Public Health Emergency Preparedness and Response: Non-Pharmaceutical Interventions to Reduce Transmission of Viral Respiratory Infections in Long-Term Care Communities

The CPSTF finding is based on evidence from a systematic review of 42 studies (search period from database inception to January 2024). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods and subject matter experts.

LTC communities provide a broad range of health, personal care, and supportive services to residents who may have limited selfcare capabilities due to physical, cognitive, or mental disability. Individuals may receive long-term care services in a variety of settings, including residential care communities or group homes, continuing care retirement or life care communities, assisted living, nursing homes or skilled nursing facilities. Services offered may include nursing care, 24-hour supervision, three meals a day, and assistance with activities of daily living (Harris-Kojetin 2019, NIH National Institute on Aging 2019).

The COVID-19 pandemic highlighted the vulnerability of residents in LTC communities to viral respiratory infections. LTC community residents make up less than 1% of the U.S. population but accounted for more than 23% of all COVID-19 deaths as of January 2022 (Kaiser Family Foundation 2022).

CDC’s guidance to prevent and slow the spread of viral respiratory infections includes vaccination, treatment, and nonpharmaceutical interventions (CDC 2024a). NPIs are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of infections (CDC 2024b, Qualls 2017). A combination of individual, community, and environmental NPIs can be used to prevent or respond to respiratory infection outbreaks or pandemics in LTC settings (Qualls 2017).

NPIs implemented in LTC communities reduced viral infection in residents and staff by 46% (10 studies). These interventions also decreased hospitalization or ED visits by 57% (5 studies) and mortality due to infection by 33% (3 studies).

LTC communities in the included studies used different combinations of NPIs based on their needs and resources, and it could not be determined which NPI or NPI combination was the most effective.

The review team examined the impact of community level NPIs on residents’ mental health and quality of life during the COVID-19 pandemic. The evidence was inconsistent regarding the effectiveness of these interventions on mental health and quality of life outcomes (8 studies).

A systematic review of economic evidence has not been conducted.

The CPSTF finding is applicable in all types of LTC communities with adult residents across the United States. The CPSTF finding is likely applicable to different combinations, types, or levels of NPIs implemented. The finding is mostly based on responses to SARS-CoV-2 but can be applied to infections caused by other respiratory viruses.

CPSTF identified the following questions as priorities for research and evaluation:

• What is the impact of these interventions on residents’ mental health and quality of life, considering the need for comparative study designs, having U.S.-based studies, and using standardized mental health outcomes?
• How effective are NPIs in the following settings:
  • Rural LTC communities?
  • LTC communities with high proportion of residents from historically disadvantaged racial and ethnic populations?
  • Residential LTC communities?
  • LTC communities for people with disabilities?
• Which individual or combinations of NPIs work the best?

Remaining questions for research and evaluation identified in this review include:

• Does intervention effectiveness vary with the following factors?
  • Compliance with NPI
  • Population characteristics such as gender or vaccination status
  • Community characteristics such as size of community, room sharing, staff to resident ratio, staff working in multiple communities
  • Provision of education or support services to allow better implementation of NPIs

Studies evaluated interventions implemented in:

• United States (11 studies)
• the Netherlands (5 studies)
• Spain, the United Kingdom (3 studies per location)
• Canada, Germany (2 studies per location)
• Belgium, Cyprus, France, Hong Kong, Israel, Sweden, Taiwan (1 study per location)

Studies included:

• all types of LTC communities (15 studies)
• nursing homes or skilled nursing facilities only (13 studies)
• residential LTC communities only (2 studies)
• LTC communities, unspecified (2 studies)

Studies examined LTC communities serving:

• older adults (22 studies)
• older adults and people with dementia (4 studies)
• adults with disabilities (3 studies)
• older adults and adults with disabilities (2 studies)
• older adults, people with dementia, and adults with disabilities (2 studies)

Studies included NPIs implemented in response to:

• SARS-CoV-2 (28 studies)
• respiratory illnesses caused by other viruses, including flu or flu-like illnesses (3 studies)
• pneumonia (2 studies)

NPIs that were implemented in response to outbreaks or pandemics lasted:

• fewer than three months (14 studies)
• between three and six months (4 studies)
• between six and nine months (4 studies)

