Officials in New York last November began working to launch a handful of nursing homes designated for COVID-19 patients only — after a firestorm of criticism for a directive in the spring of 2020 that sent COVID-19 patients to any nursing home at all.
The Manhattan campus of the New Jewish Home in became one of those facilities in late January 2021, and as of the end of February, it was operating with 100 patients — or full capacity, administrator Sandra Mundy told Skilled Nursing News in a February 26 interview.
“We’ve been running at anywhere between 95 and 100 for at least the last two weeks,” she said.
To become a New York State Department of Health COVID-19 Designated Nursing Home, facilities had to meet some specific physical plant parameters and staffing requirements.
The Department of Health started the effort to set up such facilities in November 2020, according to a February 10 letter from New York Commissioner of Health Howard Zucker to the state Senate and Assembly. As of February 4, there were 19 COVID-19 only nursing homes in New York, with a total of 1,941 beds, according to that letter.
After the New Jewish Home submitted its application on January 7, the Department of Health sent a survey team to address life safety code and building requirements, inspecting the buildings to ensure that they had proper separation. The New Jewish Home has three buildings that are connected but easily separated, making it easy for the operator to create a dedicated unit and establish a separate entrance for the COVID-19 recovery building, Mundy told SNN.
The facility opened on January 26.
“We have no crossover of staff,” she said. “We have staff that are exclusively dedicated to this COVID recovery building, myself included.”
This translates to 160 staff dedicated solely to the COVID recovery building, and about 40 of those were new hires, she added. The hires include staff nurses, certified nursing assistants, therapists, social workers, and others, she said.
The New Jewish Home is still admitting non-COVID patients into its COVID-free units, but in terms of COVID-19 patients, it is getting referrals “from all over New York; we’re getting referrals from hospitals that we’ve never even heard of before,” Mundy said.
The geographies of origin include upstate New York and Long Island, as well as New York City.
The COVID unit also accepts residents from the non-COVID side who test positive, though this happens infrequently; no patients coming from the hospital are accepted unless they are at least 10 days post-diagnosis with no symptoms, Mundy said.
“It’s really representative of the demand that this serves, or the need that this serves, rather,” she said. “These are patients that don’t need to be in the hospital, and they’re lingering there, waiting to get tested negative — and sometimes it could get a while to test negative but technically, you’re not really infectious. So it’s causing [these patients] to just linger in hospitals and not get the rehab they need.”
The COVID-19 recovery patients tend to have more complex needs, which was a trend the New Jewish Home had noticed in the first wave that New York faced in the spring. Because of the toll COVID-19 takes clinically on older adults with any sort of comorbidities, the patients who stay in the hospital end up deteriorating even further.
“Almost everybody needs some type of oxygen, and they just need a tremendous amount of therapy,” Mundy said. “That’s really the biggest change, just the physical debilitation — which happens when you don’t have COVID, but it’s definitely more significant with COVID.”
New Jewish Home has always provided short-term rehab, but the COVID-19 recovery unit necessitated having enough therapists, with patients receiving a minimum of five days a week of physical and occupational therapy; all therapy has to be delivered one-to-one. Speech therapists, sometimes hard to find, were also necessary, and the COVID recovery building has two dedicated speech therapists alone.
Most nursing homes can only do virtual visitation options for their residents in any case, but since those in the COVID-19 recovery unit particularly cannot have on-site visitation, New Jewish Home hired staff dedicated to handling connections with family, whether virtually or over the phone, Mundy said.
Another critical personnel area was social work.
“The social workers here are doing a tremendous amount of discharge planning,” Mundy said. “So we wanted to make sure that we had enough staff to make sure that people get the right home care, get the right services, get the right equipment, whatever needs to be done. Again, you’re dealing with 100 people who are at some level of discharge planning, and the length of stay is not that long. They’re here maybe two or three weeks, and then they’re going home.”