Hepatitis in Assisted Living Facilities
Americans are living longer than ever before in our history. As the population ages, an increasing number of elderly people are choosing to reside in assisted living facilities. While these complexes have much to offer senior citizens, there is a concern regarding hepatitis transmission that residents and assisted living facility employees should be aware of.
About Assisted Living Facilities
Assisted living is a residential option for seniors who want or need help with some of the activities of daily living, but don’t need the 24-hour medical care and supervision of a nursing home. People typically chose an assisted living facility when they need more personal care services than you can get at home or an independent living retirement community – like cooking meals, getting to the bathroom in the middle of the night, house cleaning and maintenance and traveling to appointments. Some of the advantages of assisted living facilities include:
- Safety and security
- Easy access to support and care
- Encouragement of privacy and independence
- Environment conducive to socializing
- Help managing medications (in some states)
Health Care in an Assisted Living Facility
Although they don’t have extensive medical capabilities, assisted living complexes typically have staff members who assist with residents’ basic health needs. Each state has its own specific licensing requirements for these facilities, so those concerned with health care are urged to investigate what services are provided in their state. When it comes to hepatitis, this is especially important. Those with chronic Hepatitis B and Hepatitis C may not require intensive medical treatment, but there is concern about preventing viral hepatitis transmission amongst residents.
Hepatitis transmission in assisted living facilities received nationwide publicity in 2010 when an outbreak of Hepatitis B in a North Carolina assisted living home was discovered. State and national experts predicted that the lenient legislation for assisted living staff will increase the commonality of this misfortune.
Due to the reuse of glucometers and other devices, unsafe diabetes care led to six fatal cases of Hepatitis B at Glen Care Mount Olive (a North Carolina assisted living center). Under state and federal law, only highly trained professionals such as registered and licensed practical nurses can administer insulin at nursing homes. However, the state-overseen assisted living residences have much looser guidelines. At these facilities, “med techs,” who are unlicensed and may only get one-on-one training from a nurse on diabetes care, are allowed to take blood glucose samples and inject insulin for people with diabetes.
Polly Johnson, former executive director of the state Board of Nursing and now CEO of the nonprofit Foundation for Nursing Excellence describes this problem as a disconnection. According to Johnson, “Part of that disconnect is related to the way assisted living was set up – not as a health-focused system.”
The Bigger Issue
Along with our aging population, there is no shortage of people with a strain of viral hepatitis in their blood. Experts estimate that approximately 1 in 60 Americans have been infected with Hepatitis C and as many as 1 in 20 have been infected with Hepatitis B at some point in their lives. Although treatments for these two types of chronic viral hepatitis are improving every year, not everyone is a candidate for treatment – and for those who are – many don’t respond to treatment.
Thankfully, following universal precautions can prevent transmitting Hepatitis B and Hepatitis C. Regrettably, too many “med techs” or other staff members at assisted living facilities are not taught and/or do not follow universal precautions – a practice designed to prevent the transmission of infectious diseases. Regardless of the source, universal precautions instruct us to treat all of the following as if they are infectious: blood, tissues, semen and vaginal secretions and the following body fluids (cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic). Barrier protection and proper disposal and cleaning methods are to be used when handling contaminated materials or surfaces. By assuming that each person is infectious, reuse of any type of equipment coming into contact with body fluids on another person is strictly forbidden.
Since coming into the public eye, many states have developed more stringent guidelines to ensure that universal precautions are mandated in assisted living facilities. Assisted living facilities are often viewed as the best of both worlds for the elderly, having some independence while also receiving assistance for daily activities. Most are superb institutions, as long as the management is stringent with its infection control policies. Since a sizeable proportion of their residents are likely to have Hepatitis B or Hepatitis C, double-checking for adherence to universal precautions is a must for preventing the spread of these illnesses within the walls of assisted living facilities.
http://helpguide.org/elder/assisted_living_facilities.htm, Assisted Living Facilities, Joanna Saisan, MSW, et al, Retrieved August 28, 2011, helpguide.org, 2011.
http://www.assistedlivinginfo.com/Assisted-Living-Care/What-is-Assisted-Living, What is Assisted Living?, Retrieved August 28, 2011, SeniorLiving.net, 2011.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6006a5.htm, Notes from the Field: Deaths from Acute Hepatitis B Virus Infection Associated with Assisted Blood Glucose Monitoring in an Assisted-Living Facility, Retrieved August 28, 2011, Centers for Disease Control and Prevention, 2011.
http://www.natap.org/2010/newsUpdates/123010_06.htm, Diabetes care raises alarm: Deadly hepatitis outbreak at an assisted-living home throws harsh light on training, state’s rules, Thomas Goldsmith, Retrieved August 28, 2011, natap.org, 2011.
http://www.ccld.ca.gov/res/pdf/10rcfe02.pdf, Evaluator Manual Transmittal Sheet, Retrieved August 28, 2011, State of California Health and Human Services Agency, 2011.
http://www.cdphe.state.co.us/dc/hepatitis/BeHiptoHep.pdf, Be Hip to Hep – Hepatitis Update for Assisted Living Facilities, Retrieved August 28, 2011, Colorado Department of Public Health and Environment, 2011.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/HCV%20and%20Aging_09.pdf, Aging & Hepatitis C, Lucinda K. Porter, RN, Retrieved August 28, 2011, Hepatitis C Support Project, 2011.
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