Studies evaluated the impact of adding NPIs at the:

• individual level (2 studies)
• community level (21 studies)
• environmental level (2 studies)
• a mix of the different levels (7 studies)

NPIs were implemented based on decisions made at the:

• LTC community level (13 studies)
• local or state level (9 studies)
• national level (11 studies)

Effectiveness Review

• Logic Model – Effectiveness Review (Print Only) [PDF – 128 KB]
• Text Description – Effectiveness Review [PDF – 107 KB]

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review [PDF – 588 KB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Abu-Fraiha Y, Robinson SG, Maimon M, Hassan L, Grotto I, et al. National weekly SARS-CoV-2 RT-PCR screening of all workers in long-term care facilities associated with decrease in resident mortality rate. Gerontology 2023;69(5):541-8.

Allan-Blitz L, Aboabdo B, Turner I, Klausner JD. Effect of frequent SARS-CoV-2 testing on weekly case rates in long-term care facilities, Florida, USA. Emerging Infectious Diseases 2022;28(9):1918-20.

Angevaare MJ, Joling KJ, Smalbrugge M, Hertogh CMPM, Twisk JWR, et al. The effects of the 2020 COVID-19 lockdown on mood, behavior, and social cognitive functioning in older long-term care residents. Journal of the American Medical Directors Association 2022;23(9):1608.e9-18.

Backhaus R, Verbeek H, de Boer B, Urlings JH, Gerritsen DL, et al. From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes. BMC Geriatrics 2022;21(1):588.

Bakaev I, Retalic T, Chen H. Universal testing-based response to COVID-19 outbreak by a long-term care and post-acute care facility. Journal of the American Geriatrics Society 2020;68(7):e38-9.

Balestrini S, Koepp MJ, Gandhi S, Rickman HM, Shin GY, et al. Clinical outcomes of COVID-19 in long-term care facilities for people with epilepsy. Epilepsy & Behavior 2020;115:107602.

Belmin J, Um-Din N, Donadio C, Magri M, Nghiem QD, et al. Coronavirus disease 2019 outcomes in French nursing homes that implemented staff confinement with residents. JAMA Network Open 2020;3(8):e2017533.

Cazzoletti L, Zanolin ME, Tocco IT, Alemayohu MA, Zanetel E, et al. Risk factors associated with nursing home COVID-19 outbreaks: a retrospective cohort study. Journal of Environmental Research & Public Health 2021;18(16):8434-52.

Ehrlich HY, Harizaj A, Campbell L, Colt M, Yuan K, et al. SARS-CoV-2 in nursing homes after 3 months of serial, facilitywide point prevalence testing, Connecticut, USA. Emerging Infectious Diseases 2021;27(5):1288-95.

Geeraedts F, Luttje M, Visschedijk J, van Hattem M, Hasper HJ, et al. Low-threshold testing for SARS-CoV-2 (COVID-19) in long-term care facilities early in the first pandemic wave, the Twente region, the Netherlands: a possible factor in reducing morbidity and mortality. Journal of Applied Gerontology 2022;41(8):1802-11.

Gil-Llario MD, Diaz-Rodriguez I, Fernandez-Garcia O, Estruch-Garcia V, Bisquert-Bover M, et al. Mental health of people with intellectual disabilities living in residential care before, during, and after lockdown. Behavioral Sciences 2023;13(8):21.

Green R, Tulloch JSP, Tunnah C, Coffey E, Lawrenson K, et al. COVID-19 testing in outbreak-free care homes: what are the public health benefits? Journal of Hospital Infection 2021;111:89-95.

Gustafsson PE, Schröders J, Nilsson I, San Sebastián. Surviving through solitude: a prospective national study of the impact of the early COVID-19 pandemic and a visiting ban on loneliness among nursing home residents in Sweden. The Journals of Gerontology: Series B 2022;77(12):2286-95.

Hodge E, Oversby S, Chor J. Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective. BMC Public Health 2023;23(1):597-609.

Huang CY, Kuo YH, Chuang ST, Yen Hr, Tou SI. The experience of executing preventative measures to protect a nursing homein Taiwan from a COVID-19 outbreak. European Geriatric Medicine 2021;12(3):60917.

