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Protecting Vulnerable Residents From Coronavirus – LTCCC News Alert


March 3, 2020 — Concern over coronavirus is growing as a significant outbreak in the United States becomes increasingly likely. According to researchers, residents in nursing homes and other adult care facilities are particularly vulnerable to coronavirus due to their age, pre-existing medical conditions, and frequent exposure to facility staff, other residents, and visitors to their facility. In fact, the first sizeable outbreak in the U.S. took place in a nursing home.


  • It is essential that all residential care facilities, whether they are a nursing home or another type of congregate setting, such as assisted living, take concrete steps now to protect both residents and staff. The U.S. Centers for Disease Control & Prevention (CDC) and others recommend common sense protocols such as ensuring that staff wash their hands, and that frequently touched surfaces are cleaned and disinfected.
  • According to the CDC1 to 3 million serious infections occur every year in nursing home and assisted living facilities and as many as 388,000 residents die each year due to infections. How are facilities going to meet the challenge posed by the coronavirus if they cannot protect residents from common and well-known illnesses and infections?
  • Though infection prevention and control deficiencies are one of the most frequently cited health violations in nursing homes, inadequate enforcement of minimum safety standards and deregulation efforts under the Trump Administration have made American nursing home residents even more vulnerable. Federal studies and data indicate that nursing homes are rarely penalized despite the prevalence of substandard care, abuse, and neglect. As a result, too many facilities are inadequately staffed and provide substandard care with impunity every day. “Inadequate enforcement of federal nursing home standards is, unfortunately, commonplace, leaving nursing home residents vulnerable to sickness and death such as that which we have already seen in Washington state,” Richard Mollot, LTCCC’s Executive Director, stated.


  • Hygiene. Follow recommended protocols and make sure that caregivers and facility staff are too. This includes frequent hand washing; covering when you cough or sneeze (preferably with a tissue or upper arm); avoiding touching your eyes, nose, and mouth with unwashed hands; avoiding close contact with people who are sick. Surfaces in bedrooms, common areas, and on equipment should be regularly cleaned and sanitized.
  • Safety Protocols. What protocols does the facility have in place to (1) prevent and control infection and (2) ensure appropriate staffing, services, food, and medication if there is an outbreak in the facility or community? Are the protocols being implemented effectively?
  • Beware of Deregulation. The Trump Administration has taken considerable steps to reduce safety standards, including those relating to infection control and prevention. In addition, they have reduced penalties for substandard care, even when residents die or are harmed.
  • Past is Prologue. Check out your facility’s record for infection control and staffing. We have posted recent citations for nursing home infection control deficiencies here and nursing home staffing levels here Note: Since assisted living is not federally regulated there are no federal data for us to provide these reports. Individual state’s websites often provide some data, though this varies widely.
  • Good Care No Matter Where. Though the federal standards only apply to nursing homes, everyone – no matter where they live – has the right to live safely and expect that appropriate infection control and prevention safeguards will be implemented in their facility.


LTCCC believes that it is important for the public to understand that the distinctions between different types of residential care facilities are likely to have a profound impact on the extent to which residents are protected against the coronavirus. Nursing homes are licensed under federal law and must meet federal requirements. On the other hand, assisted living and other types of adult care facilities are licensed under individual state laws, with less comprehensive protections and, generally speaking, weaker monitoring and oversight. “The absence of any federal care standards for assisted living makes residents in those settings particularly vulnerable,” Mollot stated.

NURSING HOMES. The vast majority of nursing homes are licensed under federal law and subject to a range of care standards to protect residents and promote safety. Relevant standards in respect to protecting residents from infection include:

  1. Staffing. Nursing homes are required to have a registered nurse (RN) for at least one shift every day, including weekends. This is important because RNs are professional caregivers with the training and education to provide a clinical assessment of residents. Also important is that in order to provide any resident care in a nursing home, one must at least be a certified nurse aide (which requires a minimum of 75 hours of training and ongoing in-service education).
  2. Infection control & prevention. Nursing homes are required to have “an effective infection prevention and control program to mitigate the onset and spread of infections.” [See our new Fact Sheet: Infection Prevention & Control for information on federal requirements.]

ASSISTED LIVING AND OTHER ADULT CARE FACILITIES (ACFs). Though residents in ACFs are often as vulnerable as nursing home residents, they operate without any federal safety standards and state standards tend to be much more lax.

  1. Staffing. Most states do not have any registered nurse requirement or a requirement that care staff be certified nurse aides. The staff that provide services and monitoring to residents may have as little as 15 hours or so of training, with no ability whatsoever to assess a resident or provide clinical monitoring.
  2. Infection control & prevention. As noted above, ACFs are not subject to the federal requirements for infection control and prevention.

Long Term Care Community Coalition
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