Context: Social, demographic, and regional factors are known to be associated with nursing home quality-measures, including the use of risky drugs. Early data suggests stressors of the COVID-19 pandemic are further exaggerating existing quality variance between facilities.

Objective: Survey a regionally diverse sampling of Virginia long-stay clinicians regarding their facility’s response to the COVID pandemic with an emphasis on dementia care and outcomes, resource adequacy, barriers to care, and lessons learned.

Hypothesis: The perspectives of long-stay clinicians regarding nursing home responses to the COVID pandemic will vary based on the social, demographic, and regional factors of the community in which they practice.

Study Design: Survey. A purposive sampling of Virginia long-stay clinicians will be electronically surveyed regarding their perspectives on changes in dementia care resulting from the COVID-19 pandemic, with an emphasis on obstacles and barriers to care but also successes and lessons learned. Facility characteristics including location (urban vs rural), ownership (private vs public) and staffing resources as well as community characteristics including demographic composition and social determinants of health will extracted from CMS and Virginia Department of health Public Use Files.

Participants: Nursing-home clinicians recruited by a SurveyMonkey email campaign directed at the membership of partner professional organizations representing nurse practitioners, physician assistants, internists, family doctors, neurologists, and psychiatrists providing geriatric and nursing home care in Virginia. We anticipate a 5% response rate with a goal for 200 participants.

Survey content: Survey will include core, demographic, and open-ended components. Core questions will assess issues surrounding dementia care including changes in dementia management and outcomes over the pandemic.

Analysis: Structured data will be described with summary statistics. Open-ended data will be coded using open-ended analysis using template-based an emergent coding techniques to identify themes within the data. Univariate statistical tests will assess for variance between survey results and respondent community and facility factors.

Outcomes: Evaluation for variance in clinician surveys describing long-stay responses to the pandemic based on nursing home facility characteristics including resources, region, demographics, and community social factors.