Jutkowitz E, Shewmaker P, Reddy A, Braun JM, Baier RR. Pilot study demonstrates benefits of nursing home air purification on COVID-19 outcomes. MedRxiv 2022;01.

Kovach CR, Taneli Y, Neiman T, Dyer EM, Arzaga AJ, et al. Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbialburden, infection and hospitalization rates. BMC Infectious Diseases 2017;17(1):186.

Lipsitz LA, Kosar C, Dufour AB, Travison TG, Mor V. Evaluation of a state-wide effort to improve COVID-19 infection control in Massachusetts nursing homes. Journal of the American Geriatrics Society 2022;70(11):3273-80.

Lipsitz L, Lujan A, Dufour AB, Abrahams A, Magliozzi H, et al. Stemming the tide of COVID-19 infections in Massachusetts nursing homes. Journal of the American Geriatrics Society 2020;68(11):2447-53.

Makris AT, Morgan L, Gaber DJ, Richter A, Rubino JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. American Journal of Infection Control 2000;28(1):3-7.

McArthur C, Saari M, Heckman GA, Wellens N, Weir J, et al. Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents’ mental health: a data-driven approach in New Brunswick. Journal of the American Medical Directors Association 2021;22(1):187-92.

McGarry BE, Gandhi AD, Barnett ML. COVID-19 surveillance testing and resident outcomes in nursing homes. New England Journal of Medicine 2023;388(12):1101-10.

Oliveira ACS, Gallego MG, Martínez CG, EC Martínez, Molina JM, et al. Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: a prospective observational study. BMC Geriatrics 2023;23(71).

Orlando S, Mazhari T, Abbondanzieri A, Cerone G, Ciccacci F, et al. Characteristics of nursing homes and early preventative measures associated with risk of infection from COVID-19 in Laxio region, Italy: a retrospective case-control study. BMJ Open 2022;12(6):e061784.

Pereiro AX, Leiva D, Glavañ A, Pinazo-Hernandis S, Pinazo-Clapés C, et al. Psychological and functional impacts associated with restrictions in long-term care facilities (LTCF) due to the COVID-19pandemic: a multicentre study. Aging & Mental Health 2023;27(8)1544-51.

Reyné B, Selinger C, Sofonea MT, et al. Analysing different exposures identifies that wearing masks and establishing COVID-19 areas reduce secondary-attack risk in aged-care facilities. International Journal of Epidemiology 2021;50:1788-94.

Rolland Y, Lacoste MH, de Mauleon A, Ghisolfi A, de Souto Barreto P et al. Guidance for the prevention of the COVID-19 epidemic in long-term care facilities: a short-term prospective study. Journal of Nutrition, Health & Aging 2020;24(8)):812-6.

Saegerman C, Donneau AF, Speybroeck N, Diep AN, Williams A, et al. Repetitive salive-based mass screening as a tool for controlling SARS-CoV-2 transmission in nursing homes. Transboundary &Emerging Diseases 2022;69(4):e194-203.

Schuengel C, Tummers J, Embregts PJCM, Leusink GL. Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports. Journal of Intellectual Disability Research 2020;64(2):817-24.

Shallcross L, Burke D, Abbott O, Donaldson A, Hallatt G, et al. Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey. The Lancet Healthy Longevity 2021;2(3):e129-42.

Shimotsu ST, Johnson ARL, Berke EM, Griffin DO. COVID-19 infection control measures in long-term care facility, Pennsylvania, USA. Emerging Infectious Diseases 2021;27(2):644-5.

Simoni-Wastila L, Wallem A, Fleming SP, Le TT, Kepczynska P, et al. Staffing and protective equipment access mitigated COVID-19penetration and spread in US nursing homes during the third surge. Journal of the American Medical Directors Association 2021;22(12):2504-10.

Stemler J, Kramer T, Dimitriou V, Wieland U, Schumacher S, et al. Mobile PCR-based surveillance for SARS-CoV-2 to reduce visiting restrictions in nursing homes during the COVID-19 pandemic: a pilot study. Infection 2022;50(3):607-616.

Suwono B, Steffen A, Schweickert B, Schonfeld V, Brandl M, et al. SARS-CoV-2 outbreaks in hospitals and long-term care facilities in Germany: a national observational study. The Lancet Regional Health. Europe 2022;14:100303.

