Theresa Edelstein, MPH, LNHA
New Jersey Hospital Association
Pam Kaiser, MSN, RN
As states are moving through the different phases of reopening, hospital groups are looking to the future, and many believe in that future looms a resurgence of the new SARS-CoV-2 (COVID-19). Hospital strategists are planning their way forward by addressing needs for the short and the long-term. Reviewing their plans can help Skilled Nursing Facilities (SNFs) establish their own strategies.
Hospitals: Short-Term Strategies
The short-term takes a “lessons learned” approach. In other words, knowing what the outcome has been, what can be done differently or better in the future to improve?
Supply Chain & Testing
Not surprisingly, teams will make supply chain improvements and increase their stockpile of personal protective equipment (PPE). Understanding that availability of testing kits is a wildcard, they will establish testing and retesting plans to assist with cohorting patients and staff assignments. Based on the physical plant, they’ll establish COVID-19 positive units, COVID-19 negative units and if possible, a transitional unit to hold new admissions or potentially positive patients.
Coordination of testing between providers will have a significant benefit to transitioning patients to SNFs and residents to the hospital in an efficient way. Being able to place patients in alternative care settings to quickly open Intensive Care Units beds without a pre-established communication process was challenging.
Regional Work Plans
Another approach involves creating a regional work plan that identifies predetermined COVID and non-COVID locations. Cohorting in this manner potentially reduces the use of PPE and testing. Patients would be less isolated and able to move about as able. Creation of a centralized information hub for care providers to share admission status, bed availability, staffing needs, test and PPE availability saves valuable time and resources.
Using a local approach follows similar preparations with hospitals and post-acute care providers (PACs) establishing communication plans to share capacity and ability to accept admissions, to cohort, to staff and to equip with proper PPE.
Leveraging technology to provide care and demonstrating a culture of safety gives hospitals a way to provide confidence to healthcare consumers. Using parking lot registrations, mobile check ins, and telehealth software allows for access to care in a way that reduces exposure. Confidence in safety and infection control practices will attract those patients that do require care during a pandemic.
SNFs: Short-Term Strategies
For SNFs, several of the hospital short-term steps apply; specifically, in the areas of supply chain improvements and an increased on-hand supply of PPE. With that, staff should be educated, trained and retrained on the use of PPE.
Just like hospitals, testing residents and staff is the only way to cohort and treat effectively in a manner that reduces the virus’ opportunity to spread. Additionally, dedicating a specific area for COVID-19 residents and a COVID-19 free area contributes to containment.
Establish Communication with Hospital Partners
To assist with opening hospital ICU beds, establishing a communication system now will allow you to inform hospitals if you are open for admission of COVID-19 residents on a daily basis. Assess the skills of your current staff and close any gaps before any resurgence happens. Many hospitals developed strike teams to bring their knowledge to the SNFs; reach out to your local hospitals for their current protocols so your team is well prepared to take their overflow. Work with other PAC providers to triage COVID patients/residents in the care setting best equipped to deal with that individual’s needs. Also, if you have included a neighboring hospital in your disaster plan, be sure the hospital administration is aware, but consider looking to other PAC providers as potential discharge locations under the blanket waivers available.
Homecare & Telehealth
Happening already, the use of outpatient and ambulatory services to meet patient care needs will expand. Smaller core hospitals will provide inpatient care for only those patients that need the highest level of acute care. The move to this model will accelerate as telehealth use grows.
The focus will be on convenience and access to care in order to attract patients. To that end, virtual care and telehealth will be front and center. Current patient portals in hospital systems allow patients to communicate with providers, but hospitals will need to continue to innovate to improve market share.
Additionally, hospitals will get creative with contract renegotiations. As value based contracting gains wider acceptance, hospitals will look to partners that are prepared to go at risk. Whether with physician groups or other providers, hospitals are discussing how to weave quality outcome expectations and total cost of care goals into this new normal.
SNFs: Long-Term Strategies
For SNFs, the lingering negativity around care delivered and conditions in a SNF setting will be hard to overcome. Although progress has been made and stories of resilience and selflessness in the face of COVID are circulating, the pandemic and subsequent media coverage has cast a shadow over SNFs and the care delivered in those settings.
Teams will need to continue to push for balanced reporting and legislation that address the needed changes to our healthcare delivery system. Activating residents and families to make the case for SNFs and the key role they play in the care of the frail and elderly can help raise public awareness. The gaps exposed during the pandemic point to the need to transform how we provide healthcare to our frail and elderly.
SNFs should be ready to show how they drive quality through Quality Assurance Performance Improvement activities. Leveraging data can point towards areas of improvement and create opportunities to partner with other providers along the continuum in ways that reward quality outcomes. Collaboration on ways to be more efficient and to collectively drive down the cost of care is also essential. Successful collaborations are built on shared data, timely analysis and transparency.
The Bottom Line
SNFs who communicate strategically with their partners become providers that are ready to meet hospitals and health systems where they have the greatest need.
Senior Vice President, Partnerships Transforming Health
New Jersey Hospital Association
Vice President, Clinical Resources Team