BLOG

COVID-19:  As Daily Norms Shut Down, Healthcare Gears Up 

By: Sharon Harder, Trella Health Consultant| March 24, 2020

As COVID-19 becomes an inescapable fact of daily life, the old saying about things changing “in the blink of an eye” has taken on new meaning. For post-acute providers and those who serve the industry, COVID-19 has effectively set us on a course that few could have reasonably anticipated and into a realm that would have been, just weeks ago, unthinkable.   

In the space of a few short weeks, patients have been diagnosed with COVID-19 in all 50 states. Based on epidemiological studies of the infection patterns in Asia and Europe, we are now at the point where cases are expected to double every few days. Note those cases will not necessarily reflect new infections, though, as testing has ramped up significantly across the country. Hospitals are already anticipating the overload, and many are rightly concerned about shortages of critical items such as personal protective equipment to shield healthcare workers from avoidable exposure and ventilators to treat the most critical COVID-19 cases.   

As hospitalization projections are quantified, and as we learn about the rate of infection in nursing facilities where the virus was accidentally introduced, several things become clearer in thinking about post-acute care alternatives.   

Skilled Nursing Facilities (SNFs), even those with unoccupied beds, may not be willing or able to accept patients with active COVID-19 infections. All Medicare certified SNFs have active infection control programs, surveillance protocols for infections, active procedures for outbreak investigations, and isolation protocols. What they don’t typically have is isolation units with negative pressure rooms that can prevent the spread of airborne contaminants. As a result, even with the emergency waiver of the 3-day inpatient stay rule for SNFs, many COVID-19 patients may not be candidates for a post-discharge, recuperative spell at a SNF.  

Nonetheless, with experts such as Dr. James Lawler of the University of Nebraska Medical Center predicting nearly five million hospitalizations related to COVID-19, patients will be discharged ‘quicker and sicker’ to make room for others. If patients sickened with the virus are not discharged to sub-acute inpatient care, they will likely be discharged to home health. This will create a surge of patients coming home with potentially intensive skilled care needs. And, as the expected surge intensifies, home health providers may be hard-pressed to keep up with escalating demand. Health workers, including home health nurses who see multiple patients in a day, are more apt to be exposed. Some have already contracted the illness while many more are self-quarantined due to concerns about known exposure.   

We are on the precipice of an exponential rise in demand for post-acute services that will precisely coincide with a contraction of post-acute capacity.

This creates a real dilemma for many who are valiantly trying to figure out how to cover the bases as COVID-19 continues gaining momentum. 

As provider organizations come to grips with the realities of COVID-19, we expect many will consider ways to mitigate capacity gaps by redefining certain staff roles. An example is the role of the business development team, which is often called upon to pinch-hit in various ways. Opportunities for traditional sales calls have significantly diminished as inpatient providers limit access to facilities and redirect their operational focus to the emergency at hand – treating, stabilizing, and discharging COVID-19 patients to free up rooms for those who are coming. It will be an all hands on deck situation. The silver lining, though, could be business development teams helping to smooth planned care transitions with a downstream effect of building stronger hospital relationships.

For patients and families interested in inpatient care, the SNF’s outreach team can be instrumental in answering questions about what is involved in a SNF stay and how patients and families need to be prepared, especially considering continuing visitation restrictions.   

For patients who may be able to return home, there are other criteria to ensure the home is the right place for a COVID-19 patient. The CDC has published interim guidance for determining whether a patient is appropriate for post-discharge home health, including evaluation of: 

1. 1. Whether the patient is stable enough to be discharged to his/her home
   2. Whether the patient has willing and able caregivers who will provide care at home
   3. Whether the home environment has a separate, private room where the patient can be isolated
   4. Whether the patient and his/her caregivers have adequate access to food and other necessities
   5. Whether the patient and his/her caregivers have adequate access to personal protective equipment and can exercise precautions 
   6. Whether other members of the patient’s household may be at increased risk for infection or disease complications

Non-clinical members of the outreach team can be taught to ask the appropriate questions and deliver information back to the clinical team to enable an informed and safe admission decision. Once the decision is made, care can be arranged and promptly initiated, as time will be of the essence for many elderly and frail Medicare patients. 

As the COVID-19 pandemic progresses, Trella expects future quarters’ data will show some surprising and previously unanticipated shifts. We will be there to measure outcomes of this unprecedented challenge. In the meantime, we stand ready to assist and support post-acute providers as you work diligently to care for your employees, your patients, and their loved ones. We’re all in this together – adaptability, commitment, and organizational agility will carry the day. 

If you’re in need of extra support or data-driven guidance at this time, we’re here for you. Reach out to your Customer Success Manager or email us at [email protected] and let us know how we can help. 

About the Author:

Sharon Harder, Trella Health Consultant

Sharon works with post-acute healthcare providers to improve compliance and bolster sustainable growth in an era of escalating regulatory scrutiny. By developing strategic, common sense approaches to handling operational, financial and regulatory challenges, her clients are far more likely to achieve long term success.

Sharon specializes in home health and hospice process improvement, regulatory compliance, acquisition due diligence and post-acquisition integration. She is an expert in Federal and State regulation of home health and hospice with over 20 years of executive management and post-acute consulting experience.