AHCA is issuing interim guidance to help skilled nursing facilities (SNFs) make decisions about accepting hospital discharges to SNFs during COVID-19 pandemic. The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community.
This guidance is designed to help reduce the risk of admitting someone with COVID-19 into your building, along with the steps you should take to prevent any spread. During a COVID-19 epidemic, the elderly will still have other medical problems that require hospitalization and post-acute care (e.g., strokes, CHF exacerbations, surgeries, etc.).
The volume of some traditional post-acute admission is decreasing as hospitals are discontinuing most elective surgeries and elective admissions. However, hospitals expect to see a surge in admissions related to COVID-19, who will need post-acute care, especially as COVID-19 becomes more wide-spread in the surrounding community.
CMS has also waived the 3-day stay requirement for all discharges, regardless of COVID-19 status, to allow hospitals to more easily create new beds for the surge in COVID-19 admissions. As such, SNFs will face the challenge as to which hospital discharges, they can accept. The decision-making process will vary depending on if the SNF has COVID-19 positive residents already, the prevalence of COVID-19 in the surrounding community, and the hospital’s capacity, as well as the ability of the SNF to manage residents who are COVID-19 positive or suspected to have COVID-19.
We strongly urge SNFs to begin now creating separate wings, units or floors by moving current residents to handle admissions from the hospital and keep current resident separate, if possible. It is likely state public health officials may issue state or regional specific guidance that supersedes this guidance.
Transfers from SNFs to the Hospital
A positive test for COVID-19 or a person with fever or respiratory symptoms does NOT need to be hospitalized. They should be put in contact precautions and follow CDC guidance for COVID-19 positive or presumptive cases in long term care. If a resident requires IV fluids, oxygen and other treatments due to their respiratory symptoms, Medicare will allow you to switch the person over to Medicare Part A without a 3-day SNF stay. Discussion with families and residents should occur about the risks of hospitalization with COVID-19 during this pandemic period.