5 Considerations for Nursing Homes as They Reopen Amid Heightened Scrutiny

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By Nick Westfall

While much remains uncertain and unpredictable about COVID-19’s ongoing impact on the US healthcare system, it’s clear that gradual reopening of the nation’s nursing homes will be accompanied by heightened scrutiny from federal regulators, state inspectors, family members, the press and the general public.

The reopening guidelines require extra vigilance and new ways of providing care by facility operators and staff members. Fortunately, nursing homes do not have to “go it alone” as they define a new normal for nursing home care.

Existing community partners, including hospice providers, stand ready and willing to lend their expertise to support common goals and meet the new reopening guidelines issued on May 18 by the Centers for Medicare and Medicaid Services (CMS). Experienced partners can help facilities define and provide:

  • Safe and appropriate care at all levels of care for residents and staff members in the nation’s long-term care facilities, including residents who are eligible for comfort-focused end-of-life measures
  • Support for family members and healthcare partners who, until now, have been watching from the outside as the COVID-19 pandemic shifts and presents new information

External partners can provide expertise in key areas, including continuously updated safety policies and procedures, ongoing staff education, seamless care coordination, infection control and survey compliance.

The CMS reopening recommendations allow nursing home administrators and state/local health officials to respond and react based on specific reopening criteria, metrics and ongoing monitoring. The recommendations ensure that facilities’ policies and practices align with COVID-19’s presence in their respective communities.

How Hospice and Healthcare Partners Can Help

The rapid transformation of hospice care in the first few weeks of the pandemic by key hospice providers can serve as a model for nursing homes as they embrace CMS’ guidelines. The bulk of end-of-life care is provided by hospice teams to patients/residents in their private homes, nursing homes, and assisted living facilities. Based on hospice’s COVID-19 experience, nursing home operators should keep key considerations in mind in their search for industry partners as they reopen.

  1. Ensure All Partners Have the Necessary Experience and a Strong Focus on Safety: Nursing homes should vigorously evaluate the safety protocols of external healthcare partners who provide care inside nursing facilities. They should look specifically for partners committed to safety for their own staff, the nursing home staff, residents/patients and visitors/vendors. Partners must bring sound, time-tested safety protocols, training, oversight, technology and the flexibility to adapt to a fluid healthcare environment. As an example: As soon as the CDC’s initial guidelines for COVID-19 were issued in early March, VITAS quickly developed new protocols for patient visits by our hospice teams, defined by limited-but-direct patient assessments within 6 feet for no more than 15 minutes (to avoid prolonged contact), followed by longer evaluations and conversations outside the 6-foot distance to continue addressing important questions and updating care plans.
  2. Pay Close Attention to Oversight, Inspections and Survey Experience: Choose providers with expertise in regulatory guidelines, inspections, survey visits and re-visits can help nursing homes meet all the appropriate standards linked to increased scrutiny and monitoring. Expertise will be critically important for oversight related to safety, training, PPE protocols, infection control, facility use and visitor screening.
  3. Prioritize Robust, Transparent Testing Procedures and Data: Nursing homes and their healthcare partners must coordinate and share the results of COVID-19 testing, especially if a partner’s staff members access multiple facilities in any given week or month to care for residents and patients. Shared information adds a reassuring level of safety and visibility to residents, family members, internal staff, external healthcare partners and officials in charge of inspections and oversight.
  4. Embrace and Expand Telehealth Capabilities for Resident Care, Education, Connections and End-of-life Conversations: Telehealth must continue to expand within the nursing home environment as a platform to care for patients—a valuable communication tool to keep family members/friends connected and for emotional and spiritual support when in-person visits are restricted or limited. Telehealth also facilitates partner education of nursing home staff on a variety of topics, including safety, advance care planning, workplace stress, grief/bereavement and more.
  5. Prioritize Goals-of-care Conversations and Advance Care Planning: Beyond its impact on the delivery of healthcare, COVID-19 has turned the spotlight on the need for physicians to talk with their patients/residents about the kind of healthcare they want, and do not want, when they face an advanced illness. One of the most heart-wrenching aspects of the pandemic, in fact, has been the inability of family members to visit with a loved one in a nursing home, or the anguish of family members who struggle to make life-and-death decisions without having discussed care preferences and values with their loved one. Partnering with the right organization can bring personal expertise and telehealth technology to support goals-of-care conversation and advance care planning, removing yet another burden from already overworked nursing home staff. “Having the conversation” ensures that residents’ wishes, vales, and goals of care will be honored.

As the nation’s nursing homes begin to reopen to other healthcare providers, family members, and visitors, they must ensure that their residents, staff, and community partners can provide care safely and react with agility to COVID-19’s ongoing challenges and realities. Nursing homes should prioritize the selection of experienced healthcare partners who are ready to help as facilities reopen across the country, a process that ensures all residents and patients, especially those nearing the end of life, receive the care they prefer and deserve.

About the author

Nick Westfall is president and chief executive officer of VITAS® Healthcare, the nation’s leading provider of end-of-life care.

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