New York State has already told nursing homes that they cannot deny admissions solely because of a positive COVID-19 test — nor can they require residents to submit to testing as a condition of entry.
Multiple other states are now mulling similar orders, according to the American Health Care Association, which on Saturday warned that the cost of such mandates could be dire.
“This approach will introduce the highly contagious virus into more nursing homes,” AHCA CEO Mark Parkinson and chief medical officer David Gifford said in a joint statement. “There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths. Issuing such an order is a mistake and there is a better solution.”
The coronavirus has placed a significant premium on skilled nursing beds, which policymakers have increasingly eyed as overflow for critical hospital space. As the acute-care setting fills up, the thinking goes, skilled nursing facilities can ease the burden by accepting lower-level patients — keeping the hospitals free for COVID-19 cases.
But that solution doesn’t account for what happens when a COVID-19 patient requires post-acute care. Accepting just one positive resident into a nursing home raises the real possibility of a deadly spread, with the initial outbreak at a facility in Kirkland, Wash. serving as a grim reminder of the stakes.
“Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment, and staff to accept COVID-19 patients is a recipe for disaster,” Parkinson and Gifford said.
To solve the problem, the pair — whose organization represents a wide swath of the nation’s nursing homes — called on federal and state governments to temporarily suspend regulations regarding patient transfers in order to ease the creation of specific wings, or even entire nursing homes, aimed at treating coronavirus patients.
“Governors and public health officials should be directing nursing homes to create as many segregated units as possible right now. They should also explore asking nursing homes to move residents from one nursing home to another to create dedicated COVID-19 facilities that can accept hospital discharges,” Parkinson and Gifford said. “As a profession, we have made these recommendations, but we need state officials to waive regulations that limit our actions.”
While testing residents before discharge from the hospital would also represent a solution to the problem, Parkinson and Gifford acknowledged the lack of widespread access to COVID-19 testing kits, as well as delays in receiving results, make that strategy “unworkable” in the current landscape.
In addition to encouraging the creation of coronavirus-focused facilities, the pair called on state and local governments to boost shipments of personal protective equipment (PPE) in order to help nursing homes safely care for the predicted influx of patients from hospitals.
“We will work with every governor, public health official, and hospital to identify nursing homes that have the capability to handle these transitions and provide this care,” Parkinson and Gifford concluded. “In return, we need their commitment to fight for us.”