HHS, FEMA Release New Framework for ‘Crisis Standards of Care’ in Nursing Homes Amid COVID

A federal working group this week released a new report outlining how nursing homes and other long-term care facilities should marshal limited resources during future COVID-19 outbreaks and other public health crises.

As operators stare down the fall flu season and the continued risk of coronavirus spread, leaders should focus on identifying the top challenges that a facility might face during a crisis — such as staffing and equipment shortages — and develop strategies to maintain as close to a normal level of care as possible even as prevailing conditions worsen, according to the COVID-19 Healthcare Resilience Working Group.

“Post-acute and long-term care (PALTC) facilities … may need to adjust operations and standards of care in order to preserve and effectively allocate limited facility and health care system resources in the face of overwhelming demand due to the national public health emergency response,” the group wrote. “While a number of frameworks, guidance documents, and resources are available to help healthcare systems and stakeholders prepare for and respond to the emergence of crisis standards of care (CSC), relatively few address the unique circumstances and information needs of PALTC facilities.”


The group, a joint effort between the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), divided the progress of a COVID-19 or other emergency into three categories: conventional, contingency, and crisis.

As demand for health care increases, the situation at a facility may transition from conventional — or generally normal — to contingency, in which operators can still provide regular levels of care, but with some significant adaptations. Crisis mode means that the overall health care system has become overloaded, and providers can no longer offer typical comprehensive care.

The federal working group’s report acknowledged that COVID-19 can have substantially varied effects on different aspects of a facility’s operations.


“In fact, actions meant to preserve conventional standards of care in one area of operations may require introduction of contingency or crisis level standards in another area,” the team observed. “For example, efforts to conserve staff and PPE resources may require a general shift towards virtual visitations using remote communication technologies, while still allowing access to support persons for individuals with disabilities and compassionate care, including end-of-life visits by family, friends, and clergy.”

The HHS/FEMA report outlines the different steps that providers should take when they observe pressures on multiple aspects of operation, while also providing a blueprint that facilities can follow when transitioning from a crisis mode back to regular operations.

The group included a variety of leaders in post-acute and long-term care, including medical directors, geriatricians, and members of AMDA — The Society for Post-Acute and Long-Term Care Medicine.


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