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Protecting Current Residents

Published on April 4th, 2020

Health care experts recommend that nursing homes may need to take patients from over-burdened hospitals. At the same time, assisted living facilities (ALFs) need to accept nursing home residents who must be relocated to make room for those post-acute patients. Without adequate training and staffing, and proper equipment, this idea is a non-starter. Because so many hospitals have stopped doing elective surgeries, especially knee and hip replacements, the demand for that common SNF rehab has fallen off sharply. That may free-up more beds for non-COVID hospital discharges.

Massachusetts has designated 12 nursing facilities to take COVID-19 patients, and the state is beginning to move nursing home residents, starting with 147 in a Worchester facility. And the American Health Care Association, a trade group representing much of the nursing home industry, agrees with these changes, as long as they are managed carefully.

New York is doing this in a very different way. In an effort to free-up desperately-needed hospital beds, it has ordered all nursing facilities to accept hospital discharges, even those who have tested positive for COVID-19.

The issue:  How to make this work while still protecting extremely vulnerable residents and patients at nursing facilities who do not have coronavirus. These transfers should not happen if they put current residents at risk.

The first priority should be to find any facilities that already have ventilators, the staff skilled at managing them, and strong infection controls. I doubt any currently exist.  But using SNFs to care for COVID-19 patients may require the facilities to move long-stay residents, many of whom have dementia or functional limitations, to other facilities. Some may go to other nursing homes, others to assisted living, and some back home. It is essential to protect current residents, who are at extremely high risk form COVID-19.

How should the system handle someone who is suspected of having coronavirus but has not tested positive? Where should they stay? There is no room in hospitals. And nursing homes without intensive infection control are inappropriate. Until we have enough test kits and technology to read those tests within hours rather than days, this will remain a critical problem.

The system can make this shift work, but only if hospitals, nursing homes, assisted living facilities, home care agencies, states, and the federal government work together. Time is running out for many vulnerable adults.

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