March 30, 2020: This Afternoon, the CT Department of Public Health (DPH), in conjunction with the Long-Term Care Ombudsman, announced plans to temporarily designate select nursing homes within the state as COVID-positive and COVID-negative skilled nursing facilities.
This plan will allow facility residents who have tested positive to receive more concentrated skilled care, to have access to more skilled health professionals and equipment at their facility, while maximizing the change that those who have tested negative are at minimal risk of contracting COVID-19 during this wave of infection. However, accomplishing this plan means that many nursing home residents, including those who have not been tested for COVID-19, will be temporarily relocated to other facilities.
This will be deeply troubling to some families concerned about quality and continuity of care for a parent or other senior in a nursing home. In this article, I provide some educated guesses about what this will mean, and also what proactive measures you should be taking in the event that your loved one is selected for relocation.
First, My Assumptions
- You should not be expecting calls about this tomorrow; it is a plan that will unfold during the next several weeks, throughout April and possibly into May.
- This move is likely to have a proactive and reactive phase. In a proactive phase, the state will start relocating resident’s soon to establish dedicated facilities. Then, if individual facilities develop a cluster of infection, moves will be made to confirm and isolate uninfected residents, moving one group or the other.
- In the immediate future, for practical reasons, I would expect the state to focus on low-census facilities for proactive transfers, except of course for facilities that already have outbreak clusters. By low-census facility, I mean nursing homes with a high number of empty beds relative to their size. This is simply the most practical way to do it. Most larger facilities (175+ beds) and those rated poorly by Medicare tend to be low-census facilities.
- In larger facilities that have multiple wings, I would expect attempts to be made to isolate residents in different wings before transfers between facilities is considered. Whether or not that is feasible is based on a number of factors (ability to isolate staff/airflow to separate units; whether units are separated by distance or merely floor; elevator access to different units, etc.). While DPH will move with some quickness, reactive facility changes should and likely will be a last resort.
- If your loved one tests positive for COVID-19 and is moved to a designated facility, I would expect that facilities will have increased respiratory therapy and equipment on site, and residents will only be hospitalized as a last resort. Additionally, toward the height of “the curve,” healthcare workers who have tested positive but are only mildly symptomatic or post-symptomatic could be allowed or assigned to work in the COVID-positive facilities. This can be scary, but in the context of a state-wide response, is a low-risk, and an important one relative to the larger needs of the community.
Some Tips For Relocation
Normally, a nursing home resident can’t even be required to change their room without their permission. In light of the national and state health care emergency declarations, these moves are considered essential, they are not the facility’s decision, and there is not likely to be a significant method of objection or appeal. There are a few things that you can do, however, to make a potential relocation as easy as possible:
1. Ask for psychiatric consult. If your resident is on any significant psychiatric medication, it is likely being prescribed by a visiting Psychiatric APRN from an outside service. If you have any question about whether your loved one is receiving appropriate medication right now, you should ask for them to be seen on the provider’s next visit in, and request a copy of the visit summary.
Unlike other visiting services at nursing homes (podiatry, dental, optical), which can swap providers with little need for continuity, your psych prescriber has relied on a history with your resident and the knowledge of staff familiar with him or her. Additionally, our state has a history of overusing antipsychotic medication in nursing homes to address behavioral issues, which is something that should be monitored. For nursing home residents with severe Alzheimer’s Disease or other forms of dementia, the act of relocating can be very unnerving and cause a need for adjustments in psych meds, but as part of a larger behavioral plan. With a recent assessment from a familiar provider in hand, you will be empowered to have a new, temporary provider justify any changes being made in their drug regimen.
2. Get the transfer orders. If you are notified that your loved one is being transferred, you should ask for a copy of their current physician’s orders, and also ask for a copy of their transfer orders, commonly called a “W-10” when it is ready. You should review the physician’s orders first, and if they seem correct, make sure the diagnoses, medications, and service orders being sent to the new facility match what is currently being recieved. Pay particular attention to the following:
- Prescription Medication Daily meds are normally listed first, followed by “as needed” medication and then over-the-counter medication.
- Major Diagnoses Any chronic or current condition, particularly if it is the basis for medication, should be prominently listed.
- Frequency of Blood Sugar Checks for Type 1 Diabetes
- Frequency of Weigh-ins for Congestive Heart Failure or edema
- Physical Therapy and Occupational Therapy if any is currently received.
- Dietary Plans (low salt, carb-controlled or no sugar for diabetics, chopped or pureed foods for swallowing difficulty, calorie supplement (Boost, Ensure, Hi-Cal) for poor eaters losing weight.