Teesing GR, Richardus JH, Nierboer D, Petrignani M, Erasmus V, et al. The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial. Antimicrobial Resistance & Infection Control 2021;10(1):80-9.

Telford CT, Onwubiko U, Holland DP, Turner K, Prieto J, et al. Preventing COVID-19 outbreaks in long-term care facilities through preemptive testing of residents and staff members – Fulton County, Georgia, March-May 2020. MMWR – Morbidity & Mortality Weekly Report 2020;69(37):1296-9.

Temte JL, Checovich MM, Barlow S, Shult PA, Reisdorf E, et al. Rapid detection of influenza outbreaks in long-term care facilities reduces emergency room visits and hospitalization: a randomized trial. Journal of the American Medical Directors Association 2023;24(12):1904-1909.

Tulloch JSP, Micocci M, Buckle P, Lawrenson K, Kierkegaard P, et al. Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study. Age & Ageing 2021;50(6):1868-75.

Vijh R, Ng CH, Shirmaleki M, Bharmal A. Factors associated with transmission of COVID-19 in long-term care facility outbreaks. Journal of Hospital Infection 2022;119:118-25.

Vijh R, Prairie J, Otterstatter MC, Hu Y, Hayden AS, et al. Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities. Infection Control & Hospital Epidemiology 2021;42(10):1181-8.

Vogazianos P, Argyropoulos CD, Haralambous C, Mikellidou CV, Boustras G, et al. Impact assessment of COVID-19 non-pharmaceutical interventions in long term care facilities in Cyprus: Safety improvement strategy. Safety Science 2021;143:105415.

Yeung WK, Tam WS, Wong TW. Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infection Control & Hospital Epidemiology 2011;32(1):67-76.

Linked Studies

Dufour AB, Kosar C, Mor V, Lipsitz LA. The effect of race and dementia prevalence on a COVID-19 infection control intervention in Massachusetts nursing homes. Journals of Gerontology: Medical Sciences 2022;77(7):1361-5. Brain Sciences 2021;11(8):986.

Pereiro AX, Dosil-Díaz Carlos, Mouriz-Corbelle R, Pereira-Rodríguez S, Nieto-Vietes A, et al. Impact of the COVID-19 lockdown on a long-term care facility: the role of social contact. Brain Sciences 2021;11(8):986.

Teesing GR, de Graaf M, Petrignani M, Erasmus V, Klaassen CHW, et al. Association of environmental contamination with hand hygiene and infections in nursing homes: a prospective cohort study. Infection Prevention in Practice 2021;3(2):100129.

Effectiveness Review

A search was performed to identify potentially relevant publications between database inception to January 2024.

Two team members independently screened each paper to determine eligibility. Uncertainties and disagreements were resolved by consensus among review team members.

Literature Search Strategies

Database: Ovid MEDLINE® 1946-2024

1 ((care or “care home*” or facility or facilities or residen* or residenc* or communit* or housing or home) adj3 (“senior citizen” or “senior citizens” or “assisted living” or longterm or long-term or “special needs” or convalescent or disabil* or disabl* or retirement or rest or “residential care” or aged or “extended care” or “old age” or old people* or charitable or elder* or “continuing care” or “life care” or “skilled nursing”)).ti,ab. 103720
2 “care home resident*”.mp. 737
3 Skilled Nursing Facilities/ 5359
4 assisted living facilities/ 1610
5 homes for the aged/ 14833
6 residential facilities/ 5756
7 nursing homes/ 39754
8 ((day care or daycare*) adj2 (senior* or adult)).mp. 552
9 (congregat* adj2 (care or “meal service” or “meal program”)).mp. 128
10 or/1-9 142290
11 (“public health” or epidemic* or Influenza* or RSV or flu or H1NI or H3N2 or Middle East Respiratory Syndrome or MERS or Pneumonia* or Coronavirus* or COVID* or SARS-Cov-2 or SARS or Tuberculos* or TB or Streptococcus* or Legionella* or (respiratory adj3 (infection* or illness* or disease*))).mp. 1783584
12 (response* or prepare* or disaster* or emergenc* or securit* or outbreak* or infection* or pandemic* or epidemic* or transmi*).mp. 7359359
13 10 and 11 13243
14 12 and 13 8372
15 limit 14 to dt=20230301-20240103 849
16 limit 15 to english language 829

