Post‐Acute Care Preparedness in a COVID‐19 World

Abstract

Coronavirus disease 2019 (COVID‐19) has led to a surge of patients requiring post‐acute care. In order to support federal, state and corporate planning, we offer a four‐stage regionally oriented approach to achieving optimal systemwide resource allocation across a region's post‐acute service settings and providers over time. In the first stage, the post‐acute care system must, to the extent possible, help relieve acute hospitals of non‐COVID‐19 patients to create as much inpatient capacity as possible over the surge period. In the second stage after the initial surge as subsided, post‐acute providers must protect vulnerable populations from COVID‐19, prepare treat‐in‐place protocols for non‐COVID‐19 admissions, and create and formalize COVID‐19 specific settings. In the third stage after a vaccine has been developed or an effective prophylactic option is available, post‐acute care providers must assist with distribution and administration of vaccinations and prophylaxis, develop strategies to deliver non‐COVID‐19 related medical care, and begin to transition to the post‐COVID‐19 landscape. In the final stage, we must create health advisory bodies to review post‐acute sector's response, identify opportunities to improve performance going forward, and develop a pandemic response plan for post‐acute care providers. J Am Geriatr Soc 68:1150–1154, 2020.

Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery

“…Post-acute care has been recognized as required for COVID-19 patient recovery; respiratory physiotherapy and other post-acute rehabilitation are necessary to return these individuals to functional levels as quickly as possible. 37 , 38 , 39 , 40 , 41 , 42 Even with a less severe COVID-19 response, therapy may be required to counteract muscle weakness that could delay patient recovery. 17…”

COVID‐19 in Nursing Homes: Calming the Perfect Storm

“…[60][61][62][63][64] Further development of units for viral-positive residents and those who require quarantine after hospitalization in wings of existing facilities, dedicated facilities, or repurposing existing locations in the community is essential. [65][66][67][68] Without this capacity, we may not be able to manage additional waves of COVID-19 that may occur (and are already occurring in some states), as well as for the surge in other respiratory illnesses that will add to the need during the upcoming fall and winter. Many organizations have developed geographically separate COVID-19 units within facilities with separate entrances and exits and dedicated staff.…”

“…Other approaches, such as repurposing large spaces for temporary use, as was done early during the pandemic, may be necessary in some areas. 67,68…”

Spatial association patterns between post-acute care services and acute care facilities in the United States

“…There is also absence of a uniform response across states and local providers. For example, some local agencies completely ban the transfer of patients to post-acute services regardless of COVID-19 status, while others accept all patients to relieve hospitals from overwhelming capacity constraints [38]. Post-acute care is expected to have a paramount importance in COVID-19 era and geography will be a local moderator.…”

“…For example, in urban areas, post-acute services will have to serve as valve to preserve acute care hospital capacity or re-purposed as designated post-COVID-19 centers. These roles may not apply in the rural setting and the optimal nationwide and regional resource use for postacute care during the epidemic is a matter of ongoing debate [38].…”