Discharge and Transfer Guidance
Suggested Guidance: Accepting Admissions from Hospitals During COVID-19 Pandemic

In the event that the Indiana State Department of Health (ISDH) issues formal guidance on the matters contained in this piece, those should be followed. Until then, the purpose of this suggested guidance is to provide some advice to long term care facilities (SNFs and ALs) to determine when making decisions about the interplay between hospitals and LTC facilities. The advice below might likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community as a whole. Also, an individual facility might proceed differently based on any number of factors particular to its member census or psychical community.  

Hospital Discharges to a LTC Facility
During the COVID-19 pandemic, your residents will still have other medical problems that require hospitalization and post-acute care. The volume of most traditional post-acute admission is decreasing as hospitals are discontinuing elective surgeries and elective admissions. 

COVID-19 admissions are expected to rise, and these admissions will likely need post-acute care. CMS has waived the 3-day stay requirement for all discharges, regardless of COVID-19 status, to allow hospitals to more easily create new beds for the surge in COVID-19 admissions. As such, LTC facilities will face the challenge as to which hospital discharges they can/will accept. The decision-making process will vary depending on if the LTC facility has COIVD-19 positive residents already, the prevalence of COVID-19 in the surrounding community, and the hospital’s capacity. Most importantly, is the ability of the LTC facility to manage residents who are COVID-19 positive or suspected to have COVID-19. 

LTC facilities must NOW create and implement a plan to have separate rooms, wings, units or floors by moving current residents to handle admissions from the hospital and keep current residents separate, if possible . If this is not possible, the facility must create and implement a plan to cohort COVID-19 positive and negative residents as appropriate. NOTE: The ISDH will not permit LTC facilities to transfer residents to, or prevent residents’ re-admission from, hospitals who are not in need of immediate hospitalization.  

In the event ISDH issues state or regionally specific guidance that supersedes this guidance, we will update this information.

Transfers from LTC Facilities to the Hospital
A positive test for COVID-19 or a person with fever or respiratory symptoms does not necessarily need to be hospitalized. Such an individual should follow standard contact precautions and follow CDC guidance for COVID-19 positive or presumptive cases in long term care . If a resident requires IV fluids, oxygen and other treatments due to their respiratory symptoms, Medicare will allow you to switch the person over to Medicare Part A without a 3-day SNF stay . Discussion with families and residents should occur about the risks of hospitalization with COVID-19 during this pandemic period.

Some Recommended Advice for Admissions to LTC Facilities from the Hospital
The draft chart below will offer a basic algorithm to follow in most circumstances relative to admission referrals where COVID-19 status is positive, negative, or unknown. This draft chart is subject to change and may be superseded by ISDH. 

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Navigating the Use of Telemedicine During the COVID-19 State of Emergency
WEBINAR - Tuesday, March 31, 2020 at 1PM (EST). REGISTER HERE
Provided by Hall Render Killian Heath & Lyman