How a Barcelona Post-Acute Facility became a Referral Center for Comprehensive Management of Subacute Patients With COVID-19

Abstract

The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in posteCOVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.

Nursing Homes and Long Term Care After COVID-19: A New ERA?

“…This may have contributed to further spreading SARS-CoV-2 within facilities and has led to questions about levels of medical and palliative care, with palliative care and access to integrated medical care already undeveloped (6). There are very few international examples of actions to increase health care, either within homes (7,8) or by providing care in hospitals or sub-acute facilities (9) during the crisis.…”

Two European Examples of Acute Geriatric Units Located Outside of a General Hospital for Older Adults With Exacerbated Chronic Conditions

“…Another benefit is that this model of care can be scaled up within a facility; the SCU was scaled up and used to deliver acute care to older adults affected by COVID-19. 23 Telemedicine could also be implemented within this model of care for example by inviting consulting specialists and primary care providers to partake in multidisciplinary consultations. 21,46 Moreover, the Ear-lySense could also be used to monitor vital signs (ie, respiration and heart rate) from an outside location.…”

“…14,22 Recently, this model of care was successfully scaled up to provide acute care to older adults affected by COVID-19 and thereby reduce the caseload of general hospitals. 23 In the Netherlands, a similar unit, the Acute Geriatric Community Hospital (AGCH), opened in 2018. 24 These 2 units, the SCU and the AGCH, both offer an age-friendly environment, where a comprehensive geriatric assessment (CGA) is used to direct care and provide early rehabilitation.…”

Design and Implementation of a Skilled Nursing Facility COVID-19 Unit

“…At least 2 other SNF COVID-19 units, perhaps the most similar reported models to our own, have been described, one in a Veterans Affairs hospital/post-acute facility in southern California and another in a post-acute facility in Barcelona, Spain. 12,13 The Veterans Affairs unit was physically attached to an acute hospital, took only post-acute patients referred from that hospital who were in the recovery phase of COVID-19 with clinically mild signs/symptoms, and relied entirely on in-person provider visits. The Barcelona unit had a similar target population (both post-acute and direct access) and referral sources (hospital, ED, community) to our own, but also relied completely on in-person visits and benefited from being housed in a facility with much greater baseline provider support (dedicated physicians already present on a daily basis and on-call 24 hours per day before the pandemic).…”