In the latest episode of Long Covid, MD, I speak with Dr. Jean Storm, a specialist in long-term care medicine and medical director of Quality Insights, a healthcare quality improvement organization. We talk about the hidden burden of long COVID in facilities like nursing homes. While the early pandemic made headlines for its devastating impact on these facilities, the long-term consequences for survivors—especially those with chronic conditions and cognitive impairments—have received little attention. As a internal medicine physician who worked in nursing homes during the height of the pandemic, Dr Storm is witness to the vulnerability of this population and is continuing to champion them as a quality improvement expert. In our conversation, Dr Storm explains why nursing homes are so vulnerable to infection, how to tell if a long-term care resident has long COVID, and ways to protect this demographic from COVID-19 in the first place.Subscribe
The Perfect Storm for Infection and Long COVID
Long-term care facilities house some of the most medically complex and vulnerable individuals—older adults with multiple chronic illnesses, frailty, mobility impairments, and cognitive decline. Many residents require assistance with daily activities, and a significant portion live with dementia, making infection control a constant challenge. As Dr. Storm explains, preventing the spread of COVID-19 among residents with cognitive impairment is nearly impossible. These individuals may not understand or remember safety measures like mask-wearing or isolation protocols, leading to repeated exposures.
Because severe COVID infection increases the risk of long COVID, this population faces a particularly high burden of post-viral complications. Yet, as Dr. Storm points out, research on Long COVID in long-term care remains scarce, and many facilities are not even aware that their residents could be experiencing long-term effects. Symptoms such as fatigue, shortness of breath, cognitive decline, and increased frailty often go unnoticed or are misattributed to aging or dementia rather than post-viral dysfunction.
The Cascade Effect of Illness and the Dangers of Overmedication
A key takeaway from our conversation is the cascade effect that occurs once an infection starts. A frail nursing home resident who develops COVID may experience a decline in appetite, leading to weight loss and muscle wasting (sarcopenia). This weakness increases the risk of falls, which in turn can lead to fractures, hospitalization, or further immobility. For those with dementia, even a mild illness can accelerate cognitive decline, making it difficult for them to return to their prior level of functioning.
Compounding this problem is polypharmacy, or the excessive prescribing of medications, which is already a widespread issue in long-term care. During the pandemic, there was a documented increase in prescriptions for antipsychotics, opioids, and other psychiatric medications—often as a response to agitation, depression, or behavioral changes in residents. But as Dr. Storm emphasizes, these medications come with their own risks, including increased confusion, fall risk, and drug interactions that can worsen overall health. In many cases, non-pharmacologic interventions like music therapy, creative activities, and structured rehabilitation may be far more beneficial than additional prescriptions.
The Increased Risk with Higher Levels of Care
One of the most important points Dr. Storm makes is that every escalation in medical care—whether it’s moving from a nursing home to a hospital, an ICU, or a ventilator—significantly increases morbidity and mortality. Studies show that nursing home residents who are hospitalized experience worse health outcomes and shorter life expectancy. Hospital stays are disruptive, often causing delirium in those with cognitive impairment and increasing the likelihood of functional decline.
For this reason, Dr. Storm urges clinicians and families to carefully consider whether hospitalization is truly beneficial. In many cases, residents may receive better overall care and have better outcomes if treated within the nursing home rather than being transferred to the hospital, where they are at risk for further complications.
The Role of Vaccination in Prevention
Prevention remains the best defense against severe illness and long COVID. Dr. Storm is clear: vaccination is a crucial tool for protecting long-term care residents. While vaccines may not prevent all infections, they significantly reduce the severity of illness, lowering the risk of hospitalization, ICU admission, and death. Given that severe COVID is a major risk factor for long COVID, keeping infections as mild as possible is key to reducing long-term complications.
Despite vaccine hesitancy, particularly in recent years, Dr. Storm underscores that nursing home residents benefit tremendously from COVID and flu vaccinations. These vaccines are not just about individual protection but also about reducing outbreaks in a setting where infections spread rapidly and have devastating consequences.
How Families Can Advocate for Their Loved Ones
Families play a crucial role in ensuring their loved ones receive appropriate care. Dr. Storm offers several actionable strategies for advocacy:
- Track Changes in Function – Families should monitor declines in activities of daily living (ADLs) such as dressing, eating, mobility, and cognition. Tools like the Barthel Index can help quantify these changes, providing concrete evidence when discussing care with staff.
- Request Regular Interdisciplinary Care Meetings – Nursing homes have leadership teams that include the medical director, director of nursing, and nursing home administrator. Families should schedule regular meetings to discuss their loved one’s condition, treatment plans, and any concerns.
- Advocate for Rehabilitation Services – Physical and occupational therapy can help residents regain strength and independence after illness. Studies show that facilities with more therapy hours have lower rates of emergency room visits and hospitalizations.
- Ensure Personalized Care – Instead of relying solely on medications for behavioral or psychiatric symptoms, families should encourage non-drug interventions such as music therapy, social activities, and structured routines.
- Push for Infection Control and Vaccination – Ensuring that staff follow strict infection control protocols and that residents receive recommended vaccines can significantly reduce the risk of severe illness and Long COVID.
A Call to Action
Dr. Storm’s insights reveal an urgent need to recognize and address long COVID in long-term care. As she points out, nursing home residents are often forgotten, but their care—or lack thereof—affects not just individual lives but the healthcare system as a whole. The vulnerabilities of this population demand greater awareness, more research, and a shift toward proactive, rather than reactive, care.
Listen to the full conversation for a deeper look into the intersection of aging, post-viral illness, and the ongoing challenges facing long-term care facilities, and hear more from Dr Storm about ongoing challenges to healthcare quality in her podcast “Taking Healthcare By Storm.”
Wishing you well, as always. Share your thoughts in the comments below.
Links
Dr Storm’s Podcast: Taking Healthcare by Storm
Function Calculator: Barthel Index for Activities of Daily Living
Resources for COVID-19 treatment, surveillance, and vaccinations in the long-term care population: New York Medical Directors Associateion COVID-19 Resource Project
Articles
Prevalence and Predictors of Persistence of COVID-19 Symptoms in Older Adults: A Single-Center Study