Variations in State Essential Caregiver Programs for Nursing Homes During the COVID-19 Pandemic

Area of Science:

• Public Health Policy
• Geriatric Care
• Infectious Disease Epidemiology

Background:

• During the COVID-19 pandemic (2020-21), essential caregiver (EC) programs were implemented in nursing homes to facilitate in-person support for residents.
• These state-level programs aimed to balance resident well-being with infection control measures during a critical public health crisis.

Purpose of the Study:

• To comparatively analyze the designs of state-established essential caregiver programs for nursing home residents.
• To evaluate differences in COVID-19 outcomes, staffing, and social distancing policies between states with and without EC programs.

Main Methods:

• Conducted online searches for federal and state nursing home visitation and reopening guidelines (2020-2022).
• Compared COVID-19 infection/death rates, nursing home staff shortages, and social distancing restrictiveness between states with and without EC programs.
• Summarized key characteristics of state EC programs.

Main Results:

• Twenty states implemented EC programs; these states showed slightly higher COVID-19 infection rates but slightly lower death rates compared to states without programs.
• Staffing shortage rates were similar, and states with EC programs had less restrictive social distancing policies.
• State EC programs were less restrictive than CMS guidelines, allowing visits under various conditions (e.g., high positivity rates, unvaccinated residents, outbreaks), but could still restrict visits during resident-specific precautions.

Conclusions:

• Nursing home EC programs did not substantially impact COVID-19 infection/death rates or staffing shortages, though they eased social distancing restrictions.
• Significant variation exists in the design and implementation of state EC programs.
• Further comparative evaluations are necessary to determine the effectiveness of different EC program designs.