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Journal of the American Medical Directors Association

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COVID-19 (Disease), Medical policy -- United States, Congregate housing, Long-term care of the sick, Physician services utilization


At the end of 2019, international attention was drawn to an outbreak of zoonotic coronavirus SARS-CoV-2, formally named COVID-19, in Wuhan, China. The World Health Organization officially declared the outbreak a global pandemic on March 11, 2020, with the United States recording >1600 confirmed and presumptive travel-related and community-acquired cases at that time. As of April 10, 2020, all 50 US states and the District of Columbia, have reported cases, with the total number of US cases now totaling >400,000.2 Seattle, WA, is the US epicenter, with nursing facilities experiencing the greatest number of fatalities. Because of the communal living environments of long-term care settings, as well as the majority resident population aged 65 years and older with underlying health conditions, long-term care settings are at a high risk of sustained COVID-19 transmission.3 Nursing homes have federally regulated infection prevention and control guidelines and are surveyed annually for regulatory adherence. However, states have primary responsibility for licensing and oversight of residential care/assisted living (RC/AL) communities, a setting where 82.4% of residents are aged 75 years. It remains unclear if and how states require RC/AL communities to mitigate, prepare, and respond to infection among their residents, a group particularly vulnerable to the effects of the current COVID-19 pandemic.


© 2020 by the authors. Licensee: Elsevier. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (



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