AHCA/NCAL has revised our
guidance for long term care facilities
on accepting admissions from and transferring patients to hospitals during COVID-19 (previously released on March 20). The revisions are based on
new evidence from the CDC
published in its March 27th Morbidity and Mortality Weekly Report (MMWR), which found that
57% of elderly who tested positive for COVID-19 did not have symptoms
but shed virus at levels that likely made them infectious to others.
As more data becomes available, this guidance may continue to change. Some State or Federal officials may issue state specific guidance that supersedes this guidance.
Admitting residents from the hospital
We revised the decision-making and guidance from the earlier version.
Based on this new CDC data,
unless a person is tested for COVID-19 and negative before admitting them to your building, you should assume the person has COVID-19 regardless of their having or not having symptoms
The decision-making process to accept hospital admissions will vary depending on the ability of the LTC facility to manage residents who are COVID-19 positive or suspected to have COVID-19. Accepting residents from the hospital is also contingent on the LTC facility having adequate staffing levels and PPE to manage COVID positive residents. If not possible, the LTC facility should stop accepting all admissions until the facility has staffing levels and PPE to manage residents, which may not be at typical levels from prior to this pandemic.
We strongly urge LTC facilities to begin creating separate wings, units or floors now, by moving current residents to handle admissions from the hospital and keeping current residents separate, if possible
. LTC facilities should also start now to develop plans for consolidating residents between facilities to create “new” facilities that can accept hospital discharges who may be COVID positive or negative or harboring the virus because testing is not available.
Transferring residents to the hospital
Sending a resident to hospital, even if they test positive for COVID-19 or they have a fever or respiratory symptoms, is not always necessary. Facilities should implement droplet precaution procedure and follow
for COVID-19 for all 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.
We urge members to update residents' advanced directives accordingly after having these discussions