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COVID-19: Flattening the curve for America's elderly patients through quarantine and isolation

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Editor’s note: This episode of the MGMA Insights podcast continues a series focused on COVID-19 and its effects on healthcare professionals and their patients. Keep up with the latest updates by visiting the MGMA COVID-19 Action Center.

Experts agree that one of the most promising ways to flatten the curve is through quarantine or isolation, and this is especially important with the senior community.

Geriatric neuropsychologist Bill Mansbach is CEO and founder of Counterpoint Health Services, a multi-disciplinary behavioral healthcare company specializing in geriatrics and dementia care working in about 115 communities. He is also CEO and founder of the BCAT Research Center, which focuses on cognitive assessments and interventions and mitigation strategies for dementia.

Family worries and quality measure concerns

With the spread of COVID-19, Mansbach noted that the work he does with providers has gotten harder as challenges evolve. “We have certainly noticed that there’s an uptick in anxieties experienced by residents, staff and family members,” Mansbach said, “probably exacerbated by facilities increasingly setting limits or restrictions on families” coming to visit their loved ones.

When nursing homes and other senior care facilities encounter staffing issues due to school closures, childcare concerns among workers and similar issues, it makes it harder to maintain the numerous quality measures that the organizations report to payers.

“The nursing homes in particular are in a tough spot. On one hand, their star ratings are greatly dependent on their quality measures and those outcomes,” Mansbach said. “There are certain outcomes that have to be maintained, and it’s really difficult to maintain those outcomes if you’re restricting” doctors and other professionals from coming in. “You need very quickly to get all your diagnostic stuff underway, because your payment’s going to be tied to that.”

Restriction of how many people can assist individuals may interrupt that work with a cascading effect. “It’s reasonable to think that there’s going to be a lowering of these ratings,” Mansbach cautioned.

Responding to COVID-19 has forced many nursing home operators to go beyond their existing policies on quality of care and traditional workflows to account for the added layer of complexity that COVID-19 brings to these facilities and communities.

Be ready for tough conversations

Mansbach, however, cautioned that the public should have a balanced view of what’s happening in these facilities. While many individuals in nursing homes and senior care facilities are more at risk with comorbid conditions present, “it’s not a situation where everyone who is residing in these communities is going to perish,” Mansbach said.

For providers in these facilities, they should be prepared to have conversations with family members about social distancing and restrictions on access to facilities amid the COVID-19 pandemic. “You should expect that families are going to ask you a lot of questions, they’re going to have a lot of consternation about” the situation, Mansbach cautioned, emphasizing the need for providers to spend more time on the phone to guide and reassure family members.

Lessons from Kirkland, limits to telehealth

Mansbach noted that his organization has learned some key things from the much-publicized story of a nursing home in Kirkland, Wash. Concerns such as having enough nursing aides and other staff on creative staffing patterns were raised by seeing what occurred in Washington State.

While telehealth services have been touted as a crucial means to expand access to patients in other specialties, Mansbach said that telemedicine likely will only have a minor role in nursing homes or other care facilities where a large portion of individuals have dementia or significant cognitive impairment. “They are going to need some assistance with telehealth,” he noted, and that type of staffing may not be readily available. There are also WiFi dead zones in some nursing homes that would inherently limit the ability for internet connectivity to enable telehealth visits.

If you're a healthcare professional and you want to know more information about how COVID-19 might impact geriatric patients, particularly those that are in long term care, email info@thebcat.com. If you’re a family member or loved one and want more information, go to www.enrichvisits.com.

As a reminder, you can keep up with the latest MGMA coverage by visiting the MGMA COVID-19 Action Center at MGMA.com/covid.

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