Abstract
Objectives
Characterize the implementation, benefits, and challenges of an Essential Family Caregiver
(EFC) program, a novel policy implemented in long-term care (LTC) settings during
the COVID-19 pandemic in Indiana. Characterize LTC administrator perspectives on family/caregiver
involvement in the LTC setting.
Design
Semi-structured qualitative interviews.
Setting and Participants
Administrators from 4 Indiana LTC facilities.
Methods
In this qualitative study, a convenience sample of 4 LTC administrators was recruited.
Each participant completed 1 interview during January to May 2021. Following transcription,
a thematic analysis approach with 2 cycles of qualitative coding identified relevant
themes.
Results
Four LTC administrators participated, representing both urban and rural nonprofit
nursing homes. Participants spoke positively of the program despite implementation
challenges including perceived infection risk, policy interpretation, and logistical
challenges. The psychological impact of isolation for nursing home residents was emphasized
as a critical consideration alongside physical health concerns. LTC administrators
desired to support resident well-being while maintaining good standing with regulatory
agencies.
Conclusions and Implications
Based on a limited sample, Indiana's EFC policy was viewed favorably by LTC administrators
as a tool to balance resident and family psychosocial needs with infection-related
health risks. LTC administrators desired a collaborative approach from regulators
as they worked to implement a novel policy. Consistent with participant desire for
broader caregiver access to residents, more recent policymaking has reflected growing
recognition of the critical role of family members not only as companions but also
as care providers, even in a structured care environment.
Keywords
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References
- COVID-19 in nursing homes: Calming the perfect storm.J Am Geriatr Soc. 2020; 68: 2153-2162
- The impact of COVID-19 pandemic on long-term care facilities worldwide: An overview on international issues.BioMed Res Int. 2020; 2020: 8870249
- Center for Clinical Standards and Quality/Quality, Safety & Oversight Group Ref: QSO-20-14-NH UPDATE: 03/10/2021: Guidance for infection control and prevention of coronavirus disease 2019 (COVID-19) in nursing homes (REVISED). March 2020.https://www.cms.gov/files/document/qso-20-14-nh-revised.pdfDate accessed: April 25, 2022
- Facing dementia during the COVID-19 outbreak.J Am Geriatr Soc. 2020; 68: 1673-1676
- Evaluating perspectives of relatives of nursing home residents on the nursing home visiting restrictions during the COVID-19 crisis: A dutch cross-sectional survey study.J Am Med Dir Assoc. 2020; 21: 1746-1750.e3
- The difficult balance between ensuring the right of nursing home residents to communication and their safety.Int J Environ Res Public Health. 2021; 18: 1-11
- Finding the right balance: An evidence-informed guidance document to support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus disease 2019 pandemic.J Am Med Dir Assoc. 2020; 21: 1365
- Social isolation—the other COVID-19 threat in nursing homes.JAMA. 2020; 324: 619-620
- COVID-19 and the consequences of isolating the elderly.Lancet Public Heal. 2020; 5: e256
- Essential family caregivers in long-term care during the COVID-19 pandemic.J Am Med Dir Assoc. 2020; 21: 983
- Essential Caregiver Program aims to reunite families with loved ones in long-term care–being patient. Being patient.https://www.beingpatient.com/dementia-caregiver-program-reunite/Date accessed: December 9, 2022
- Essential Family Caregiver Program implementation toolkit.https://www.coronavirus.in.gov/files/EFC toolkit 6.28.21.pdfDate accessed: September 30, 2022
- Recommendations for welcoming back nursing home visitors during the COVID-19 pandemic: Results of a Delphi panel.J Am Med Dir Assoc. 2020; 21: 1759-1766
- #MoreThanAVisitor: Families as “essential” Care partners during COVID-19.Gerontol. 2021; 61: 145-151
- Allowing visitors back in the nursing home during the COVID-19 crisis: A Dutch National Study into first experiences and impact on well-being.J Am Med Dir Assoc. 2020; 21: 900-904
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101
- Immersion–Crystallization: A valuable analytic tool for healthcare research.Fam Pract. 2022; 39: 785-789
- Immersion/crystallization.in: Crabtree B.F. Miller W.L. Doing Qualitative Research. SAGE Publications, 1999: 179-194
- Nursing home visitation–COVID-19 (REVISED). Center for Clinical Standards and Quality/Survey & Certification Group, Ref: QSO-20-39-NH.https://covid.cdc.gov/covid-data-tracker/#county-viewDate accessed: May 23, 2022
- COVID-19 and long-term care: The essential role of family caregivers.Can Geriatr J. 2021; 24: 195-199
- Essential caregivers coalition community. Caregiver/support person bills by state.https://docs.google.com/spreadsheets/d/1IDAmPQPap7NTdyQXdddsMo4eloGHHJuyAomLZL-Xs-8/edit#gid=0Date accessed: May 23, 2022
- Time for an upgrade in the nursing home survey process: A position statement from the Society for Post-Acute and Long-Term Care Medicine.J Am Med Dir Assoc. 2020; 21: 1818-1820
Article info
Publication history
Published online: March 17, 2023
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
KU is the founder and chief medical officer of Probari, a health care start-up that provides clinical support services in nursing homes. The other authors declare no conflicts of interest.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.