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April 1, 2020

4 steps nursing homes can take to prepare for COVID-19 positive patients

Daily Briefing

    In the wake of several high-profile outbreaks in nursing homes across the country, the CDC has recommended that skilled nursing facilities (SNFs) and long-term care providers only accept new patients if they meet certain criteria to care for COVID-positive patients in-house. As the number of cases have multiplied across the last several weeks, these policies are intended to keep current nursing home patients—an especially vulnerable population—and staff safe.

    Nursing homes: The front line in the fight against COVID-19

    But with hospital capacity reaching a breaking point in several markets, home care and other alternatives sites of care may also be overwhelmed or unavailable. In these situations, many hospitals are looking to their partner SNFs to offload some of this capacity.

    Additionally, because of the highly contagious nature of the virus, and the fact that many who have it can appear asymptomatic, even SNFs that are not accepting new admissions need to be ready for a Covid-19 outbreak in their facility.

    Here's how nursing facilities—and hospitals—can prepare.

    What nursing homes should do now:

    1. Stick to CDC infection control guidelines. CDC has an abundance of information available online about what skilled nursing facilities and long-term care providers can do to prevent infection in their buildings, and what to do if a positive case arises. To prepare for current and future cases, providers must start by ensuring staff members across their organization understand and adhere to these protocols.

    2. Communicate with upstream providers about your capabilities. You'll need to be in constant communication with referrers about the types of patients they need help offloading and your ability to accept new patients. What support do you need from them to be able to take on more patients? And what information do you need to effectively cohort patients at admission, and isolate if necessary?

    3. Prepare a separate area for new admissions and positive cases. As new admissions come in, it is imperative that facilities have separate units—or even buildings—set aside to cohort patients by status: suspected cases, confirmed positive cases, and confirmed negative cases. Across the next few weeks, continue to audit your census and number of available beds to determine when such a move can take place. We'll be sharing more information about how select facilities have been able to operationalize this in the coming weeks.

    4. Prioritize staff health, safety, and preparedness. It goes without saying that taking care of your staff is more important now than ever. Schedule daily communications with your staff about COVID-19 planning, reach out to community organizations to see if you can build a backup pipeline for additional staff, and monitor all staff for signs of infection, stress, and burnout. See how other providers are managing staff engagement and shortages on our resource page.

    How hospitals can help:

    1. Prioritize discharging COVID-negative patients to post-acute first. Unless there is a mandate to discharge COVID-positive patients to post-acute care facilities, hospitals should focus on freeing up capacity by discharging non-COVID patients to post-acute. This helps both free up inpatient beds and consolidate the number of cases in as few settings as possible, thus reducing the risk of spreading the disease.

    2. Share knowledge, expertise, and resources with nursing homes. Providers across the continuum are stretched thin right now, and all providers will need to continue to be interdependent as we try to contain the virus. Hospitals should share:
      • Clear, complete patient information. Communicate early and often about the types of patients you need help offloading, and about the specific patients you’re sending their way. Prioritize information about what risk factors the patient has, and whether or not they've been tested or exposed.
      • Knowledge and protocols. Nursing facilities have lower staffing than hospitals, limited availability of existing isolation spaces, and less experience managing conditions as infectious as COVID-19. As you evolve your own protocols, share what you can with post-acute partners to help prevent outbreaks downstream.  
      • Vendor relationships. Nursing homes, like hospitals, are experiencing shortages in PPE.  If you have found opportunities to acquire PPE through vendor relationships or government sources, include nursing homes in those conversations.
    Across the next few weeks, we'll be gathering more in-depth examples of how to meet each of these imperatives. Have any to share? Contact us at

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