in a high-risk group for these diseases, and we need to do what we can to protect them,” said Sandy Mrkacek, a former assisted living executive who runs Mrkacek Consulting.
Of course, the arrival of COVID-19 brought dramatic and abrupt changes to the way senior living communities manage infectious diseases.
“Once COVID hit, whatever plan you put in place, you had to rethink everything – you had to revisit 100% of your operations,” said John Schulte, vice president of quality improvement for Argentum. “We had to rethink how we care for people on a day-to-day basis. It was a real challenge.”
Now, new guidelines under development are poised to help senior living operators in their ongoing efforts to combat infectious diseases. The guidelines are being developed by the Quality in Assisted Living Collaborative (QALC), which comprises five partnering organizations: Argentum, the American Seniors Housing Association, LeadingAge, the National Association for Regulatory Administration and the National Center for Assisted Living. The organizations have joined forces to identify, define and develop model guidance for assisted living related to infection prevention and control.
“Every operator wants to protect their residents,” Mrkacek said. “What can be helpful is a clear roadmap of what needs to be done so they can get processes in place. These guidelines are going to help do that.”
Applying lessons learned
During the pandemic, state regulators updated their regulations in response to the unique challenges of COVID. Schulte said many regulators simply took regulations that they created for skilled nursing facilities and applied them to assisted living communities. It was often a poor fit and put assisted living communities in a difficult place, Schulte said. Compounding the challenge, the regulations could vary widely by state, making the situation daunting for operators with communities in different states.
“Some state regulations have sparse information on infection control standards, where others have really robust instructions on what needs to happen or how communities should manage their business related to infection control,” Mrkacek said.
The QALC’s guidelines will offer state regulators and communities critical support, allowing them to choose components of the plan that make the most sense for them. The IPC guidelines will also benefit other assisted living stakeholders, including clinicians, researchers, educators, ombudsmen, government officials, medical directors, consumer advocates, and others.
The IPC guidelines were developed using reputable sources, such as the Occupation Safety and Health Administration (OSHA) and the Center for Disease Control (CDC). These materials were further vetted by subject matter experts from among assisted living providers, state regulatory officials, physicians, consumer representatives, and other interested stakeholders to ensure their applicability for assisted living.
Schulte said the guidelines encompass 17 infectious diseases of interest in assisted living communities, ranging from Legionnaires’ disease to the “triple threat” of COVID, the flu and RSV, as well as emerging pathogens. Ultimately, QALC hopes to have a finalized set of guidelines when the Senior Living Executive Conference is held at the end of April, Schulte said.
Coming out of COVID, communities have adopted elevated IPC practices, and QALC is working to document those essential practices with the proposed guidelines.
“We convened a diverse group of assisted living subject matter experts and asked, when it comes to preventing and controlling infection, what are the essential things that should be done?” Schulte said. The proposed IPC guidelines are currently out for stakeholder review – an important part of the consensus-building process.
Formalize a written program and establish a leader
Among the basic guidelines recommended by the QALC’s IPC Workgroup – the subject matter experts who are leading development of the guidelines – is that each community have a written infection prevention and control program. A written program helps position communities to respond in the event of an outbreak and ensures team members understand what is expected so they can act accordingly, Mrkacek said.
In addition, QALC’s guidelines include an emphasis that each community name an individual to serve as its infection prevention and control leader. This leader gives the community a clearcut centralized resource for all things related to infection prevention and control.
“That’s not to say that person can’t delegate some of the responsibility to others, but overall, that one person oversees the plan. They ensure the plan is implemented consistently. They monitor communications from public health authorities to see if there are updates, which could include information on a new pathogen that’s identified, or a new variant of COVID, that may need to be addressed differently than what we may have been doing in the past,” Mrkacek said. “The guidelines suggest that the infection prevention and control leader build a relationship with their local health department. This way, a community has access to an expert who can guide them.”
Training is paramount
Perhaps most importantly, QALC’s guidelines detail the need for comprehensive IPC training.
“If the employees don’t do what’s expected, it all falls apart,” Mrkacek said. “If you have a thorough training program, you’re making sure the employees understand what is expected. Skills and protocols are then reinforced by monitoring and holding employees accountable. The wheels will come off if that doesn’t happen.”
Mrkacek noted that most states already have regulated precautions that assisted living employees providing direct resident care should take in infection prevention and control.
“It’s essential to ensure employees aren’t taking shortcuts when it comes to infection prevention and control standards. They need to understand the importance of what they’re doing and why they’re being asked to do it, because that will make it more meaningful to them,” Mrkacek said. “Not only are they protecting their residents but they are protecting themselves and mitigating the risk of taking any infectious disease home to their own families.”
Mrkacek said the concept of “just-in-time training” plays a vital role in QALC’s proposed guidelines. That means that in addition to staff receiving infectious disease training when they are hired and on a regularly scheduled basis, communities also should commit to providing immediate training when an infectious disease is suspected or identified within a community.
“That ensures that it’s fresh in caregivers’ minds, and they can apply it immediately in practice,” Mrkacek said.
An enduring lesson of the pandemic in assisted living was the negative impact of isolation on emotional well-being, and that lesson is incorporated into the proposed guidelines.
“One of the things that the IPC Workgroup believes is important is training employees to watch for changes in a residents’ emotional well-being,” Mrkacek said. “If they feel a resident is struggling, the employee is expected to report their observations to their supervisor. Additionally, the guidelines suggest employees should be provided with techniques to support a resident during a difficult time. This may include specific communication techniques or alternative ways to connect a resident who may be isolated.”
