Based on the negative outcomes of the coronavirus, long-term care facilities should not automatically send COVID-19-positive residents to the hospital for treatment, the chair of AMDA-The Society for Post-Acute and Long-Term Care Medicine told McKnight’s Long-Term Care News on Wednesday.

“Instead of having a knee-jerk reaction and say I’ll send all of [the residents] to the hospital … every transfer consideration should have patients’ wishes in it,” said Swati Gaur, M.D., chair of AMDA’s Infection Advisory Committee and one of the organization’s COVID-19 experts. “I would say that it’s even more important now as ever to keep that in mind and not panic. The principles of good medicine and [honoring] patients’ wishes should be a huge part of what you should continue to apply.”

Facilities need to consider two issues before sending a COVID-19-positive resident to the hospital: how medically unstable they are and if hospital treatment is what the resident wants, she said. It is now well-known that the virus has a high mortality rate among older adults, along with complicated medical interventions. Sending a positive resident to the hospital also introduces the possibility they will spread the illness to others and also takes up an acute care bed, Gaur noted.

“We want to cure everything, but at the end of the day, it’s always important to have the patient make the decision as to what they want and to do what is important to them,” she said. “If the patient’s wish is to ‘be in my home’ regardless of whether they have COVID-19 or not, we have to be able to honor that. Long-term care knows and understand that. The value of the promise we give to our patients is to follow their wishes.”

‘We may lose one-third of our patients nationally’

Citing a Centers for Disease Control and Prevention report, which stated that the mortality rate among nursing home residents is between 15­-30%, Gaur said that nursing homes should be prepared for the possibility that “we may lose one-third of our patients nationally.”

“We want to follow the principle of care for our patients, which is to have an honest discussion about the disease and follow what that patient wants you to do,” she said.  

All facilities should plan for the possibility they will have COVID-19-positive residents, she said. Planning includes creating a separate unit that is a mini-hospital with the capability for increased oxygen, and a separate staff and equipment that is not shared with the rest of the building.

Outbreak preparation

David Grabowski, Ph.D., professor of health care policy at the Department of Health Care Policy at Harvard Medical School, agreed that nursing homes need to be prepared for the possibility of additional outbreaks.

“Let’s do everything we can do to prevent [significant loss of life] from happening,” he said. “I think we all share that goal.”

He continued, “We should be prepared for a COVID outbreak at a nursing home. I want to make certain we have a plan in place in terms of advanced care planning and infrastructure. I hope facilities and medical directors are working with residents to put their wishes in place.”  

CMS waivers promote sending residents to coronavirus-specific treatment facilities 

As the number of positive cases climbs, nursing homes are facing many difficult decisions regarding treatment of residents. The Centers for Medicare & Medicaid Services this week said it will be waiving requirements and allowing long-term care facilities to transfer or discharge residents to other facilities for coronavirus-related reasons. 

Reasons include transferring confirmed COVID-19-positive residents, or residents with symptoms of respiratory infection, to another facility that agrees to accept them and is dedicated to care for them; and transferring residents without symptoms or those who’ve been confirmed to not have the disease into facilities dedicated to preventing them from acquiring it. 

The waiver also applies to the transfer of residents without symptoms to another facility that agrees to accept them to observe them for any signs of respiratory infection over a 14-day period. 

Providers must receive confirmation from the receiving facility that the resident will be accepted, the agency noted. Confirmation can be in writing or verbal. 

“If verbal, the transferring facility needs to document the date, time and person that the receiving facility communicated agreement,” the agency wrote. 

The waivers come as providers across the country are considering various strategies to treat and prevent the spread of the disease, including creating coronavirus-specific treatment facilities. 

In other coronavirus-related news:

• COVID-19 has foisted many surreal circumstances on the world in recent weeks, and one of the latest is finding consumer advocates and nursing home associations agreeing on an issue. It’s happened over the controversial move by some states to declare that nursing homes must accept COVID-19 patients or suspected patients from hospitals. On Saturday, California joined New York and several others in making the declaration.

“California’s directive is nothing less than a death sentence for countless residents,” said Patricia McGinnis, executive director of the California Advocates for Nursing Home Reform (CANHR), on Wednesday. “The state should instead look to alternative locations such as hotels and conference centers as much safer places to send COVID-19 patients for care,” a goal previously endorsed by provider groups.

Professional long-term care nurses association AAPACN on Wednesday announced the release of a colorful healthcare personnel screening form, ready for use in any healthcare facility. It includes daily check-off criteria, an access-to-facility decision tree and more.

• In a move that may occur in other states, Georgia’s nursing homes and assisted living facilities impacted by the coronavirus will now receive additional help from the National Guard. Gov. Brian Kemp (R) announced that 100 guardsmen will help facilities reduce exposure to vulnerable residents. 

• As an example of how devastating an outbreak can be, single California nursing home is reporting that 51 residents, and six staff members have tested positive for coronavirus.

• The National Association of Health Care Assistants announced a CNA-focused, three-part course on COVID-19 that’s aimed at helping senior care workers protect themselves and residents. 

• In brighter news, an Ohio man enlisted the help of a bucket truck to visit his mother at an assisted living facility. His mother lives on the third floor of the facility and he used the truck to “go up” and see her.