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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