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For SNFs Nationwide: An Escalation in COVID-19 Cases

During a special CMS call for nursing homes on August 13, CMS' Seema Verma reported some grim facts. With the increasing spread of the virus in communities throughout the country, COVID-19 cases in SNFs are also on the rise. With more than 12,000 cases in SNFs and an increasing number of deaths, CMS estimates that 50% of SNFs have at least one COVID-19 case.

Realizing it's not a time for CMS to be punitive, Ms. Verma pledged a problem-solving approach to help with staffing/supplies and encouraged SNFs to communicate their needs. CMS is planning an internal call for Monday to refine their strategy for the escalating cases, inclusive of:

  • Focusing on containing further spread for those SNFs with only a few cases to avoid more of a crisis.
  • FEMA on alert to assure needed supplies are available for SNFs in need;
  • Working with test manufacturers to assure point of care tests are dispersed and prioritized for regions with higher cases;
  • Urging all SNFs to have plans to test staff and residents;
  • Labs prioritizing nursing home tests;
  • Addressing the deficiencies noted by CMS in infection control practices for front line staff. QA organizations are available and a national training program will be rolled out for SNFs to assist with planning for improved infection control measures.

Ms. Verma advises SNFs with only 1-2 cases be vigilant to avoid what can be a quick escalation in cases. Additional recommendations included:

  • Having an emergency preparedness plan in place;
  • Doubling down on supplies; and
  • Reviewing back up staffing plans.

During the call, CMS advised that all efforts should be made to reduce COVID-19 transmissions because cases can double within 3-6 days if immediate action isn't taken within 24-72 hours. SNFs are reminded to commit to best practices that includes:

  1. Having staff observe each other to assure proper hand washing techniques and donning/doffing of PPE;
  2. Developing local relationships with state, county and hospitals to share best practices;
  3. Maintaining ample PPE - shortages can cause staff to avoid best practice for infection control;
  4. Not allowing staff who have tested positive to return to work until a negative test result is obtained;
  5. Actively managing issues related to the psychological impact of the PHE;
  6. Dedicating space for testing. Consider doing this outside of the facility so staff who are positive are not entering;
  7. Having ample supply/availability of alcohol-based hand sanitizer in all areas;
  8. Being vigilant about maintaining social distance, especially in areas such as break rooms and lunch rooms;
  9. Wearing masks and avoid touching face at all times;
  10. Participating in new learning module (being released in 12 days);
  11. Having emergency preparedness plans that must be easily accessible and easy to execute

Additional 'lessons learned' to prevent the spread were also reviewed, including:

  • Work to detect COVID-19 cases quickly;
  • Have a good screening system for visitors/staff entering the facility;
  • Provide peer constructive feedback for staff when there are deviations from the recommendations;
  • Watch for common symptoms and empower staff to speak up about residents they know well when they see anything suspicious;
  • Don’t wait for tests to come back. Take precautions to prevent further transmission;
  • Have a process for reducing risk of further transmission with cohorted patients;
  • Training once is not sufficient. CMS has table-top exercises that can be done more than once;
  • Real time improvement of care delivery that is pertinent;
  • Early detection of COVID-19 to reduce deaths is critical, and;
  • Fortify relationships with local hospitals for a team-based approach to training and for collaborating on patient care

Redesigning Tomorrow Together
In response to CMS updates and recommendations from HealthPRO Heritage’s consulting physician (Dr. James Avery), our expert team of clinicians and strategists are focused on front line imperatives – such as infection prevention – to help stop the spread of COVID-19. To that end, our team of certified RN Infection Preventionists provide critically important guidance, resources and tools for staff and partners.

Stay tuned for critically important advice related to root-cause analyses for facilities with at least one COVID-19 case to avoid exponential escalation of the infection.

Learn more about HealthPRO Heritage’s go-forward approach for assuring innovative solutions and best practices amidst the threat of COVID-19. Our team’s pledge – ReDesigning Tomorrow Together – is highlighted in a message from our senior leadership team here and outlined for partners & peers to review here.

Tags: skilled nursing facility, CMS, snf, COVID-19