key: cord-320104-cgzqwbzs
authors: Lester, Paula E.; Holahan, Timothy; Siskind, David; Healy, Elaine
title: Policy Recommendations regarding Skilled Nursing Facility Management of COVID-19: Lessons From New York State
date: 2020-06-02
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.05.058
sha: 
doc_id: 320104
cord_uid: cgzqwbzs

ABSTRACT To provide policy recommendations for managing COVID-19 in Skilled Nursing Facilities (SNFs), a group of certified medical directors from several facilities in New York state with experience managing the disease used email, phone, and video conferencing to develop consensus recommendations. The resulting document provides recommendations on screening, and protection of staff, screening of residents, management of COVID-19 positive and presumed positive cases, communication during an outbreak, management of admissions and readmissions, and providing emotional support for staff. These consensus guidelines have been endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society.

COVID-19 has rapidly affected the health care systems in New York. The impact of this 15 pandemic has been widely recognized in hospital systems but guidelines for care for this 16 disease in the Skilled Nursing Facility (SNF) are sorely lacking. 17 One of the biggest challenges we have faced in SNFs is the transmission by 18 asymptomatic carriers and patients. As a result, COVID-19 can insidiously spread prior to 19 awareness of the first case, which leads to rapid spread within the facility. 1 Many older adults 20 manifest COVID-19 with low grade temperatures, diarrhea or fatigue, and may not have overt 21 respiratory symptoms -causing rapid spread without detection. 22 We describe expert consensus policies for SNFs to prepare for and manage COVID-19. 23 METHODS 24 The consensus statements presented here have been formulated by the authors who 25 had experience with outbreaks of COVID-19 as the SNF community needed to rapidly adapt to 26 the dynamic changes which occurred in these healthcare facilities during this unprecedented 165 6. Consider antibiotics if concern for bacterial pneumonia. can be admitted to a "transition" unit for 14 days while they are monitored for 278 symptoms of COVID-19 and tested if indicated (and available). 279 Additional supportive measures for staff and residents: 280 • Unlike hospital staff who generally care for patients for short periods of time, the SNF 281 staff care for SNF residents often for many years. This strong connection can make the 282 death of SNF residents even more devastating. Emotional support should be provided to 283 staff as they grieve loss of residents. 284 • Cheerful drawings and messages from the community can be uplifting to SNF workers 285 and patients. They can be posted in hallways and distributed to residents. 286 • Many hospitals are touting their "success" stories as patients coming off a ventilator or 287 being discharged. "Success" in the SNF, especially for long term care residents, is 288 different.

• "Success stories" for the SNF which can be acknowledged: 

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