The good news is that the vast majority of coronavirus patients who end up in the hospital recover. The bad news is that there are few places who will take them in if they need to be discharged to another medical care center.
According to David Grabowski, a Harvard professor who studies post-acute care, there isn’t a nursing home in the country who would accept a patient who has been tested positive for COVID-19.
He tells Axios that a flood of coronavirus patients who need further care would put a huge strain on our already overwhelmed healthcare system. Since nursing homes already have a poor track record of controlling infections and are also prime places for the disease to spread and kill, stringent regulations and options must be set in place, says Grabowski.
One of his recommendations, according to Axios, is that individual states should assign post-hospital facilities dedicated only to COVID-19 patients to contain the risk of spreading.
According to Tradeoffs, at least two states, Connecticut and Massachusetts, have designated select nursing homes as COVID-only facilities. This eliminates the need for isolation, but requires moving existing patients to other facilities, which can be upsetting. Grabowski suggests using dorms and hotels as designated facilities to avoid disrupting existing patients in homes.
Another option is to send patients home to be cared for by home health agencies. They are the largest providers of post-acute care, serving about twice as many people as skilled nursing facilities, according to Tradeoffs.
“If patients get intensive, hospital-like care at home, it can lead to lower costs and fewer hospital readmissions,” says Rachel Werner, executive director of the Leonard Davis Institute of Health Economics. “People have set up the equivalent of a hospital at home to prevent them from being hospitalized. They send them home with 24/7 monitoring, using remote technology and frequent visits from nurses and doctors.”
To make this option work, Werner says Medicare would have to start paying for more home visits and also for telephone and video visits. Currently, it is limited to one visit per day. The second thing required is to have Medicare pay informal caregivers to provide the type of care needed to help people rehabilitate at home, she tells Tradeoffs.
Grabowski sees an opportunity in the challenge of finding the best post-hospital care for COVID-19 patients.
“I feel like with the coronavirus, we’ve been playing catchup from the very beginning,” he tells Tradeoff. “We were obviously behind in testing. We’ve been behind on physical distancing. We’ve been behind on building enough hospital ICU beds. Post-acute care is actually an opportunity for us to get ahead.”
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