Elderly person wearing mask

The Upper Midwest Nursing Home COVID-19 ECHO Collaborative Advances Preparedness, Safety and Infection Control During COVID-19

Jennifer Syltie Johnson


In March 2020, images from the Life Care Center of Kirkland, Washington nursing home were displayed to the world as the epicenter of the first COVID-19 outbreak in the United States. As the facility struggled to assess and contain the risks associated with a new coronavirus, citizens across the United States were shown firsthand the risks to long-term care facility residents.

When the CARES Act was signed into law on March 27, 2020, resources were dedicated to assistance for nursing homes to prevent and mitigate COVID-19. In response, Project ECHO—an initiative launched in 2003 by the University of New Mexico School of Medicine—sent out a request to participate and develop a national nursing home COVID-19 action network to provide nursing homes with practical, useful information, skills and resources to address the immediate challenges presented by the pandemic.

Through funding from the AHRQ, the Project ECHO network was designed to ensure training that is easily accessible for nursing home professionals with the goal of reducing the risk of spreading SARS-COV-2 infections.


One of the MN GWEP’s top goals is bringing together Minnesota’s best minds in geriatrics care and education. Teresa McCarthy, MD, MS, associate professor in the Department of Family Medicine and Community Health, is a geriatrician and co-investigator in the MN GWEP. When McCarthy learned about the national request for participation, she teamed up with Roberta Meyers, MD, MPH, faculty physician at Hennepin Healthcare and an assistant professor of medicine in the Medical School.


“We have an alignment between the University and Hennepin Healthcare and we wanted to collaborate,” said Meyers. “We knew we would be better working together, and we knew it would be better for the nursing home community to get this information out as efficiently and quickly as possible.”

For McCarthy, the collaborative was an opportunity to achieve more together than separately. “The University is extremely interested in supporting our local long-term care community and the nursing homes in our state,” she said. “This collaborative model was the most efficient and effective way to get this time-sensitive training out to these facilities.”


The team quickly developed The Upper Midwest Nursing Home COVID-19 ECHO Collaborative website and worked with the two nursing home trade associations in the state—Care Providers of Minnesota and LeadingAge Minnesota—to recruit nursing homes to participate.

By early October, the website was live and nursing home recruitment began in mid-October. A total of six cohorts of 33 nursing homes each were formed and the first training began in November with a majority of nursing homes in the state participating.

“Our aim was to train and support more than 200 nursing home teams on best practices for infectious disease prevention,” said McCarthy. Kari Everson, MS, director of clinical care & clinical consultant at LeadingAge Minnesota, served as the infectious disease prevention nurse instructor. Adam Suomala, executive director of the Minnesota Leadership Council on Aging, served as facilitator for the University’s cohort. Greg Leierwood, APRN, CNP served as the co-lead for the Hennepin Training Center. Deanna Bauer, MBA, provided project coordination.

In addition to the local leadership, AHRQ worked with IHI to assign a quality improvement specialist for each Project ECHO session. “As guidance from the CDC and MDH evolved during the pandemic, we really benefitted from these experts and their insight,” said McCarthy.

“We recognize these nursing homes have a wealth of practice knowledge, so by initiating conversations among peers we are able to have a rich discussion,” said Rajean Moone, PhD, faculty director of the long-term care administration program at CCAPS, who helped bring the collaboration to life. “We’ve had geriatricians, clinical nurses, quality improvement professionals, regulatory experts and more participate in the sessions.”

Along with the 16-week curriculum delivered virtually via Zoom, participating nursing homes have access to weekly office hours. During the office hours, nursing home staff tackle a particular topic such as vaccine distribution or other topics of importance. “We’ve had a diversity of nursing homes participating in the collaborative—from urban to rural, for-profits and non-profits, some part of a corporate chain to independent and family-owned and operated,” said Moone. “Sharing best practices has been incredibly powerful.”

The challenges of the participating nursing homes constantly evolved. During the second surge of COVID-19 beginning in November 2020, the pandemic hit another crisis level in nursing homes with two extremely challenging months. “The ECHO model is not didactic—it’s a sharing and discussion about knowledge and best practice using the ‘all teach, all learn’ real-time exchange of experiences and listening,” said Meyers. “During this time, nursing homes were also facing the challenges of grief with seeing so many people get sick in a concentrated time and also the social isolation that occurred when they had to prohibit visitation and lock down their facilities to prevent infections.”

The issues related to personal protective equipment were significant in the early weeks, and in nursing homes we still have challenges with access to N95 respirators, according to McCarthy. However, workforce issues continued to be the most significant challenge—one that continues today. As the weeks went on during the sessions and infection and rates of deaths in long-term care facilities went way down, the participation in the virtual sessions increased. “We want to make sure that the fundamental principles for managing these complex issues are solidified, so as an industry we continue to build a base of infection control best practices in long-term care,” McCarthy added.

At the start of the first session for the Upper Midwest Nursing Home COVID-19 ECHO Collaborative on November 9, 2020, the state reported a total of 2,600 deaths from COVID-19 with 1,800 of those as residents of skilled nursing facilities, assisted living facilities or group homes. At the end of the 16 weeks of the ECHO collaborative, in Minnesota, there had been 6,500 COVID-19 deaths with 4,000 of those from congregate living facilities. “We lost an additional 2,200 people in congregate settings during the 16 weeks we were holding our sessions. Participants in the ECHO shared their challenges while they provided care at the frontlines,” said Meyers.


For both institutions—the University and Hennepin Healthcare—this collaborative builds on past experiences with the ECHO model. The University had a Pediatric Dental ECHO, while Hennepin Healthcare used the model to help vulnerable populations, focusing on opioid and addiction care, Midwest tribal health, and viral hepatitis in Minnesota. “Because of the alignment that is already existing, we decided it was best if we worked together collaboratively to provide Project ECHO to nursing homes,” said Meyers. “People rose to the occasion to address the extreme challenges.”

McCarthy sees great potential in clinical academia supporting the long-term care community. “This has been a seismic move in relationship-building with the long-term care community,” she said. “We’re so grateful for the collaborative approach as we continue to address the challenges nursing homes face.”

For more information on the Upper Midwest Nursing Home COVID-19 ECHO Collaborative, contact Teresa McCarthy, MD, MS at [email protected].

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