Policy Decisionmaking in Long-Term Care
Oct 20, 2022
Decisionmaking Lessons from the COVID-19 Pandemic
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The coronavirus disease 2019 (COVID-19) pandemic made existing problems in long-term care (LTC) worse and introduced new challenges. Policies designed to minimize mortality and morbidity harmed residents' physical and mental health. The pandemic also highlighted that residents, families, and staff are rarely represented in institutional LTC policy decisionmaking. Responses to the pandemic across the LTC industry failed to account for what was important to residents. In other words, policies were not resident-centered.
Given these problems — and that the last major legislative action directed at LTC occurred more than three decades ago — change in LTC is overdue.
The National Imperative to Improve Nursing Home Quality, a 2022 report by the National Academies of Sciences, Engineering and Medicine, can provide a foundation for change. The recommendations in that report address LTC staffing and financing, among other issues. Participatory policy decisionmaking — decisionmaking that meaningfully involves residents, staff, and others — can expand the impact of those recommendations.
The COVID-19 pandemic can be a catalyst for establishing inclusive policy decisionmaking as the new cultural norm in LTC.
RAND researchers developed a blueprint for transforming the decisionmaking culture in long-term care and to avoid a recurrence of the substantial harm that the pandemic caused in these settings. They held one-on-one interviews with LTC residents, direct care staff, consumer advocates, facility administrators, LTC industry organizations, and clinicians and researchers working in LTC, along with a panel meeting with a range of LTC stakeholders, to understand how infection-control policy decisions were made and to explore how such decisionmaking could be improved. of perspectives that would be included in a participatory approach to infection control in LTC facilities. These stakeholders provided keys to transforming LTC.
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