A Health System Response to COVID-19 in Long-Term Care and Post-Acute Care: A Three-Phase Approach

Gina Kim; Mengru Wang; Hanh Pan; Giana H Davidson; Alison C Roxby; Jen Neukirch; Danna Lei; Elicia Hawken-Dennis; Louise Simpson; Thuan D Ong

doi:10.1111/jgs.16513

A Health System Response to COVID-19 in Long-Term Care and Post-Acute Care: A Three-Phase Approach

J Am Geriatr Soc. 2020 Jun;68(6):1155-1161. doi: 10.1111/jgs.16513. Epub 2020 May 30.

Authors

Gina Kim¹, Mengru Wang¹, Hanh Pan², Giana H Davidson^{3

4

5}, Alison C Roxby^{6

7}, Jen Neukirch, Danna Lei³, Elicia Hawken-Dennis^{2

3}, Louise Simpson³, Thuan D Ong^{1

3}

Affiliations

¹ Division of Gerontology and Geriatrics, Department of Medicine, University of Washington, Seattle, Washington.
² Office of the President, University of Washington, Seattle, Washington.
³ Post-Acute Care Services, University of Washington, Seattle, Washington.
⁴ Department of Surgery, University of Washington, Seattle, Washington.
⁵ Department of Health Services, University of Washington, Seattle, Washington.
⁶ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington.
⁷ Department of Global Health, University of Washington, Seattle, Washington.

Abstract

Background: The Seattle, WA, area was ground zero for coronavirus disease 2019 (COVID-19). Its initial emergence in a skilled nursing facility (SNF) not only highlighted the vulnerability of its patients and residents, but also the limited clinical support that led to national headlines. Furthermore, the coronavirus pandemic heightened the need for improved collaboration among healthcare organizations and local and state public health.

Methods: The University of Washington Medicine's (UWM's) Post-Acute Care (PAC) Network developed and implemented a three-phase approach within its pre-existing network of SNFs to help slow the spread of the disease, support local area SNFs from becoming overwhelmed when inundated with COVID-19 cases or persons under investigation, and help decrease the burden on area hospitals, clinics, and emergency medical services.

Results: Support of local area SNFs consisted of the following phases that were implemented at various times as COVID-19 impacted each facility at different times. Initial Phase: This phase was designed to (1) optimize communication, (2) review infection control practices, and (3) create a centralized process to track and test the target population. Delayed Phase: The goals of the Delayed Phase were to slow the spread of the disease once it is present in the SNF by providing consistent education and reinforcing infection prevention and control practices to all staff. Surge Phase: This phase aimed to prepare facilities in response to an outbreak by deploying a "Drop Team" within 24 hours to the facility to expeditiously test patients and exposed employees, triage symptomatic patients, and coordinate care and supplies with local public health authorities.

Conclusions: The COVID-19 Three-Phase Response Plan provides a standardized model of care that may be implemented by other health systems and SNFs to help prepare and respond to COVID-19. J Am Geriatr Soc 68:1155-1161, 2020.

Keywords: COVID-19; coronavirus; long-term care; nursing home; post-acute care.

MeSH terms

Adult
Aged
Aged, 80 and over
Betacoronavirus
COVID-19
Coronavirus Infections*
Female
Health Plan Implementation / methods*
Humans
Infection Control / methods*
Long-Term Care / methods*
Male
Middle Aged
Pandemics*
Pneumonia, Viral*
SARS-CoV-2
Skilled Nursing Facilities
Subacute Care / methods*
Washington / epidemiology