Karen McPhail, RN, MSN
Additional Guidance and Updates as Things Unfold - Covid-19
These are stressful and challenging times as things are changing on a daily basis in these uncharted waters. In speaking with clinicians today across the country and through Mid Atlantic town hall discussions with those in the local health care community we have learned the following
In terms of policy issues - The House has passed and hopefully today the Senate will pass: expansion of the federal contribution to Medicaid, senior nutrition, and the family leave and sick benefit. Telehealth is also being addressed and expanded upon. New Telehealth codes and Telehealth office based codes have been opened up to allow for Telehealth services via a variety of platforms including Skype, FaceTime, Zoom, etc so that clinicians can cover patient needs from anywhere including home. Remote patient monitoring will go hand in hand with this and is also being expanded upon by many to allow for blood pressure, weigh, pulse oximetry and more to be monitored in real time. Mental health monitoring aspects are also being discussed.
Development of virtual senior centers needs to be expanded upon - please reach out if interested in this or doing work in this area locally as we want to get the word out to others!
Since visitation for safety is not permitted at this time in care communities I encourage family members to check in by phone and provide virtual options to their loved ones if possible. Amazon echo can a be great, easy option as you can even do an audio check in through the simple dot. I pads and other mechanisms can also be used as care community staff should be able to provide assistance with these items for residents.
Local care communities need to follow CDC guidelines. Residents who are moving into a community or returning to the community from the hospital or a rehab stay should be quarantined in their apartment home for 14 days. This includes residents who had an inpatient stay or simply visited the emergency room, but were not admitted. Residents returning from a rehab stay should notify the community one week before they plan to return to ensure a proper assessment is completed based on testing and clearance guidelines at the time. Any residents moving into a care community should be required to provide a physicians statement certifying that they are free of any communicable disease. in addition to normal screening. Residents who choose to leave the care community to stay with their families should be screened prior to their return. If a resident is on quarantine at a care community, all meals and any care such as occupational or physical therapy will need to be provided in their apartment. The care community should provide socialization opportunities and activities for the resident to do in their apartment to help them to stay engaged from a physician and cognitive standpoint while the quarantine period is in place. Mental health aspects should. be routinely assessed and addressed with all residents in quarantine. It is critical that care communities do everything possible to minimize spread and keep the virus out of their communities. These procedures follow guidance provided by the Virginia Department of Health and the Centers for Disease Control and Prevention (CDC), so there should be no exceptions being made in any care communities as this would be unacceptable and put all at risk.
Hospitals and other medical providers are running out of personal protective equipment (PPE). If we have staff exposure we will have less staff to provide care for a still growing demand, which is clearly a problem. Medical providers without PPE are encouraged to reach out to their local emergency network to tap into the national stockpile for supplies. Some medical centers such as UMMS are looking at creative approaches such as cloth mask production which is still being evaluated for effectiveness, but has approximately 80% coverage in terms of protection. Other local Northern VA medical centers are proactively planning in a variety of areas and for projected increasing numbers of ICU beds and ventilators needed to try to limit shortages.
More and more companies are developing Covid-19 tests. Several are local in the MD area. There is still a shortage of tests, but by next week many are optimistic that we will have a reasonable supply locally and we are hoping to have a faster turn around time for testing. However, current tests are being found to have false positives and negatives. An approximate 30% false negative rate has been recently reported. Some clinicians are indicating that we may need to test individuals more than once as a result. Again these are uncharted waters so things are changing daily.
Many clinicians are recommending that home care companies advise live in caregivers when possible to minimize the caregivers going in and out of homes. Homecare companies are encouraged to have COVID-19 training with all staff and to do updates n policy and procedure changes as they unfold.
Since Covid-19 is transmitted through mucous membranes (eyes, nose, mouth), nebulizers can be a transmission risk and shed the virus so those who can be safely transitioned off of a nebulizer and converted to another lower transmission risk respiratory treatment / medication may need to be advised to do so to minimize the risk to others and private duty. Physician guidance will be critical for these individuals as always.
Highest risk individuals are those with chronic respiratory issues (COPD), cancer (immunosuppressed), and heart disease. Many are dying as a result of the disease from ARDS or through myocarditis as the virus then is attacking the heart.
Discussions about how to best manage care overall due to projected volumes continues on the part of clinicians across the country. For example what are going to be the discharge protocols to assisted living, skilled nursing, rehab, etc to minimize risk to communities and residents? How can care be shifted to skill nursing from hospitals to handle volumes and then to assisted living... How can Medicare and Medicaid through legislation perhaps be modified to meet needs in these care environments. There are no simple answers at this time, but things will continue to change and evolve. We will continue to provide updates as things unfold. Stay safe and well!