Skilled nursing facilities are on high alert for signs of coronavirus disease 2019 (COVID-19), as long-term care facilities have been a focal point during the initial spread of the disease in the U.S.
With this evolving situation and the status of elderly residents as high-risk for complications from COVID-19, questions about appropriate changes in procedures and additional precautions are a top concern for many healthcare personnel working in long-term care facilities (LTCF).
While therapy is important to maintaining and improving the mobility and independence of skilled nursing facility (SNF) residents, the way that therapy is provided must be considered carefully.
As healthcare professionals, we are often on the front lines in times of crisis, and yet we may struggle at times to determine what our role should be. We want to provide targeted services to our clients, maintain and improve their health, and at the same time, protect ourselves and our families.
Giving Laser-Like Attention to Infection Prevention
As we all know, infection control measures are at the heart of efforts to prevent the spread of COVID-19. As therapists providing care to elderly residents, we obviously must do our part to be diligent in following infection prevention protocols.
To inform those efforts, the Centers for Disease Control and Prevention (CDC) has issued guidance for SNFs on preparing for the coronavirus, emphasizing that “nursing home populations are at the highest risk of being affected by COVID-19.” According to the CDC, the U.S. has about 15,600 nursing homes with about 1.3 million residents.
Populations at risk for severe illness from the disease include those 65 and older, people living in nursing homes, immunocompromised patients, and people with cardiovascular disease, diabetes, chronic respiratory disease, and cancer.
Although the heightened alert status is new to this virus, the prevention techniques are not. The CDC notes, “The general strategies CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.”
The CDC advises SNFs to educate consultants as well as facility-based personnel about COVID-19 “because they often provide care in multiple facilities and can be exposed to or serve as a source of pathogen transmission.”
Essential or Non-Essential Healthcare Workers
Based on risk factors and the unfortunate outbreak at Life Care Center of Kirkland, Washington, it is understandable that the Centers for Medicare and Medicaid Services (CMS) would be establishing strict guidelines for the ongoing care of the elderly and all patients receiving healthcare.
One question that often comes up during a state of emergency, or in this case a pandemic, is which personnel are considered essential. To best determine this, we should look to the Patient Protection and Affordable Care Act of 2010, which identifies 10 categories of essential healthcare benefits, including rehabilitative services.
As clinicians we fought hard to have therapy included as an essential healthcare benefit. It would make sense that in times of crisis you would want your highly skilled clinicians in place assisting with the care of patients.
An article in Skilled Nursing News emphasizes that therapy is an essential service for SNF residents during the COVID-19 crisis and that physical, occupational, and speech therapy services can help get vulnerable patients home more quickly and into a lower-risk environment.
Keep in mind that therapists’ roles may vary during this emergency situation and you may be asked to assist in areas outside your traditional role. In time of crisis, it is all hands-on deck, and you should rally as a team to assist each other.
Considerations for Continuation of Therapy
As COVID-19 continues to threaten the health of the public in general and SNF residents in particular, facility leaders will need to consider whether providing ongoing therapy services is prudent at their site. That depends on the current environment and the circumstances occurring each day at your location.
If you are practicing at a facility that has no active COVID-19 cases and infection prevention and control systems are in place, your role is to continue working with residents according to their care plans. These residents deserve treatment. However, it may be necessary to modify the way services are delivered.
Therapy can only be provided if you have taken the appropriate safeguards to ensure that you are not putting your patients at risk.
Caring for Patients Who Have COVID-19
If you do have a resident in your facility with COVID-19, the provision of therapy services would be dependent on the comprehensive plan of care prescribed by the physician and the interdisciplinary team.
Also, you should work closely with administration and nursing staff to determine the facility’s COVID-19 policy. If a facility outbreak occurs, facility leaders may decide to cease all group activities, including communal dining, social activities, and therapy services. Any therapy services provided to a resident who is suspected or confirmed to have COVID-19 would more than likely be reserved to one-on-one, in-room-only services.
In these circumstances, you would need to determine how to provide the care the resident requires while minimizing your exposure to the virus’s respiratory pathogens. In addition to following standard infection control procedures, you would also take contact and droplet precautions and use the appropriate personal protective equipment (PPE).
As guidance from the World Health Organization states, healthcare personnel working with suspected or confirmed cases of COVID-19 should adhere to contact and droplet precautions, which require the use of the following PPE prior to entering the patient’s room:
- Disposable gloves
- Non-sterile, long-sleeve gown
- Medical mask
- Goggles or face shields
On an additional note related to PPE, keep in mind that routine use of face masks by healthy team members and patients is not recommended by the World Health Organization. Misuse and overuse of PPE are causing a shortage for healthcare professionals who need them to care for patients with suspected or confirmed cases of COVID-19.
Reviewing Standard Precautions and Protocols
As clinicians, we have been trained to use standard precautions with all interactions with patients, regardless of their illnesses. The CDC defines standard precautions as using PPE whenever there is potential exposure to infectious materials; using appropriate hand hygiene; following respiratory hygiene and cough etiquette principles; and adhering to proper handling, cleaning, and disinfecting of patient equipment, instruments, and devices.
This is a good time to review clinic practices with all staff and consultants to ensure adherence to infection protocols. For additional support, consider reaching out to your facility’s designated infection preventionist for guidance and accessing training resources specific to COVID-19.