3. Alternate Clothes and Toiletries. While some effort will certainly be made to transfer a loved one with the personal property they will need, oversights are made even on the best of days, and a mass-departure of residents is not nearly that. Under current guidelines, you are not able to visit nursing home residents, and this includes in a new facility after transfer. However, if you have spare clothing or quality toiletries for them, you should still be able to leave these at the new facility to be brought to your relation, ideally after they have physically arrived. For best results,
- Make sure each article of clothing is labelled with the resident’s name on or near the tag. Permanent marker is best.
- Clothing should be clean, in good repair, and neatly folded.
- Goods should ideally be placed in a plastic bag, ideally a clear garbage bag, and contain a note that prominently indicates the name of the resident, and that the clothing has been labelled and freshly washed.
- DO NOT INCLUDE ANY FOOD. Facilities may allow prepackaged, shelf stable snacks such as cookie or cracker snack packs, but even for these get explicit permission first and bring them separately bagged in the original outer packaging from the store.
These steps maximize the chance that your provisions will be promptly delivered to your loved one in their temporary new home.
If you have any questions about a loved one in transition to or from a skilled nursing facility during the outbreak, feel free to call us at (203) 871-3830 or email scott@CTElder.com for a free case assessment.
Read the Full Letter Here:
Dear Resident, Family Member or Responsible Party,
There have now been positive tests for the coronavirus (COVID-19) in many nursing homes across our state. It is normal to have questions, feel uneasy or even scared. This is unprecedented in our lifetimes. The Office of the Long-Term Care Ombudsman and the Department of Public Health have received many calls from residents and family members as they look for Information about how to protect themselves.
We understand that this period of uncertainty and extra safety measures is incredibly challenging. The Governor, In consultation with the State Department of Public Health, has had to make extremely difficult decisions that impact all of you. It has not been easy to know what will come next, but I am thankful that at every step State Officials have kept the rights of residents at the forefront of their decision making and want to keep all parties informed.
Unfortunately, we are at a point in this pandemic that more extreme precautions need to be taken. This is not something any of us ever thought would happen in our long-term care community, but these are unprecedented times. We must take immediate action to prevent and delay further spread of COVID-19 to keep all residents and staff safe. These measures, outlined below, will impact residents throughout Connecticut.
In order to protect residents, the state will designate specific nursing homes for residents who have tested positive for COVID-19 and those who have not. Providing this physical distance is an attempt to concentrate the care and service needed to provide the highest level of care for each group of residents.
This means that some nursing homes will have to move residents to another nursing home. Residents who have tested COVID-19 positive will be transferred to a nursing home that has been designated as a COVID-19 positive home. If a nursing home has been designated as a COVID-19 positive home, residents who are negative or without symptoms will need to be transferred to a home that has been designated as a COVID-19 negative nursing home.
This measured decision is the only option available at this time. This will be in effect for an unknown period of time, perhaps months, but will allow you to transfer back to your home when it has been determined that this separating of residents is no longer necessary. We know this is going to be overwhelming for both residents and families. As we have learned from other areas of the country, to address the pandemic and meet the health, safety and well-being of all residents, these necessary measures must be taken and begin as soon as possible.
If you or your loved one need to move to another room or nursing home, a team member from your nursing home will contact you directly. The rights, safety and well-being of the residents are always at the forefront of the State Official’s decision making. This is an incredibly trying time and we are asking for your assistance keeping residents’ well-being as the priority.
We will be setting up Zoom meetings for residents and families to have an opportunity to ask questions to representatives of the Department of Public Health and the Long-Term Care Ombudsman Program. We will be providing the dates and times for these meetings through your nursing home as well as on the Long-Term Care Ombudsman website (https://portal.ct.gov/LTCOP), Facebook page (https://www.facebook.com/CTLTCOP) and the Department of Public Health website (https://portal.ct.gov/DPH).
If you have specific questions or concerns related to your nursing home, you can contact the Long-Term Care Ombudsman’s office at: 860-424-5200, or toll-free 1-866-388-1888.
The Long-Term Care Ombudsman Program and the Department of Public Health are here to support you through this very challenging time. Please remember it is normal to have questions, feel uneasy or even scared due to this unprecedented situation. Our offices as well as the care team members at your nursing home are here for you. Reach out, tallk about how you are feeling and what you think might help you cope with all of this. We need to do things differently right now and will continue to offer support so that we can get through this together.
Sincerely,
Mairead Painter, State Long-Term Care Ombudsman
And
Donna Ortelle, R.N., M.S.N., Section Chief, Facility Licensing & Investigations Section
Letter to Families LTCOP/DPH, March 30, 2020