On April 1, 2020, the Indiana State Department of Health (“ISDH”) released new COVID-19 guidance for hospital discharge to long-term care facilities and facilities sending residents to hospitals. This new guidance is substantially different from earlier guidance and recognizes the current resource limitations and staffing challenges facing long-term care facilities and hospitals, as well as the danger of introducing COVID-positive and presumptive positive patients into long-term care facilities. This guidance is consistent with the recommendations of the Centers for Disease Control and Prevention (“CDC”) and was done in collaboration with Indiana’s hospital and long-term care organizations.
This guidance, found here, should be used when evaluating the discharge, admission, or re-admission of a resident from a hospital who has presumed or confirmed COVID-19.
Here is a summary of the guidance:
- Local Agreements – Long-term care facilities and hospitals may collaborate to create their own transfer policies, which may require frequent adjustment based on local conditions.
- Emergency Department and Hospital Transfers – Transfer of a presumed or confirmed COVID-19 resident to a hospital should be based on: 1) the resident’s medical needs determined by the long-term care facility clinical staff and attending physician; 2) the long-term care facility’s ability to provide the resident’s medical care at the long-term care facility; and 3) the patient’s goals of care, including advance directives and decision for hospitalization.
- Accurate and timely communication between the long-term care facility, EMS, and the hospital is key.
- Admission/Re-Admission to a Long-Term Care Facility – Patients are broken down into five categories:
- Patients with no clinical concern for COVID-19 are acceptable to transfer/return to a LTC facility via the standard process.
- Patients with clinical concern for COVID-19 but negative testing during hospitalization are acceptable to transfer/return to a LTC via the standard process but transmission-based precautions may be needed under CDC’s non-test-based strategy.
- Patients with clinical concern for COVID and pending test results will not be transferred/return to a LTC facility until results are confirmed. Transmission-based precautions may be needed under CDC’s non-test-based strategy but may be reevaluated during surge conditions.
- Patients with COVID-19 but for whom transmission-based precautions have been discontinued are acceptable to transfer/return to a LTC facility via the standard process after the patient has been without a fever for at least 72 hours without the use of fever-reducing medications, improvement in respiratory symptoms, and at least 7 days have passed since COVID-19 symptoms first appeared.
- Patients with COVID-19 and for whom transmission-based precautions are still required may be transferred/return to a LTC facility adequately prepared to isolate and manage the patient, or place the patient with cohorted residents of the same status (in separate wings, units, floors, or building according to their COVID-19 status).
If you have questions about guidance for hospital discharge to long-term care facilities, contact your DSV attorney or Jennifer L. Strange at firstname.lastname@example.org.