Nursing homes in several states have found themselves in standoffs with hospitals over requests to re-admit residents who were previously sent to hospitals for medical care. The nursing homes are refusing to readmit residents unless the hospital can provide proof via a COVID-19 test that the person does not have the Coronavirus.
In one instance, the resident had been sent to the hospital with pneumonia and was successfully treated. However, she had been tested 12 days earlier for COVID-19, but could not prove she did not have the Coronavirus because the results had not been received by the hospital.
Nursing homes are fearful due to the vulnerability to COVID-19 of the elderly and ill who comprise most of the residents in their facilities. Hospitals, on the other side of the controversy, are trying to discharge patients in an effort to free-up beds for the anticipated wave of COVID-19 victims.
Nursing homes have received conflicting instructions from the Department of Health (DOH) in several states. For example, California DOH initially issued instructions to accept patients from the hospitals, and then not to take patients, but to be prepared to care for COVID-19 victims. Nursing homes have also been discouraged from sending residents to the hospital except when there is a need for intensive care that only the hospital can provide.
For the most part, nursing homes, out of concern for what happened in the Washington nursing home where 35 residents died from the Coronavirus, are standing firm in not accepting residents without proof that they are not infected with COVID-19. In mandates from leadership in some states, such as New York, there are plans to override that screening and require that recovering residents and others whose status is unknown be admitted to nursing homes, bringing relief to the hospitals. The Society for Post-Acute and Long Term Care Medicine (AMDA) is opposing that decision (https://paltc.org/sites/default/files/Statement%20on%20the%20March%2025%20NYSDOH%20Advisory.pdf).
Compliance Perspective
Failing to perform self-assessments to ensure that a facility is prepared to prevent the spread of COVID-19 may result in placing residents in immediate jeopardy and be considered provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures regarding self-assessment of the facility’s Infection Control Plan using the CMS Infection Control checklist.
- Train staff regarding the facility’s Infection Control Plan and performing self-assessment of that plan, using CMS’s Infection Control checklist.
- Periodically audit to determine if the facility is continuing to self-assess its Infection Control Plan using the CMS Infection Control checklist.
FOR MORE INFORMATION ON THIS TOPIC: COVID-19 FACILITY PREPAREDNESS SELF-ASSESSMENT and HAND HYGIENE GUIDELINES FOR HEALTHCARE SETTINGS.
