Sick elderly person

“Blanket, one-size-fits-all” statewide orders barring long-term care facilities from denying admission based solely on confirmed or suspected COVID-19 diagnoses, or prohibiting long-term care facilities from requiring COVID-19 tests prior to admission or re-admission of hospitalized residents, are “a short-term and short-sighted solution that will only add to the surge in COVID-19 patients that require hospital care,” the American Health Care Association / National Center for Assisted Living and AMDA – The Society for Post-Acute and Long-Term Care Medicine said in a joint statement released Sunday.

The organizations cited a recent New York state order applying to nursing homes but said their concerns extended to assisted living communities as well, and they noted that other states “may already be adopting a similar approach in order to free up hospital beds.”

“As organizations dedicated to preserving the safety of patients and residents in post-acute and long-term care settings including assisted living, we strongly object to this policy directive and approach to developing surge capacity,” they said.

“The question all state officials must consider is whether the risk of introducing a virus with an estimated 30% or higher mortality rate into a nursing home or assisted living community outweighs the risk of hospitals being overcrowded,” AHCA / NCAL and AMDA said. “Regrettably, this is a difficult decision that many officials will be facing now or in the near future. However, it is not a binary decision. Alternative settings for patients recovering from COVID-19 must be considered and implemented now, including large field hospitals, dormitories, hotels, and shuttered nursing homes or hospitals.”

Decisions to transfer hospitalized patients to nursing homes, they said, must include factors such as supply and staffing levels, infection control capabilities and whether buildings have private rooms, negative pressure rooms and corridor designs that permit suitable monitoring of residents with acute, high-intensity medical and respiratory needs.

“In assisted living residences and continuing care retirement communities, these factors and the challenges in managing COVID-19 (+) or COVID-19 exposed residents are even more significant,” the organizations said. “These communities are not healthcare facilities, and thus are not prepared or equipped to handle medically complex surge-related discharges.”

AHCA / NCAL and AMDA recommended approaches taken by states such as Louisiana, Florida, Iowa and Michigan, which the groups described as being “more strategic and collaborative.”

Where hospitals are overwhelmed, they said, states should move residents within nursing homes to create open wings or floors to accept admissions from hospitals, assist in moving nursing home residents between facilities to create an empty nursing home that can accept new patients, or immediately develop and implement options for alternate care sites and staffing to accommodate the expected overflow.

“We urge states to work together with nursing homes / assisted living communities, hospitals, and public health authorities,” AHCA / NCAL and AMDA said.