Database: Embase (OVID) 1974-2024

Embase <1988 to 2024 Week 01>
1 ((care or “care home*” or facility or facilities or residen* or residenc* or communit* or housing or home) adj3 (“senior citizen” or “senior citizens” or “assisted living” or longterm or long-term or “special needs” or convalescent or disabil* or disabl* or retirement or rest or “residential care” or aged or “extended care” or “old age” or old people* or charitable or elder* or “continuing care” or “life care” or “skilled nursing”)).ti,ab. 129553
2 care home resident*.mp. 1030
3 assisted living facility/ 3288
4 home for the aged/ 8833
5 residential home/ 7025
6 nursing home/ 54880
7 ((day care or daycare*) adj2 (senior* or adult)).mp. 661
8 (congregat* adj2 (care or “meal service” or “meal program”)).mp. 130
9 or/1-8 175689
10 (“public health” or epidemic* or Influenza* or RSV or flu or H1NI or H3N2 or Middle East Respiratory Syndrome or MERS or Pneumonia* or Coronavirus* or COVID* or SARS-Cov-2 or SARS or Tuberculos* or TB or Streptococcus* or Legionella* or (respiratory adj3 (infection* or illness* or disease*))).mp. 2277012
11 (response* or prepare* or disaster* or emergenc* or securit* or outbreak* or infection* or pandemic* or epidemic* or transmi*).mp. 9044692
12 9 and 10 21869
13 11 and 12 13728
14 limit 13 to dc=20230301-20240103 1712
15 limit 14 to english language 1664
16 limit 15 to “remove medline records” 608

Database: ClinicalTrials.org

Condition or Disease: respiratory disease OR respiratory illness OR respiratory infection OR Covid 19

Other Terms: (long term care facility OR nursing home OR senior housing OR congregate care OR skilled nursing) AND (response* OR prepare* OR transmission OR infection)

Database: Cochrane Library

#1 ((care or “care home” OR “care homes” or facility or facilities or residen* or residenc* or communit* or housing or home) NEAR/3 (“senior citizen” or “senior citizens” or “assisted living” or longterm or “long-term” or “special needs” or convalescent or disabil* or disabl* or retirement or rest or “residential care” or aged or “extended care” or “old age” or old people* or charitable or elder* or “continuing care” or “life care” or “skilled nursing”)):ti,ab 14464
#2 “care home resident” OR “care home residents” 197
#3 MeSH descriptor: [Assisted Living Facilities] this term only 76
#4 MeSH descriptor: [Homes for the Aged] this term only 742
#5 MeSH descriptor: [Nursing Homes] this term only 1733
#6 MeSH descriptor: [Residential Facilities] this term only 198
#7 ((day care OR daycare*) NEAR/2 (senior* OR adult)) 2702
#8 (congregat* NEAR/2 (care OR “meal service” OR “meal program”)) 6
#9 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 18183
#10 (“public health” or epidemic* or Influenza* or RSV or flu or H1NI or H3N2 or “Middle East Respiratory Syndrome” or MERS or Pneumonia* or Coronavirus* or COVID* or SARS-Cov-2 or SARS or Tuberculos* or TB or Streptococcus* or Legionella* or (respiratory NEAR/3 (infection* or illness* or disease*))) 130917
#11 (response* or prepare* or disaster* or emergenc* or securit* or outbreak* or infection* or pandemic* or epidemic* or transmi*) 505469
#12 #9 AND #10 AND #11 with Cochrane Library publication date Between Mar 2023 and Jan 2024 121

Database: CINAHL (EbscoHost)

