AUSTIN (KXAN) — Experts from the Design Institute for Health are working to redesign the nursing home system to protect residents and staff. They presented their second round of findings on the nursing home system to Austin City Council on Tuesday.

Stacey Chang, Executive Director of the institute, leads a partnership between the Dell Medical School and the College of Fine Arts at The University of Texas at Austin, which has been looking at the systemic problems contributing to the spread of the virus in nursing homes, assisted living centers, and other long-term care facilities.

In addition to identifying several broad issues to address, Chang’s presentation highlighted systemic inequality both in access to, and care at, nursing homes and assisted living facilities in Austin.

He told council they’ve now identified a few opportunities for “real change” at these facilities.

“Some of them are straightforward to implement: changes to communication, protocols, minor changes to space. Some are much more complex to implement: care models, organizational change, policy and system dynamics,” Chang explained.

“Importantly, none of them come for free,” Chang said, as affordability and funding were key factors in their findings.

What did they find?

In phase two of the study, researchers identified five main “strategic opportunities” for improvements:

  • Infection Control
  • Staff Well-being
  • Expansion & Evolution of Staff Roles
  • Staff Retention and Incentives
  • Resident Well-being

For example, they found that fostering a deeper understanding of the “why” behind infection control rules and protocols could be beneficial for facility staff. They suggested creating training materials in languages other than English or utilizing training video recordings to enhance staff comprehension.

When it comes to infection control protocols, Chang noted, “it’s mostly a one-way street, and facilities are just recipients of the information.”

They believe there is an opportunity to create a common platform that could be accessed by everyone: officials setting the guidelines and facilities acting on them.

Many of the opportunities for improvement they identified centered around the well-being of staff in these facilities.

“They are very much fending for themselves,” Chang said.

They suggested support groups, childcare options and partnerships with hotels or restaurants where staff could be housed temporarily and get local meals delivered.

Inequality in Austin

Chang noted a clear distinction in nursing home locations and access to care.

“It doesn’t take a rocket scientist to see the disparities in the quality of the care and the quality of experience and really the difference between, essentially, the haves and have nots,” Chang said.

In mapping local senior facilities, researchers noted there are 70 assisted living facilities and 32 nursing homes in Travis County, but 90% of the long-term care facilities in Austin are located west of Interstate-35.

Chang broke the area’s senior facilities into three main types: nursing, assisted living and independent living.

“Assisted living and independent living facilities are primarily private pay, which means they generally have more revenue and more freedom in how they utilize that revenue, which translates really, frankly, to a higher quality of experience for both residents and staff,” he said. “By contrast, most nursing facilities serve poor patients who depend on Medicaid for funding. That reimbursement provides much less than private pay, meaning that these facilities have less to work with and less to offer. This discrepancy is an inequity directly tied to wealth.”

Not everyone has equal access to quality care, Chang said. “This may be somewhat obvious, but it’s important to call out.”

City Council Member Ann Kitchen brought the resolution in May that prompted the study. She echoed Chang’s assessment, saying Austin has a lack of affordable senior facilities and geographical inequality.

“What you see is the lower income folks end up in nursing homes, which offer the lowest level of pay for staff and also the lowest levels of amenities,” Kitchen said.

What do families say?

Also in Phase Two, researchers also interviewed 85 different family members whose loved ones live in these facilities about their experience during the pandemic.

The primary concern families expressed were about their loved ones’ conditions declining due to isolation. The study’s researchers also report “there isn’t a one-size fits all for visitation.”

Throughout this phase of the study, visitors were either totally banned or highly restricted at facilities.

Study results on visitation
(Graph from Phase Two report of the Design Institute Nursing Home System Study)

As of the end of September, the state expanded visitation guidelines at these homes, allowing for some indoor visits with plexiglass dividers and certain, designated family members to have physical contact with their loved ones.