Date: 3/29/2020
Author: Patrick Connole
States considering steps to mandate that skilled nursing facilities (SNFs) accept hospital discharges who may have or actually already have the coronavirus (COVID-19) should instead work to direct SNFs to create as many segregated COVID-19 units as possible, leaders of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said.
The association also said it was vital for states to ensure SNFs possess the necessary Personal Protective Equipment (PPE) to keep staff safe while caring for frail and elderly residents most susceptible to acquiring the virus and work with hospitals to accomplish this goal..
Mark Parkinson, president and chief executive officer of AHCA/NCAL, and David Gifford, MD, chief medical officer for AHCA, offered their recommendations at a time multiple states are considering adopting an order similar to what was issued in New York for SNFs to accept likely or actually COVID-19 patients discharged from hospitals.
The pair said it should be understood that “this approach will introduce the highly contagious virus into more nursing homes. There will be more hospitalizations for nursing home residents who need ventilator care and, ultimately, a higher number of deaths. Issuing such an order is a mistake, and there is a better solution.”
Parkinson and Gifford said as a former governor and a former state public health official, respectively, “we completely understand the intent of the orders. Every governor and public health official is faced with the unprecedented prospect of hospitals being overrun with both COVID-19 patients and other patients who in the regular course of life need hospital care.”
“That is already happening in Seattle, New York City, and surrounding areas. No one wants a scenario where hospital beds and ventilators are unavailable and people die waiting for care. Discharging hospital patients who are well enough to be cared for elsewhere is a top priority.”
The pair, however, said recent data from the Centers for Disease Control and Prevention (CDC) found that just over half of all elderly people who tested positive for COVID-19 showed no symptoms. CDC found that these people were likely spreading the virus to others for up to seven days before they developed symptoms.
“This supports a ‘test before discharge’ approach in hospitals,” they said. “However, lack of testing and delays in getting test results make testing patients before discharging unworkable. We need a different approach.”
Instead, Parkinson and Gifford said the solution is for hospital patients to be discharged to SNFs that can create segregated COVID-19 units and have the vital PPE needed to keep the staff safe.
“Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment, and staff to accept COVID-19 patients is a recipe for disaster,” the pair said. “Governors and public health officials should be directing nursing homes to create as many segregated units as possible right now. They should also explore asking nursing homes to move residents from one nursing home to another to create dedicated COVID-19 facilities that can accept hospital discharges.”
As a profession, AHCA/NCAL has made these recommendations, “but we need state officials to waive regulations that limit our actions. We also need to find ways to work with state public health agencies to get the necessary PPE to nursing homes so they can accept hospital patients,” Parkinson and Gifford said.
“The nation’s nursing homes are more than willing to care for COVID-19 patients. Taking care of the elderly, despite all the challenges and criticism, is what we are all about. There are examples all over the country that show that well-equipped and well-staffed nursing homes can contain the virus,” they said.
Further, the pair said, “We will work with every governor, public health official, and hospital to identify nursing homes that have the capability to handle these transitions and provide this care. In return, we need their commitment to fight for us: to get PPE into all nursing homes, to waive existing regulations getting in the way of training more staff and moving residents, and to support efforts to hire and retain additional staff while we fight this battle.”
Strategically sending patients to the appropriate nursing homes, as opposed to forcing them into every SNF, will save lives and reduce the burden on hospitals, they added.
“America’s nursing homes are ready to be the solution. Let’s safely transition hospital patients to the settings where they have the best chance to recover, and those around them have the best chance to stay healthy.”
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