The first cases of COVID-19 on U.S. soil were reported in a 100-bed Washington State SNF on January 21, 2020. In the weeks and months that followed, the pandemic spread around the country and around the world, infecting millions of people and causing mass deaths.
While impacts have been felt virtually everywhere, SNFs have borne an especially heavy burden. By July 2020, SNF residents represented as many as half of all COVID-19 deaths in several European countries; over three-quarters of deaths in Canada; and about 40% in the U.S.
In this spirit, we strongly recommend six key clinical strategies:
1. Reimagine and optimize infection prevention and control.
If there’s one clinical area that SNFs must get right moving forward, it’s this. Why? Certainly the obvious— keeping residents and staff healthy is paramount. But nearly every other facet of SNF operations – including financial – is impacted by the success or failure to prevent and control infections within your facility. Additionally, expectations around infection prevention and control will almost certainly rise among residents, loved ones, regulators and even staff. If you don’t measure up, poor performance will be reflected in negative Five-Star ratings, poor quality measures and word of mouth. The time to act is now.
Prior to COVID-19, SNFs here in the U.S. generally didn’t have to deal with major outbreaks beyond seasonal flu. That partly led many to overlook basic protocols that significantly prevent and control infections throughout a facility.
So what should your facility be doing to step up its efforts?
Commit to practicing optimal hand hygiene and respiratory hygiene.
It’s basic protocol, but when it comes to doing it properly – or sometimes at all – many facilities still come up short. In fact, according to several recent surveys tracked by the Centers for Medicare and Medicaid Services (CMS), more than one-third of facilities still don’t follow proper hand-washing guidelines, and one-fourth don’t use PPE properly.
Proper hand-washing is about frequency as well as technique. Skilled nursing staff should thoroughly wash their hands after touching a resident, after touching linens and before and after eating.
As for respiratory hygiene, it’s as simple as using the crook of your elbow to cough into, rather than your hands.
One other hygienic practice that nursing staff should adhere to: Don’t apply makeup during a work shift. By doing so, nurses and staff are touching their eyes, mouth and other facial areas that could cause infections to themselves or others.
Every SNF should have someone on staff – ideally an infection preventionist – and that person should be in constant training mode. Training shouldn’t happen only after a problem has been identified; it should be proactive, and feedback should be given immediately when staff are observed performing tasks incorrectly.
2. Make sure your PPE game is rock-solid.
Ensuring adequate supplies at all times
Having a PPE procurement plan in place, and adding it to your SNF disaster plan
Making sure all resident-facing staff don and doff PPE properly. No deviations – even for the slightest oversight – should be permissible
3. Prepare policies and procedures around higher-acuity skills.
Acquire and maintain adequate stocks of supplies needed for higher-acuity residents. Consider current PAR levels to make intelligent projections moving forward.
Build the necessary capabilities with staff you currently have, and hire, retain and continually train clinical staff to handle higher-acuity residents. Under PDPM, all residents should be skilled for therapy and nursing services, so this is critical.
4. Provide training around other clinical best practices.
When staff are thoroughly trained in all relevant areas of clinical care, outcomes improve, and everyone wins. Beyond infection prevention and control, identify clinical operations where additional training can enhance outcomes. You can even identify them through your QAPI program.
5. Optimize telehealth infrastructure, policies and operation.
COVID-19 made it increasingly difficult for SNF residents to be safely seen by physicians in a timely manner. The challenges cut two ways: Residents risk their health by traveling outside their facility or home to a doctor’s office, while physicians also bear risk by traveling to SNFs.
As a result of all this, residents aren’t getting the care they need when they need it most, medical outcomes suffer and quality of care can be impacted.
Thankfully, there is a solution—one that’s existed for years, yet hasn’t been fully embraced within the skilled nursing realm until now: telehealth. At Richter, we strongly recommend integrating telehealth into the fabric of your care continuum. The benefits are sizable:
Ease of use. A telehealth visit is no more complicated than any other virtual meeting, and the process of administering one is simple and straightforward. Given the right hardware, software, processes and personnel, caregiver and resident can meaningfully interact with a click or a screen tap.
Deeper involvement of loved ones. By its very nature, telehealth enables loved ones to potentially tie into a physician visit (given the proper authorization to do so). This helps keep them better informed on the health status of their loved one, and it can help them establish and nurture relationships with physicians and other caregivers.
Reduced hospitalizations and rehospitalizations. SNFs should seek to avoid admitting residents to acute-care facilities unless doing so is deemed medically necessary. Rehospitalizations in particular are undesirable; they can be difficult – traumatic even – for residents, and they can adversely impact quality measures for the referring organization. With telehealth, physicians can order interventions that prevent hospitalizations and rehospitalizations. That, in turn, also means a shorter gap between diagnosis and treatment.
Infection prevention. When used properly, telehealth helps to prevent the potential spread of contagions caused by anyone – physicians included – who physically enter facilities.
Greater efficiency. Telehealth offers fast and easy access to physicians, so residents are seen sooner and receive treatment without unnecessary delays. Additionally, physicians that utilize telehealth are able to see more residents without delays caused by physical travel to facilities.
Improved health outcomes and health management. By facilitating quick and direct connections between physicians and residents, medical and even behavioral conditions can be more readily assessed, diagnosed and treated. For SNFs, it also can positively impact quality measures and Five-Star ratings.
Whatever stage your facility may be in its telehealth journey, it’s wise to partner with an outside telehealth company. Doing so allows physicians to see patients on off-hours and on weekends. Telehealth companies specialize in this type of care delivery and some even provide equipment as part of the agreement/contract with the facility.
6. Minimize opportunities for survey citations.
It’s been challenging enough to operate a SNF during 2020 and 2021. The last thing you need is an infection prevention survey citation. Violations are costly; each one can generate a fine up to $55,000, and penalties can stack on top of one another. Moreover, plans of correction are mandated for each violation, and failure to provide documented proof can trigger additional fines or a temporary denial of payment. It’s in your facility’s best interest to remain on-the-ready at all times.
Contact Richter’s Clinical and Financial Consultants