Hospital Discharges and Admissions to Nursing Homes and Assisted Living Communities

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On Sunday, March 29, 2020, AMDA (PALTC: Society for Post-Acute and Long-Term Care Medicine) and AHCA/NCAL issued a joint statement regarding the recent New York order:

“No resident shall be denied re-admission or admission to the NH solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.”

The joint statement also speaks to COVID-19 positive patients being discharged to Assisted Living facilities:

“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. These communities are not healthcare facilities, and thus are not prepared or equipped to handle medically complex surge-related discharges.”

Here are additional key excerpts from that joint statement:

  • 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. Regrettably, this is a difficult decision that many officials will be facing now or in the near future.
  • Decisions to transfer hospitalized patients to a nursing home are not at the sole directive of the hospitals or hospital physicians. Decisions to transfer patients to nursing homes are joint responsibilities, made collaboratively, since a new admission to a nursing home from a hospital can impact the health of all the other residents with dire, and indeed fatal, consequences.
  • We recommend a more strategic and collaborative approach statewide, similar to which has been taken in states such as Louisiana, Florida, Iowa, and Michigan. CDC data released after these states issued their guidance raises serious questions about not testing patients before discharge to nursing homes.
  • We urge states to work together with nursing homes/assisted living communities, hospitals, and public health authorities. States should take targeted action where hospitals are overwhelmed and move residents within a nursing home to create open wings or floors to accept admissions from hospitals. This will ensure hospital patients that are moved to a nursing home are kept separate from existing residents. States could also make plans, working with nursing homes, to assist with moving nursing home residents between nursing homes to create an empty nursing home that can accept new patients (e.g. a COVID (+) nursing home). Finally, states should immediately develop and implement options for alternate care sites and staffing to accommodate this expected overflow.

I encourage you to read the 3-page joint statement as well as the March 27, 2020 MMWR Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020.  The joint statement and the MMWR are eyeopeners for all of us in healthcare.  Throughout the month of March, in particular, we’ve heard the phrase “We’re all in this together.”  We absolutely should be!   In my humble opinion, there should be no silos during this pandemic.  Acute and long-term care entities must work together – now more than ever.

I will also remind you that the AMDA website has a great deal of resources now and more are added each today, including podcasts and webcasts.  Please take advantage of this resource – share it with your team, including physicians and your Medical Director.

Lastly, a big shout-out and support for ALL healthcare professionals regardless of where you work.  We so appreciate all that you are doing!  Be careful and stay safe out there.