When hospitals approach or reach patient capacity, they must turn to outside facilities to handle patient overflows. In this regard, skilled nursing facilities across the country with empty beds are receiving queries from hospital administrators about accepting overflow patients.

In nearly every case, hospitals and other healthcare settings are trying to keep all patients currently being treated for COVID-19 within their facility. Yet, many recovering COVID-19 patients require ongoing monitoring and treatment in rehabilitative environments. Still other patients being transferred out of hospitals and into skilled nursing facilities may be higher-acuity and require specific care that typically isn’t found in skilled nursing facility environments.

If your skilled nursing facility hasn’t already been contacted about accepting overflow patients by a referring hospital in your area, it very likely could in the near future. And while the challenges are significant, there are potentially great benefits associated with doing so. Assuming you currently have capacity, things could progress quickly; are you equipped to handle higher-acuity patients? And if not, what can you do to prepare?

At Richter, we recommend a progression of seven primary strategies to help you meet this challenge.

1. Prepare policies and procedures around higher-acuity skills. Again, most skilled populations require primarily rehab-focused care. With some exceptions, clinical interventions aren’t a core competency of skilled nursing facilities. So what can you do to build the necessary capabilities with the staff you currently have?
   The first step is identifying conditions and treatments that routinely occur in hospital settings that also could occur with overflow patient populations. For example, high-acuity patients often have tracheotomy (trach) tubes that require maintenance and care, so you’ll need to establish (or update as necessary) your facility’s trach management and care policies and procedures. Another common requirement for acute-care patients is maintenance and care of chest tubes.
   For validation of your assumptions and other insights, talk to nursing administration at referring hospitals to get a gauge on what types of patients and patient conditions they’re currently treating in their facilities. Different geographies could experience different patient conditions. Getting factual and anecdotal insights will help you properly prepare.
   With information in hand, you can then establish policies and procedures around this—and for that matter, all other acute-care skills that you determine could be needed.
2. Solidify formal agreements with referring hospitals. Arrangements like these can get complex, and details matter, so based on the skills you’ve identified, executives and administrators should start this process quickly.
3. Begin training now on identified skills. We recommend training selected staff – e.g., Director of Nursing, Staff Development Coordinator – through whatever means are at your disposal. From there, work to ensure that, to the extent possible, all your nurses are properly trained in these procedures. Given how contagious COVID-19 is proving to be, the more nursing staff you can train, the better.
   Some respiratory companies offer free training on their equipment; consider taking advantage of that if it’s potentially useful. Find other resources and utilize those. Time is always in short supply for healthcare and skilled nursing personnel, even in the absence of a pandemic; with COVID-19, it’s ever-more precious. While training windows may not seem feasible, training is absolutely necessary—and with the proper commitment, it’s doable. 
4. Acquire and maintain adequate stocks of equipment around identified higher-acuity skills. Trach management, chest tube management and other acute-care conditions require specialized equipment. Before you take in patients with these conditions, make sure you have adequate stocks of necessary equipment.
5. Plan for physical adjustments and relocations. There are an array of practical considerations regarding how to accommodate overflow hospital patients, and how to manage current facility residents. First and foremost, to the extent possible, you should group all overflow patients and keep them separate from current skilled nursing residents. Why? Even if they’re considered recovered, COVID-19 patients will exhibit “viral shedding” for up to 37 days after they last experienced symptoms, meaning they are less contagious than before, but still contagious.
   From there, plan for any necessary resident relocations, and when appropriate, take steps to implement those.
6. Communicate with residents, loved ones and staff. The COVID-19 pandemic has caused uncertainty and fear far and wide—and it’s especially prevalent in long-term post-acute care (LTPAC) environments. Whether directly or indirectly, residents, loved ones and staff will be impacted by an influx of acute-care, and possibly recovering COVID-19, patients. Make sure you communicate with them – proactively, candidly and clearly – about what steps you’re taking, why you’re taking them and what it means for everyone’s health and safety.
7. Step up recruitment initiatives. Adding overflow hospital residents to your population could likely stretch your nursing staff to its limits. Whatever recruitment efforts your facility currently has in place, now is the time to revisit those and make sure you’re doing everything you can to ensure an adequate volume of full-time staff.
   
   

Meeting the Acute-Care Hospital Overflow Challenge in Skilled Nursing Facilities – No Time to Waste

To put the urgency of all this in perspective, consider: If your city or region experiences a COVID-19 peak in, say, mid-May, that means area hospitals will have their highest census at that point in time. Yet, COVID-19 hospital stays are lasting, on average, 20 days. So, your facility could potentially begin admitting recovering COVID-19 patients by June. And of course, you could be pressed to admit non-COVID-19 high-acuity patients before then, since hospital capacities could have run out during the peak.

All this is to say that, no matter where your facility is located, the time to act is now.

COVID-19 presents unprecedented challenges for everyone in the healthcare and senior care realms. Yet, by taking action to expand your facility’s service scope and capabilities, you’ll be playing a key role in increasing outcomes and potentially saving lives; you could increase your census in the process; and you’ll be well-positioned to meet the demands of future crises, whatever form they may take.

To aid you in this process, we have developed a COVID-19 Resource Center for skilled nursing facilities which will be regularly updated with the latest information.

Contact Richter’s Skilled Nursing Facility Consultants

Do you have questions about preparing your skilled nursing facility to handle overflow hospital patients, or other LTPAC clinical challenges? Call Richter’s skilled nursing facility consultants at 866-806-0799 to schedule a free consultation.

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