Collateral Damages and Silver Linings

The obvious damages from COVID-19 in Post-Acute and Long-Term-Care are well known, devastating, and compelling us to change.

  • Mortality – exacerbated by chronic conditions and the high risk of frailty
  • Depression, anxiety – increased by separation from social support systems
  • Weight loss – aggravated by isolation and less mealtime support
  • Deconditioning – increased by lack of usual therapy and freedom to move about
  • Cognitive impairment – made worse by isolation, changed routine, PPE
  • Increased frailty – exacerbated by residual cognitive and functional impairments

To these visible outcomes, there is damage to the long-term-care industry’s image, financial instability, future viability, and the tremendous toll on the front line caregivers.

The silver linings are being identified for encouragement and to set the stage for a future where Post-Acute and Long-Term-Care can withstand the anticipated ravages of infection, frailty, and chronic illness and where best practices in geriatric medicine are known and incorporated into the model of care.

  • Telemedicine – increased and made health care possible for many disciplines
  • Frailty – understood as the risk factor contributing to excessive mortality
  • CMS Waivers – fast-tracked and approved with beneficial changes
  • Advance Care Planning – awareness of the importance of completion before a crisis
  • Isolation’s devastating impact – unique approaches for mealtimes and exercise
  • Fewer falls – less walking about – expected to increase from deconditioning
  • Infection Control weaknesses – acknowledged and plans to address have begun

The modernization of Post-Acute and Long-Term-Care needs to continue and the need for a higher quality model of care is enormous now and increasing as the aging population continues to grow. An era of innovation, somewhat overdue, has begun and will need to expand further to survive. Much has been written about all the changes needed to improve care and if experts in geriatric medicine help to reshape the model these advances may continue and be expanded:

  • Telemedicine – routinely used by specialists and facility clinicians
  • Frailty – consistently measured, communicated, and informing clinical care
  • Advance Care Planning – commonly included in the admission assessment
  • Isolation – designated caregivers and other approaches will be implemented
  • Deconditioning – prevented with adapted PT and OT program
  • Depression – routinely assigned visits by recreational therapists or social workers
  • Infection Control – consistently modernized and PPE always available
  • CMS Involvement – more supportive and instructive than punitive

 

These clinically relevant interventions will frame a model of care that is more appropriate for those who because of frailty are at high risk for the sudden and precipitous decline and will advance best practices in geriatric medicine. Unfortunately, this new model will not address the financial deficiencies, staff shortages, or the general tendency to forget the Post-Acute and Long-Term-Care world. 

“The way we’ve created nursing homes, they’re so separate from real life that it is altogether too easy for people to go back to their lives and just kind of forget about it and not make a difference.” (Dr. Louise Aronson, 2020)

For more information on frailty and best practices in geriatric medicine contact the Patient Pattern team today.

 

For interesting reading:

Ideal Nursing Homes: Individual Rooms, Better Staffing, More Accountability
https://www.npr.org/2020/05/21/855821083/ideal-nursing-homes-individual-rooms-better-staffing-more-accountability
WHO Calls for A “Rethink’ of Elder Care After COVID-19 Losses
https://www.medscape.com/viewarticle/937335
The Time for ‘The Talk” Is Now
https://www.nytimes.com/2020/05/19/well/live/coronavirus-end-of-life-health-care-proxy-hospitals-doctors.html
Frailty Index Predicts Poor Outcomes in COVID-19 Patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246290/