S1 MH “Day Care”) OR (MH “Nursing Homes”) OR (MH “Assisted Living”) OR (MH “Residential Facilities”)
S2 TI ( ((care OR “care home*” or facility or facilities or residen* or residenc* or communit* or housing or home) N3 (“senior citizen” or “senior citizens” or “assisted living” or longterm or long-term or “special needs” or convalescent or disabil* or disabl* or retirement or rest or “residential care” or aged or “extended care” or “old age” or old people* or charitable or elder or “continuing care” or “life care” OR “skilled nursing”)) ) OR AB ( ((care OR “care home*” or facility or facilities or residen* or residenc* or communit* or housing or home) N3 (“senior citizen” or “senior citizens” or “assisted living” or longterm or long-term or “special needs” or convalescent or disabil* or disabl* or retirement or rest or “residential care” or aged or “extended care” or “old age” or old people* or charitable or elder or “continuing care” or “life care” OR “skilled nursing”)) )
S3 TX “care home resident” OR “care home residents”
S4 ((day care OR daycare*) N/2 (senior* OR adult))
S5 (congregat* N/2 (care OR “meal service” OR “meal program”))
S6 S1 OR S2 OR S3 OR S4 OR S5
S7 (“public health” or epidemic* or Influenza* or RSV or flu or H1NI or H3N2 or “Middle East Respiratory Syndrome” or MERS or Pneumonia* or Coronavirus* or COVID* or “SARS-Cov-2” or SARS or Tuberculos* or TB or Streptococcus* or Legionella* or (respiratory N3 (infection* or illness* or disease*)))
S8 S6 AND S7
S9 (response* or prepare* or disaster* or emergenc* or securit* or outbreak* or infection* or pandemic* or epidemic* or transmi*)
S11 S8 AND S9
Limiters – Publication Date: 20230301-20240131
English Language

WHO COVID Database

(ti:(“retirement homes” OR “retirement home” OR “congregate care” OR “congregated meal plan” OR “congregated meal program” OR “long-term care facility” OR “long-term care facilities” OR “long-term care residences” OR “long-term care residence” OR “nursing home” OR “nursing homes” OR “rest home” OR “rest homes” OR “extended care homes” OR disable* OR disabili* OR “extended care facilities” OR “assisted living” OR “residential care” OR “old age home” OR “old age homes” OR “homes for the aged” OR “life care facilities” OR “adult day care” OR “senior day care” OR “old age residences” OR “retirement residences” OR “retirement residencies” OR “elder care” OR “continuing care retirement community” OR “charitable home” OR “charitable homes” OR “skilled nursing” OR “care home” )) OR (ab:(“retirement homes” OR “retirement home” OR “congregate care” OR “congregated meal plan” OR “congregated meal program” OR “long-term care facility” OR “long-term care facilities” OR “long-term care residences” OR “long-term care residence” OR “nursing home” OR “nursing homes” OR “rest home” OR “rest homes” OR “extended care homes” OR disable* OR disabili* OR “extended care facilities” OR “assisted living” OR “residential care” OR “old age home” OR “old age homes” OR “homes for the aged” OR “life care facilities” OR “adult day care” OR “senior day care” OR “old age residences” OR “retirement residences” OR “retirement residencies” OR “elder care” OR “continuing care retirement community” OR “charitable home” OR “charitable homes” OR “skilled nursing” OR “care home” )) AND (response* OR prepare* OR disaster* OR emergenc* OR securit* OR outbreak* OR transmission OR infection* OR pandemic*) AND la:(“en”) AND year_cluster:(“2023”) AND (year_cluster:[2023 TO 2024])

Scopus

( TITLE-ABS ( ( care OR “care home” OR facility OR facilities OR residen* OR residenc* OR communit* OR housing OR home ) W/3 ( “senior citizen” OR “senior citizens” OR “assisted living” OR longterm OR “long-term” OR “special needs” OR convalescent OR disabil* OR disabl* OR retirement OR rest OR “residential care” OR aged OR “extended care” OR “old age” OR “old people” OR charitable OR elder* OR “continuing care” OR “life care” OR “skilled nursing” ) ) OR INDEXTERMS ( “assisted living facilities” ) OR INDEXTERMS ( “homes for the aged” ) OR INDEXTERMS ( “residential facilities” ) OR INDEXTERMS ( “nursing homes” ) OR TITLE-ABS-KEY ( ( “day care” OR daycare ) W/2 ( senior OR adult ) ) OR TITLE-ABS-KEY ( congregat* W/2 ( care OR “meal service” OR “meal program” ) ) ) AND ( TITLE-ABS-KEY ( “public health” OR epidemic* OR influenza* OR rsv OR flu OR h1ni OR h3n2 OR “Middle East Respiratory Syndrome” OR mers OR pneumonia* OR coronavirus* OR covid* OR sars-cov-2 OR sars OR tuberculos* OR tb OR streptococcus* OR legionella* OR ( respiratory W/3 ( infection* OR illness* OR disease* ) ) ) ) AND ( TITLE-ABS-KEY ( response* OR prepare* OR disaster* OR emergenc* OR securit* OR outbreak* OR infection* OR pandemic* OR epidemic* OR transmi* ) ) AND PUBYEAR = 2023 AND PUBYEAR = 2023 AND ( LIMIT-TO ( LANGUAGE , “English” ) )

