As it has for so many aspects of our lives, the COVID-19 pandemic has completely changed the way many skilled nursing facilities (SNF) function. Policies and procedures are constantly evolving, so SNFs need to ensure that they are taking appropriate actions and documenting all that is required. As the pandemic continues to evolve, the documentation requirements evolve as well. “As you're reviewing and updating your policies and procedures, make sure that your policies are dated and that you are keeping your prior versions,” recommends Todd Selby, attorney at Hall, Render, Killian, Heath & Lyman, PC.
There are few communities hit harder by COVID-19 than the elderly nursing home population. Not only are outcomes for older individuals who contract the virus poorer, but the isolation practices necessary to keep them safe can cause a host of new health issues. Although skilled nursing facilities (SNF) are under strict requirements and must be vigilant about isolation and infection control practices to keep COVID-19 at bay, SNFs also need to ensure that depression, anxiety, and confusion don’t take over their facility.
The COVID-19 pandemic has shaken things up for SNFs and affected nearly all day-to-day activities. In order to reduce the burden for SNFs, the Centers for Medicare and Medicaid Services (CMS) has issued a variety of blanket waivers to cut through red tape that SNFs typically face. The waivers are set to last as long as the pandemic is declared a national emergency, although we don’t yet know when that declaration will expire.
Oxygen is necessary for life. Some diseases and conditions prevent enough oxygen from nourishing the body’s tissues, so supplemental oxygen is administered. Oxygen is a basic need at the lowest level of Maslow’s hierarchy of needs. Needs at the lower levels must be fulfilled before needs at the higher levels become important. Because the need for oxygen is a low level need, the resident who is having trouble breathing cannot focus on much else. Oxygen is a prescription item, and a physician’s order is necessary to administer it to a resident. Your facility policies may permit nurses to administer oxygen in an emergency, but if a general standing order is implemented for a resident, physician notification and a proper order are necessary.
As organizations around the country are beginning to reopen, the future for SNFs is still up in the air. “[The Centers for Medicare and Medicaid Services (CMS)] has emphasized that our SNFs are some of the most vulnerable populations and vulnerable facilities,” says Stefanie Corbett, DHA, founder of Corbett Healthcare Solutions, so before returning to any sense of normalcy, there are many precautions that SNFs need to take. While each state can create its own criteria for reopening SNFs, there are guidelines that all SNFs should follow for the safety of their staff, residents, and visitors.
As CMS focuses surveys on infection control in SNFs, it’s important for SNFs to make sure they have all of their bases covered. Proper infection control measures are imperative to keeping residents and staff safe as COVID-19 spreads. The following is a sample of the CMS infection control self-assessment tool. The entire tool can be viewed on the CMS website.
COVID-19 has disrupted SNFs throughout the U.S., and without proper infection control in SNFs, it will continue to do so. The following is an excerpt from the book, Infection Control: How to Implement an Effective Approach for Long-Term Care by Brian Garavaglia, PhD, available for purchase on the marketplace.
I never thought I would see this question in my lifetime, particularly in 2020, the Year of the Nurse. Several nurses have begun asking, “What is the skilled service if the resident isn’t receiving rehab services?” Every time I hear that question, I cringe. Have we been wrapped up in the “720 minute” world for so long that we’ve forgotten what skilled nursing care really is? Unfortunately, I think the answer is yes. Even during a pandemic, we have nurses who can’t recognize the value of what they are doing.
SNF surveys have pivoted over the past few months to focus on infection control amid COVID-19 outbreaks. “CMS did refocus their efforts in the midst of the pandemic to make sure that they can provide support to the community that we serve, as well as facilities by making sure that facilities were compliant with infection control practices,” explains Stefanie Corbett, DHA, in the Post-Acute Advisor podcast “Infection Control Surveys and Reopening SNFs,” available on SoundCloud. However, resident care is something that all SNFs should focus on every single day and be prepared for when regular surveys resume.
Personal protective equipment (PPE) has become an integral part of day-to-day life at SNFs. While PPE usage is standard in infection control areas of healthcare, it’s not something commonly used at SNFs. To aid SNF staff in properly wearing masks, CMS has compiled steps healthcare workers should follow to effectively don and doff masks.