IHCA/INCAL’s Statement Addressing Various Issues Affecting Long Term Care Facilities During COVID-19 Public Health Crisis

INDIANAPOLIS, IN (April 14, 2020) – Zach Cattell, President of the Indiana Health Care Association, issued the following statement that addresses recent state orders directing long term care facilities to accept patients from hospital and create COVID-19 dedicated units:

In the last few weeks, long term care facilities have received unprecedented targeted direction by federal and state governments to help mitigate the spread of COVID-19. We are in extraordinary times and recognize that all parties are making highly complex decisions often based on rapidly evolving situations. We offer our perspective on some of the challenges confronting long term care providers that can impact their ability to effectively fight the virus and protect our state’s frail and elderly population.

Patient Transfers from Hospital

Long term care facilities are home to individuals who are most vulnerable to the deadly COVID-19 virus. These facilities are also an important part of the care continuum. The Indiana State Department

of Health (ISDH) has made certain recommendations regarding the transfer of patients from hospitals to nursing facilities for surge management. We have worked with Indiana hospitals and the ISDH to ensure that long term care facilities are not forced to admit residents with COVID-19 or suspected of having COVID-19 if the facility is not equipped and staffed to implement the government-recommended isolation protocol. Anything less than supporting local collaboration between hospitals and long-term care facilities based on their settings, needs, and capabilities would not be appropriate.

We urge the state to continue to identify alternative treatment locations to address the surge in COVID- 19 positive patients.

Personal Protective Equipment (PPE)

Frontline workers in long term care facilities are putting their lives on the line every day for their residents. However, PPE is in short supply and for which long-term care facilities are secondary to hospitals in terms of distribution from the national stockpile. We appreciate the efforts of our state leaders to identify supply shortages, but more must be done to prioritize the availability of PPE to nursing facilities to ensure our frontline caregivers are protected from this deadly virus.

COVID-19 Testing

The Centers for Disease Control and Prevention’s (CDC) top priority (Level 1) for testing is hospitalized patients and health care facility workers with symptoms, which is being well addressed. Following these recommendations from our nation’s infectious disease experts, led by Dr. Anthony Fauci and Dr. Deborah Birx, we should make every effort to test patients in long-term care facilities with symptoms, and other patients over 65 or those with underlying conditions with symptoms. With this information, those patients can be more precisely cared for, properly segmented between non-COVID and COVID-19 positive patients, and referred to acute medical care when the need arises – all of which is in accordance with CDC and the Centers for Medicare & Medicaid Services guidance.

As it stands today, however, we have significantly under-tested these critical patient populations who have the highest mortality rate. Furthermore, long delays in obtaining test results are putting the lives of our residents and employees at risk, and are only compounding the problem. We urge the state to prioritize testing for nursing facility residents and that those results are accurately reported to the providers in a speedy manner.

Federal and State Guidance to Create Dedicated COVID-19 Units

The Centers for Medicare & Medicaid Services and the ISDH issued guidance in the past two weeks on creating dedicated units within facilities to minimize interaction of infectious individuals from non- infected individuals as much as possible.

We believe decisions about resident transfers should be based on guidance from federal and state governments, and not based on fear or averting treatment for COVID-19 positive citizens in a given community. Unfortunately, some long-term care facilities that desire to do the right thing according to the guidance from government, have been directly confronted with fear and misunderstanding. It is our job to help create better understanding and acceptance of the difficult choices that are being made in our health care system during the pandemic.

These difficult choices may mean that residents have to be moved from one long term care facility to another, even if they are not symptomatic or a positive for COVID-19. The guidance from federal and state authorities specifically addresses this issue. It is not an easy choice to make or option to carry out, but our communities are part of the solution and are working closely with our leaders in state government to help.

We are working with our members and providers across the state to better understand their capabilities with opening dedicated COVID-19 treatment units. The challenge for all involved is that we develop a collaborative, realistic plan that considers the “on-the-ground” realities of particular situations, including long term care facility resources, among other considerations.

Long term care facilities and their staff will continue to do their best to follow the rapidly changing government recommendations and ensure the best care possible is provided to residents. We all have one goal in mind – to protect our residents from the deadly COVID-19 virus.

Clear and rapid communication is imperative between long term care facilities, residents and families, hospital partners, and local and state governments to ensure the best possible protection and care of our residents. Together, we can further protect the most vulnerable among us during this difficult time.”

ABOUT IHCA/INCAL

 IHCA/INCAL is the state’s largest trade association and advocacy group representing for-profit and not- for-profit nursing homes, as well as assisted living communities and independent living. The association provides education, information, and advocacy for health care providers, consumers, and the workforce on behalf of its more than 446-member facilities.

CONTACT

Indiana Health Care Association

Deeksha Kapoor, Director of Communications

dkapoor@ihca.org | (317) 616-9002