Training can have critical emotional benefits in a health crisis, helping team members support not only residents but family members of residents and their colleagues as they navigate an array of challenges.
“I think we saw that the communities that came together and provided support and listened to one another during the pandemic made it through more successfully than others,” Mrkacek said.
Communications and continuous improvement
In terms of prevention, the guidelines prioritize the importance of reinforcing messages for family members, visitors and employees about steps to take to prevent the spread of an infectious disease, including standard precautions already outlined by OSHA for workers. The guidelines also outline other precautions – many enshrined via OSHA – related to personal protective equipment, EPA-registered disinfectants, food handling, cleaning and how staff interact with infected residents. In addition, guidelines detail when to enact visitation restrictions and when isolation of some kind for a resident might be necessary.
“These are all important measures to control the spread of infectious diseases within a community,” Mrkacek said.
Among the preventive messages in the guidelines are providing communities guidance on vaccinations. State regulations always supersede whatever the guidelines will say, Mrkacek said.
“It’s a matter of educating and communicating to our residents,” she said.
Communication and transparency are priorities in the guidelines, so that residents, families, visitors and team members are always well-informed about risks and how they are being handled.
The proposed guidelines also include provisions for continuous improvement of a community’s IPC program. As proposed, QALC recommendations call for review and update of an IPC program at least annually, or whenever new regulations or evidence-based guidelines are published. Operators should evaluate and prioritize potential risks for infections, contamination and exposures and their program’s effectiveness in mitigating those risks.
“It’s about evaluating the risk that our residents are under and the processes that we have in place to protect them. This means monitoring the implementation of the IPC protocols on a consistent basis, providing training, and altering protocols to meet the changing needs of the population on an ongoing basis,” Mrkacek said. “And all of that relies on investigation and data collection to determine where the infectious disease came from, how many people were infected, the length of the disease, and the impact it has on the staff. Through all of this, communities will be working hand in hand with local health departments.”
QALC’s guidelines are intended to make the process more straightforward and accessible to all communities.
“The QALC Advisory Board understands that states operate differently, and having these guidelines out there is really just another support tool for operators and for states to cherry-pick and choose what they feel works best for them,” Mrkacek said. “It’s obviously timely for those communities that might be struggling and still reeling from the aftereffects of COVID, and it gives them a plan to follow, if they so choose.”
A new path forward
Mrkacek said assisted living communities have met the challenge that infectious diseases have brought to the industry.
“I think a lot of organizations are doing a good job with the resources they have,” Mrkacek said. “They’ve certainly leaned heavily on local health departments, and they rose to the occasion during COVID-19. I think it’s very impressive what organizations have been able to pull off.”
In her previous role in the learning development department with a senior living operator, Mrkacek experienced firsthand the challenges of trying to manage a dizzying array of state regulations and training requirements across different states, including one-off exceptions that had to be accounted for. The QALC guidelines can help ease that challenge.
“For infection control, consistency will make operation much easier,” Mrkacek said. “It certainly could increase efficiency for those providers who operate in more than one state. The guidelines also have potential to save regulators time and effort by providing language they can adopt in its entirety or in parts to enhance their current state regulations. It is worth noting both of these benefits are byproducts of the main goal, which is to ensure the safety and well-being of our residents and staff.”
The Collaborative so far has received positive feedback from state regulators who are showing interest in incorporating the guidelines into their regulations, Schulte said. The role of the National Association for Regulatory Administration in the Collaborative helps ensure regulators’ input is incorporated in the guidelines. In addition, Schulte said QALC plans to develop guidelines for other risk areas beyond infection prevention, such as dementia care training, emergency preparedness and more.
“We’re all working together on these very important issues,” Schulte said. “That’s because we see how this can benefit providers, associates, regulators, residents, their families – everyone involved with assisted living.”
The QALC guidelines ultimately promise to gather energy industry-wide around infection prevention and control being bolstered in the assisted living field.
“It’s going to be a great tool for the industry,” Mrkacek said.
Argentum infectious diseases course provides basic training for senior living caregivers
A new online learning program from Argentum offers senior living providers with a crucial new tool to strengthen their infectious disease prevention and control efforts.
The course, “Introduction to Infection Prevention and Control,” is designed for frontline caregivers in senior living, emphasizing basic, foundational knowledge and skills for providing a safe and healthy environment for residents. The course features four modules: Standard Precautions, Transmission-Based Precautions, Protecting Residents Against Communicable Diseases, and Leadership – the last focuses on the steps that senior living leadership can take to implement effective infection prevention measures to help keep their community safe.
Emily O’Connor, director of learning, said Argentum recognized a need for a standardized set of information on everything from using PPE effectively to performing proper hand hygiene.
“Following the COVID-19 pandemic, Argentum saw an opportunity to expand upon the training available for caregivers in the senior living setting and to convey to them some best practices and proactive measures that they can take to help ensure the health and safety of their residents,” O’Connor said.
Argentum collaborated with subject matter experts from the Association for Professional Infection Control and Epidemiology to develop the course and ensure it tackles the most important topics for caregivers while providing them with clear guidance, O’Connor said.
The modules take approximately three and a half hours to complete. Participants click through interactive slides during the course and complete an assessment at the end of each module. At the conclusion of the course, they take a final assessment to earn a certificate of completion.
O’Connor said Argentum will complete periodic reviews of the course to make sure it remains in alignment with current guidelines and practices as they change.
Senior care professionals interested in the course can visit www.argentum.org/infection-prevention-and-control-course/ or email [email protected].
