Postacute Care Preparedness for COVID-19

Abstract

National projections suggest that hospitals may be overwhelmed with patients with coronavirus disease 2019 infection in the coming months. Appropriately, much attention has addressed the acute challenges in caring for this surge of critically ill patients. What has received less attention, however, is what happens as patients-most of whom will recover, even in the highest-risk groups-begin to do so. Many patients with COVID-19 will need postacute care to recuperate from their infection. However, postacute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes. In this Viewpoint, we present the scope of the problem and outline a series of steps that may be helpful as postacute care organizations prepare for the coming increase in patients with COVID-19.Postacute care includes rehabilitation or palliative services that beneficiaries receive following a stay in an acute care hospital. 1 Depending on the patient's needs, treatment may include a stay in a facility, such as a skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital, or care in the home via a home health agency. Although data are limited regarding the proportion of patients with COVID-19

COVID-19 in older adults: clinical, psychosocial, and public health considerations

“…Furthermore, there have been tragic instances of COVID-19 patients dying alone without their loved ones nearby. These risks can be mitigated to some extent by rapid testing of vulnerable population caregivers and having good, honest, and in-time communications with families early and often (18).…”

The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic

“…11 The COVID-19 pandemic has placed additional burden on shortterm skilled nursing facilities, thus it is likely that patients might be discharged home with even greater medical complexity and higher vulnerability to readmissions. 12 Two robust risk factors for hospital readmission are impaired physical function and unmet need for activities of daily living…”

“…Because many nursing homes are unprepared or unwilling to take patients with COVID-19 who have recovered but may still be infectious, there will be a growing burden on home health care agencies and community clinicians to meet this demand. 12 Currently, practice patterns in home health care have not been intensive, with the average older adult discharged from the ICU receiving only 4 visits of home rehabilitation. 27 Published reports have also decried lack of availability of effective post-ICU rehabilitation in clinic-based settings, 28…”

American Geriatrics Society Policy Brief: COVID‐19 and Nursing Homes

“…These include heightening infection control, banning visitors, and eliminating all group activities. 2,12 Despite these early efforts, many NHs are reporting infections among residents and staff. Most states not yet in crisis are actively planning across multiple domains.…”