Nursing Homes and Hospitals Divided Over Caring for the Elderly Amid COVID-19 Pandemic
Nursing homes in several states have found themselves in standoffs with hospitals over requests to re-admit residents who were previously sent to hospitals for medical care. The nursing homes are refusing to readmit residents unless the hospital can provide proof via a COVID-19 test that the person does not have the Coronavirus.
In one instance, the resident had been sent to the hospital with pneumonia and was successfully treated. However, she had been tested 12 days earlier for COVID-19, but could not prove she did not have the Coronavirus because the results had not been received by the hospital.
Nursing homes are fearful due to the vulnerability to COVID-19 of the elderly and ill who comprise most of the residents in their facilities. Hospitals, on the other side of the controversy, are trying to discharge patients in an effort to free-up beds for the anticipated wave of COVID-19 victims.
Nursing homes have received conflicting instructions from the Department of Health (DOH) in several states. For example, California DOH initially issued instructions to accept patients from the hospitals, and then not to take patients, but to be prepared to care for COVID-19 victims. Nursing homes have also been discouraged from sending residents to the hospital except when there is a need for intensive care that only the hospital can provide.
For the most part, nursing homes, out of concern for what happened in the Washington nursing home where 35 residents died from the Coronavirus, are standing firm in not accepting residents without proof that they are not infected with COVID-19. In mandates from leadership in some states, such as New York, there are plans to override that screening and require that recovering residents and others whose status is unknown be admitted to nursing homes, bringing relief to the hospitals. The Society for Post-Acute and Long Term Care Medicine (AMDA) is opposing that decision.
(https://paltc.org/sites/default/files/Statement%20on%20the%20March%2025%20NYSDOH%20Advisory.pdf) .
Compliance Perspective
Failure to protect vulnerable residents from being infected with COVID-19 by admitting residents who have possibly been exposed and may or may not have been tested for COVID-19, but who have not received the results of the tests, may be considered placing vulnerable residents in immediate jeopardy of infection and endangering their lives, and considered provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding state and federal regulations covering admissions of persons to prevent the spread of COVID-19.
- Train staff about using personal protective equipment (PPE), proper hand hygiene, and other infection control protocols needed when they provide care for all residents, including those with COVID-19.
- Periodically audit to ensure that the facility is prepared to provide the care needed for any residents who may become infected with COVID-19.
