Three models could help meet the surge in demand for post-acute care following the hospital surge in COVID-19 cases.
What happens as hospital patients begin to recover from COVID-19? Will post-acute care settings have the capacity to treat them as they transition home or to other care settings?
Those are the questions posed by David C. Grabowski and Karen E. Joynt Maddox in a March 25 Viewpoint in JAMA Network.
“Post-acute care is … a ‘pop-off valve’ for hospital capacity, in that moving patients to a such a setting once they recover from the most acute phase of their illness could free up hospital beds,” the authors write. “Projections suggest a major surge in post-acute care demand will occur following the hospital surge involving patients with COVID-19.”
The discharge of COVID-19 patients to skilled nursing setting is complicated, because some of those patients may still be able to transit disease to the nursing home population. Instead, the authors recommend 3 models of specialized post-acute care that would involve:
- Dedicating certain post-acute care settings—like long-term care hospitals—to be “centers of excellence” that only care for patients recovering from COVID-19.
- Building temporary capacity—possibly in rural hospitals—to address post-acute care shortages in some markets.
- Treating patients who are recovering from COVID-19 in their homes, when possible, through hospital-at-home models.
The authors suggest strengthening the post-acute care workforce by increasing access to training, personal protective equipment, and regular testing. They recommend recruiting workers displaced from other fields to perform lower skilled tasks.
They also recommend government policies that would offer paid sick leave to all post-acute care staff, pay post-acute settings an enhanced Medicare rate for COVID-19 care, and reimburse hospital-at-home models at the same level as institutional hospital care.
“The U.S. has been playing catch-up in its COVID-19 response in terms of testing, social isolation, and hospital capacity,” the authors conclude. “Making changes in post-acute care delivery and policy today could help contribute to having adequate capacity and capability in the coming weeks and months.”