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From Dorms to Tents, Hospitals Adapt for COVID-19; Some Patients Are Stuck

The gyms and dorm rooms at Sonoma State University in California are an alternate care site for St. Joseph Health System in Santa Rosa and other health care organizations that have to be creative as they place patients with COVID-19 and “persons under investigation” for the coronavirus who have nowhere to safely isolate. There are so many variations, including patients who are medically safe for discharge from the hospital but may be turned away by skilled nursing facilities (SNFs) despite CMS’s blanket waiver of a three-day qualifying hospital stay,[1] and patients who are on methadone but can’t go out for their maintenance dose. Depending on where they are, some hospitals are strategizing like mad, working with SNFs, setting up temporary locations, and dispatching home health nurses to patients who are only considered homebound because of a COVID-19 blanket waiver.

“We are coming up with interesting things,” said Sue Pearce, Sonoma County area director of care management at St. Joseph. “Layer after layer, you come across, as many layers as there are people.”

St. Joseph has a lot of things in play as it tests and treats patients for possible and actual cases of COVID-19 and Sonoma County prepares for its peak, which is predicted to hit in late May, Pearce said. The hospital has a work group with area SNFs to “work through the barriers,” including ensuring adequate personal protective equipment. It meets once or twice weekly. Before the SNFs will accept patients discharged from the hospital, they want a negative test for COVID-19, although CMS specifically said in an answer to an April 24 frequently asked question that a negative test for COVID-19 is not required “before a hospitalized patient can be discharged to a nursing home.”[2] The county also is considering a plan to dedicate one SNF for COVID-19 patients only, which is “a great recommendation,” Pearce said. SNFs are suffering themselves from a shortage of staff and personal protective equipment, with patients dying in alarming numbers at some facilities.

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