Centers for Disease Control and Prevention. (2024b) Preventing respiratory viruses. Retrieved from Preventing Respiratory Viruses | Respiratory Illnesses | CDC. Accessed 5/20/2024.

Harris-Kojetin L, Sengupta M, Lendon JP, et al. Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital and Health Statistics 2019;3(43).

Kaiser Family Foundation. (2022) Over 200,000 residents and staff in long-term care facilities have died from COVID-19. Retrieved from Over 200,000 Residents and Staff in Long-Term Care Facilities Have Died From COVID-19 | KFF. Accessed 5/16/2024.

NIH National Institute on Aging. (2023) Long-term care facilities: assisted living, nursing homes, and other residential care. Retrieved from https://www.nia.nih.gov/health/assisted-living-and-nursing-homes/long-term-care-facilities-assisted-living-nursing-homes. Accessed 5/16/2024.

Qualls N, Levitt A, Kanade N, et al. Community mitigation guidelines to prevent pandemic Influenza — United States, 2017. MMWR Recommendations and Reports 2017;66(No. RR-1):1–34. DOI: http://dx.doi.org/10.15585/mmwr.rr6601a1.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

Strategies to alleviate potential harms associated with NPI implementation in LTC communities:

• Digital technology (e.g., video chats with family and friends) may help reduce social isolation of residents when visitor restriction or physical distancing were implemented (Colas 2022).
• Small group activities may improve residents’ health, with physical activity to reduce their functional decline, and arts activities and other group programming may help enhance residents’ social engagement (Bethell 2021, Resnick 2021).
• Regular updates to family caregivers may help mitigate anxiety. Keeping family members and caregivers informed about their loved ones as well as the need for and use of NPIs may help reduce their anxiety (Gallant 2022).

Strategies to ensure timely and clear communication between LTC communities and public health agencies:

• Effective and regular communication between LTC communities and public health agencies may help to reduce viral transmission and enhance emergency preparedness and outbreak response (Dawson 2021, Jones 2022, Oldfield 2021).
• Virtual or “just-in-time” education programs for LTC staff may provide rapid and real-time dissemination of NPI best practices (Lingum 2021).

Strategies to support LTC community workforce:

• Foster supportive community among LTC community workforce to build morale (Navarro-Prados 2022).
• Provide evidence-based mental health support for staff members (Fisher 2021, Hugelius 2021).
• Consider having a contingency staffing plan to better manage workloads during any emergency response, especially with the need to incorporate additional NPIs into already busy daily routine (Dawson 2021).
• Recognize the challenges facing the LTC workforce that’s racially diverse and primarily female. Develop strategies to address issues such as lower pay, the need to hold multiple jobs, and lack of jobs offering paid sick leave, creating barriers to staying home when sick and increasing the risk of infection for themselves and the LTC residents (Dawson 2021, High 2007, Kobayashi 2016, Van Houtven 2020).

CDC: Viral Respiratory Pathogens Toolkit for Nursing Homes

• Provides strategies to help prepare for and respond to nursing home residents or healthcare personnel who develop signs or symptoms of a respiratory viral infection.
• Links out to other resources for more information on specific respiratory viruses and outbreak resources.

AHRQ: A Unit Guide to Infection Prevention for Long-Term Care Staff [PDF – 3.0 MB]

• Provides an overview of infections and infection prevention in LTC communities, a review of standard precautions and ways to implement transmission-based precautions, with a focus on influenza.

American Health Care Association and National Center for Assisted Living: Long-term Care Quick Start Guide: Preparing for Respiratory Virus Season [PDF – 127 KB]

• Links out to guidance and recommendations for prevention and management, including the CDC Toolkit.
• Includes posters for masking and hand hygiene that can be posted in LTC communities as quick aids.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the rate of hospital admissions for pneumonia among older adults — OA 06