Nursing home residents and their families have endured tragic losses from the COVID-19 pandemic. Thankfully, we have learned much about the indoor transmission of SARS-CoV-2, allowing us to take actions to protect the vulnerable elderly population and their caregivers from illnesses that are worsened by suboptimal indoor air quality (IAQ).
The rapid spread of COVID-19 in nursing homes underscored the need to understand the role of the indoor environment in the airborne transmission of infectious diseases.
COVID-19 highlighted the need to make the relationship between building design and operations, and occupant health, visible and actionable. This understanding will benefit all humans who use buildings for work or shelter.
Relationships Between IAQ And Specific Medical Conditions in the 65+ Population
Large studies in U.S. and European nursing homes have found that exposure to elevated concentrations of fine indoor particulate matter (PM2.5) and nitrogen dioxide (NO2) are associated with shortness of breath, coughing, and wheezing. Other examples of the health impact of poor IAQ include:
Elevated indoor NO2, formaldehyde, and PM2.5 concentrations are associated with poor lung function and chronic obstructive pulmonary disease
Allergic rhinitis is associated with high indoor concentrations of PM2.5
Volatile organic compounds and PM2.5 increase pulmonary infections and inflammation, and high PM2.5 concentrations are associated with increased blood pressure
A surprising and very concerning find was that these associations between poor IAQ and illnesses were found in nursing homes where building management complied with national guidelines. One study revealed that 81% of nursing homes had indoor carbon dioxide levels that exceeded ASHRAE upper limits, yet ventilation rates were considered acceptible by local guidelines.
Invisible Indoor Air Pollution In Nursing Homes Contributes To Rising Costs
A less visible consequence of exposure to indoor air pollutants (even at low concentrations) is their role in causing sudden deteriorations in resident health, which may necessitate transfers to emergency departments for evaluation, treatment, and occasionally inpatient admission. Transfers for acute care are costly and frightening for both patients and family members. Furthermore, if residents are admitted to the hospital for longer care, they risk harm from adverse events such as healthcare-associated infections.
When residents are hospitalized, Medicare, Medicaid, and private insurers withhold or reduce payment to nursing homes for “empty bed days”. The reimbursement rates for these “bed-hold” days vary by state, ranging from no reimbursement at all to partial reimbursement, but almost all states limit the number of days covered and reduce the payment amounts to 30% to 75% of their Medicaid per diem rate. Clearly, empty bed days due to hospitalization of residents creates financial hardships on nursing homes across the US.
Key Strategies To Optimize Indoor Environmental Quality (IEQ) In Senior Facilities
Optimizing nursing home IAQ can improve the health of residents and staff, thereby creating greater profitability for the facility in the following ways:
Decrease resident transfers to acute care hospitals for evaluation and treatment
Reduce early patient deaths
Avoid room rearrangements to accommodate patients with infections
Avoid empty beds
Reduce staff turnover by reducing employee illnesses as well as stress from sick and dying residents
Increase resident satisfaction and occupancy by demonstrating to families a comprehensive approach to caring for their loved ones
Building4Health: Advanced Monitoring and IAQ Management through a Medical Lens
Building4Health, an advanced IAQ system based on medical and scientific research, was developed by a physician with more than 20 years of clinical experience. Our comprehensive system and patented technology, B4H Vital Signs™ evaluates the impact of IAQ on all building occupants, including the most vulnerable populations.
B4H is a commercial-grade system that is uniquely designed to address the needs of all occupied buildings, including nursing homes, senior living communities, healthcare facilities, schools, and offices
We Need Health-Forward IAQ Solutions: The Time is Now
Now is the time to broadly implement monitoring solutions that reveal environmental conditions that positively or negatively impact occupant health. This visibility creates a data-based “test-before-you-invest” avenue for proactive remediation to safeguard the health of nursing home residents and staff and mitigate lost revenue from avoidable acute care transfers and hospitalizations.
Pulling back the curtain to reveal the connection between the indoor environment and human health is undeniably a “win-win” endeavor.
Learn more about our Building4Health Solution.
Note: This article was adapted from the original feature article published in Engineered Systems, entitled “The Benefits of Optimizing Nursing Home Indoor Environments for the Health of Residents”, September 5, 2021, by Stephanie Taylor, MD.
Sources:
Bentayeb, M. Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe. Eur Respir J 2015; 45: 1228-1238.
Ailshire, J. Fine particulate matter air pollution and cognitive function around older US adults. Am J Epidemiol. 2014;180(4):359–366.