If there was ever a time to put doubt about nursing homes’ place in the healthcare continuum to rest, it is now. After all, it is these facilities, along with other post-acute facilities, that are an essential link in the COVID-19 chain of treatment and recovery.
In any normal time, nursing homes are hospitals’ main default for post-acute care. Like an assembly line, many patients receive their treatment in the hospital and then move on to nursing homes for rehabilitation. The old silo concept, while far from ideal, has worked well enough, as hospitals did their acute-care part and then turned to nursing homes to take the post-acute angle from there.
But this is no normal time, and the idea of silos now needs to be tossed like a used facemask. The question for the system as a whole becomes: Once coronavirus patients receive treatment at the hospital, where can and do they go? With vulnerable long-stay residents in nursing homes and with facilities sorely needing proper PPE equipment, staffing and structures, there needs to be a new way of handling hospital discharges.
Public health policy experts, such as Anne Tumlinson, Howard Gleckman, David Grabowski, William Altman and Jon Glaudemans, are exhorting states to come up with sound, comprehensive, collaborative post-acute care strategies regarding how to handle hospital patients with and without COVID-19. Their recent white paper lays out a strategy for the four stages of the crisis (survive the surge, regroup and prepare, restructure to recovery, and redesign to reality).
Their recommendations include identifying acceptable SNFs, inpatient rehabilitation facilities and long-term acute-care hospitals to take non-COVID and COVID hospital patients in the near term; as well as establishing treat-in-place protocols for non-COVID admission during the summer months; tapping post-acute providers to participate in the administration of a vaccine after the initial surge; and creating local hospital/post-acute/public health advisory bodies in the long term.
Nursing homes can play a critical role in figuring out this post-acute care puzzle in the time of COVID. Who better than nursing homes, more than any other player in the healthcare space, can speak to how to care for frail, older adults and at-risk populations? They have a particular set of skills, knowledge and expertise to help direct this effort.
State and local governments need to listen to what nursing home medical directors, geriatricians and other stakeholders have to say, and then help them implement the plan.
Senior care providers, this is your time. Help healthcare get its act together.
Liza Berger is Senior Editor at McKnight’s Long-Term Care News.