Across the US, around 50,000 COVID-19 deaths have occurred in post-acute and long-term-care facilities, which represents 40% of the nation’s total count. In Utah, of 158 total deaths from COVID-19, 69 have been from residents within these facilities, making up 44% of the state’s total. Individuals in our post-acute and long-term-care communities represent our most vulnerable and fragile populations of seniors and chronically ill across all ages, and the largest proportion of severe COVID-19 cases hitting our hospitals, requiring ventilation and other interventions, and succumbing to the virus.
“COVID-19 is spreading rapidly in these environments for a number of reasons,” said Jason Spaulding, MD, Castell’s and Intermountain’s associate medical director for Post-Acute Care. “Residents are in close proximity to one other and unable to effectively social distance, healthcare personnel work in more than one facility, facility staff sometimes do not have access to sufficient personal protective equipment (PPE) or fit testing, patients often require aerosolized-generating procedures (AGPs) that are higher-risk for exposure, and there hasn’t been comprehensive, consistent COVID-19 testing for residents or for patient transfers to facilities from hospital settings.”
Dr. Spaulding is a member of the long-term-care subcommittee of Utah’s coronavirus task force. This group of post-acute and long-term-care facility leaders and medical directors across the state is working to safeguard the health of residents and caregivers in these facilities.
Some of the actions this group has already taken include: launching algorithms to identify transmission risk for staff and provide clearance or replacement to inhibit COVID-19 spread within and across facilities; providing universal testing for all hospital transfers to post-acute and long-term-care facilities; offering mobile testing units for facility-wide testing of staff and residents; and providing disaster preparedness training for identified champions at each facility. Intermountain has also supported the effort with PPE calculation and needs assessment for all facilities along with fit testing of PPE for staff at facilities with highest risk for transmission. To cohort COVID-19 positive cases, City Creek Post Acute is partnering with the Utah Department of Health and dedicating its facility to COVID-19 positive patients who can continue receiving rehabilitation and skilled nursing services. Intermountain’s Post-Acute Care Team including Dr. Spaulding and Holly Jones, NP are providing attending medical services for City Creek to support the facility and its residents. Utah is also working to dedicate other facilities to COVID-19 positive patients.
As the state continues to see more new cases each day, we will see more hospitalizations. Our post-acute and long-term-care facilities are working quickly to prepare and expand capacity for patients needing this ongoing, step-down care. The facilities are also leaning on inpatient and outpatient physicians and APPs, care managers, and other caregivers to understand the importance of discharging patients to facilities that are prepared to manage them. Patients must be tested before transferring. Consider keeping patients needing AGPs or other involved care within hospital settings, as transferring could put those patients in unsafe scenarios and warrant rehospitalization. Also test any post-acute and long-term-care facility staff who request testing, as their work involves very vulnerable populations and testing, and addressing positive cases, could save lives.
Stay tuned for more information and stories on the great work Dr. Spaulding and others are doing to support some of our most vulnerable individuals. Watch his recent, recorded presentation from the physician and APP leadership huddle (beginning at 41:00) and other updates on COVID-19 epidemiology and response.
“COVID-19 is spreading rapidly in these environments for a number of reasons,” said Jason Spaulding, MD, Castell’s and Intermountain’s associate medical director for Post-Acute Care. “Residents are in close proximity to one other and unable to effectively social distance, healthcare personnel work in more than one facility, facility staff sometimes do not have access to sufficient personal protective equipment (PPE) or fit testing, patients often require aerosolized-generating procedures (AGPs) that are higher-risk for exposure, and there hasn’t been comprehensive, consistent COVID-19 testing for residents or for patient transfers to facilities from hospital settings.”
Dr. Spaulding is a member of the long-term-care subcommittee of Utah’s coronavirus task force. This group of post-acute and long-term-care facility leaders and medical directors across the state is working to safeguard the health of residents and caregivers in these facilities.
Some of the actions this group has already taken include: launching algorithms to identify transmission risk for staff and provide clearance or replacement to inhibit COVID-19 spread within and across facilities; providing universal testing for all hospital transfers to post-acute and long-term-care facilities; offering mobile testing units for facility-wide testing of staff and residents; and providing disaster preparedness training for identified champions at each facility. Intermountain has also supported the effort with PPE calculation and needs assessment for all facilities along with fit testing of PPE for staff at facilities with highest risk for transmission. To cohort COVID-19 positive cases, City Creek Post Acute is partnering with the Utah Department of Health and dedicating its facility to COVID-19 positive patients who can continue receiving rehabilitation and skilled nursing services. Intermountain’s Post-Acute Care Team including Dr. Spaulding and Holly Jones, NP are providing attending medical services for City Creek to support the facility and its residents. Utah is also working to dedicate other facilities to COVID-19 positive patients.
As the state continues to see more new cases each day, we will see more hospitalizations. Our post-acute and long-term-care facilities are working quickly to prepare and expand capacity for patients needing this ongoing, step-down care. The facilities are also leaning on inpatient and outpatient physicians and APPs, care managers, and other caregivers to understand the importance of discharging patients to facilities that are prepared to manage them. Patients must be tested before transferring. Consider keeping patients needing AGPs or other involved care within hospital settings, as transferring could put those patients in unsafe scenarios and warrant rehospitalization. Also test any post-acute and long-term-care facility staff who request testing, as their work involves very vulnerable populations and testing, and addressing positive cases, could save lives.
Stay tuned for more information and stories on the great work Dr. Spaulding and others are doing to support some of our most vulnerable individuals. Watch his recent, recorded presentation from the physician and APP leadership huddle (beginning at 41:00) and other updates on COVID-19 epidemiology and response.