While Recognizing Dangers, California Tells Nursing Homes to Prepare for COVID-19 Patients [UPDATED]

March 23, 2020

On March 20th, the California Department of Public Health released the COVID-19 Health Care System Mitigation Playbook, which noted that COVID-19 patients should not be sent to long-term care facilities without consulting the local health department. It also added that as it will be necessary to designate facilities as receiver sites for such patients, regional health care systems need to begin planning for “this community-level cohorting now.” CDPH also revised the All-Facilities letter discussed in this story to make changes to guidance regarding asymptomatic health care personnel.

The California Department of Public Health (CDPH) issued recommendations for skilled nursing facilities on preparing for COVID-19 — and told them to prepare to receive and care for residents with suspected or confirmed COVID-19 infections.

The all-facilities letter (AFL) sent on March 19 tells SNFs to prepare for COVID-19, the disease caused by the novel coronavirus that emerged late last year. While noting that “elderly persons and those with chronic medical conditions may be at higher risk for severe illness and death from COVID-19,” it directs California SNFs to be ready to take in patients that are confirmed or suspected of having the disease.

MarketWatch first reported on the letter.

Specifically, according to the letter, SNFs in California should:

  1. Prevent introduction of COVID-19 into their facility;
  2. Detect COVID-19 in their facility;
  3. Prepare to receive residents with suspected or confirmed COVID-19 infection;
  4. Prepare to care for residents with suspected or confirmed COVID-19 infection; and
  5. Prevent spread of COVID-19 within their facility.

Concerns about bed capacity in the hospital setting are looming as the number of coronavirus cases across the country spikes. Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS), noted that the agency’s decision to waive the three-day stay rule for Medicare coverage of a SNF stay was designed to ease stress on hospitals.

But while hospital capacity amid a surge of COVID-19 patients is a concern, the risks to those who live in SNFs are significant, as even the ALF letter notes.

For the California Association of Health Facilities (CAHF), the American Health Care Association affiliate in the Golden State, the dangers that the coronavirus poses to the SNF population are too great to make admitting COVID-19 patients a possibility.

“While we recognize the reality of a possible surge of coronavirus patients, the CAHF is not in support of any plan to transfer positive COVID-19 patients to skilled nursing facilities, especially given the fatality rate in older individuals and people with serious and chronic health conditions — the very people we serve,” Deborah Pacyna, director of public affairs at CAHF, said in a statement sent to Skilled Nursing News via e-mail.

The CAHF has “urged the state to look at alternate care sites,” including closed health care facilities that could be reopened in case of a surge of coronavirus patients, she added.

Emergency 1135 Medicaid waivers granted to Washington state and Florida, for instance, allow nursing facilities to continue to receive reimbursements for care provided at alternate sites — including facilities not licensed for care — in the event of an evacuation.

SNN asked the CDPH why it expects SNFs will have to take in COVID-19 patients; whether all SNFs in California should be prepared to deal with such patients; under what conditions a COVID-19 patient can be safely transferred to the SNF setting; and when SNFs should expect to receive such patients.

The CDPH said in response that its guidance in the letter was for SNFs to be prepared to potentially start receiving patients who may require lower-level care, not acute care.

“Hospitals are required to properly care for individuals and discharge them to the appropriate levels of care when a patient is ready for release,” the CDPH said. “This includes patients who may have entered with the need for acute care as a result of COVID-19, and are ready to be released.”

‘We Don’t Want to Have an Increase in Deaths’

Even before the COVID-19 outbreak, SNFs have struggled with infection control and prevention, and CMS pledged to crack down by focusing inspections on this issue at the beginning of the month.

At the Kirkland, Wash.-based SNF a COVID-19 outbreak that ravaged residents — largely because of staff working while sick and the sharing of staff members between multiple facilities — resulted in a death toll of 23 as of March 9, according to a report from the Centers for Disease Control and Prevention (CDC).