Over recent weeks, hospitals nationwide have swelled with critically ill people suffering from COVID-19 infection. Many patients who’ve recovered from coronavirus will need post-acute care (PAC), which could be provided at home or in a specialized facility like outpatient therapy.
However, a recent article in the Journal of the American Medical Association explains that PAC facilities currently lack the ability and capacity to treat COVID-19 patients leaving the hospital.*
As the majority of hospitalized patients will recover even if they belong to a high-risk group, how will they safely receive the PAC they need?

What is PAC?

  • Patients recovering from COVID-19 require PAC to recuperate, consisting of rehabilitation or palliative services after a stay in an acute care hospital. This service may include a stay in a medical facility, ongoing outpatient therapy, or care provided at home.
  • The main rise in PAC demand is projected to happen after the hospital surge of patients with COVID-19. Yet, “PAC facilities currently lack the capacity and capability to safely treat patients with COVID-19 in their transition from the hospital to other care settings or their homes.”
  • Previous data of patients with sepsis, a condition with a similar inpatient death rate as COVID-19, indicate roughly 30% of recovering patients will need care in a facility and an additional 20% home health care.
  • PAC helps free up hospital beds to those still critically ill.

The authors note, however, that transition of COVID-19 patients into the skilled nursing facility population may be problematic since some patients may still be contagious and able to transmit disease.

Skilled nursing facilities not ready for coronavirus outbreak 

  • Skilled nursing facilities presently do not have sufficient personnel and equipment to resist the pandemic. An example of this is the March 16, 2020 COVID-19 outbreak at Life Care Center in Kirkland, Washington, causing the death of 30 people or about 25% of its residents.
  • Strict rules have now been implemented in these facilities, including no-visitor policies, no group activities, and no communal dining, initiated by the Centers for Medicare & Medicaid Services.  

What could be done to prevent the spread of infection from discharged patients?

  • All patients must be tested for COVID-19 before entering a PAC setting, “regardless of whether they were being treated for COVID-19 at the hospital.”
  • Specialized PAC facilities (“centers of excellence”), such as hospital-based skilled nursing, could be developed and dedicated for patients recovering from COVID-19 who may be potentially contagious.
  • Rural hospitals, skilled nursing facilities, or retrofitting unused buildings such as college dormitories could be effective for PAC.
  • Treating recovering patients in their own homes could avoid isolation challenges, although the level of care may be too high for home health to manage. 
  • Telemedicine should be expanded to address physician shortages from increased demand while helping avoid in-person contact. Recent Medicare reimbursement for telemedicine makes this feasible.

To avoid “playing catch up” like the US has been with COVID-19 testing, social distancing, and hospital capacity, the authors conclude that making PAC policy and delivery changes today could enable the ability and capacity needed in the months ahead.

Find the research article in the Journal of the American Medical Association.

*Grabowski, D.C. & Joynt Maddox, K.E. (2020, March 25). Postacute Care Preparedness for COVID-19: Thinking Ahead. Journal of the American Medical Association.