COVID response accelerates partnership between health system, nursing homes

When the pandemic arrived in early 2020, University Hospitals in Cleveland already had close relationships with 60 post-acute care facilities in the region through its post-acute quality network. That gave UH a direct line to the places being hit the hardest by COVID-19: nursing homes.

Through the network, the health system and local post-acute facilities had already been meeting quarterly to review patient outcomes, quality of care, CMS star ratings and the transition process, among other metrics. Patients aren’t required to use facilities in the network—and only about half do—but are guaranteed those sites are working closely with the health system on quality and care.

And as a result of the pandemic, the system built on the relationships it had with hundreds of other nursing homes—and their parent companies—within the UH service area.

“The word was going out that if you need support, give UH a call,” said Dr. Sean Cannone, medical director for post-acute care and home care at University Hospitals.

At first, their approach was reactive, Cannone said. But as they got ahead of the outbreaks, it began to be proactive.

By the time UH responded to the third outbreak at a nursing home, the system’s Intercept Team had already been on-site ahead of time providing education and started preparing the facility for the possibility of an outbreak. They’d walked the nursing home through their playbook—a dynamic cloud-based document that provided up-to-date information on governmental infection-control and prevention guidance, best-practice resources and key contacts for obtaining COVID-19 testing supplies, staffing support and personal protective equipment. Then they set up remote monitoring.

“Things were changing so rapidly, it was getting pretty overwhelming,” Cannone said. “I don’t know of any other hospital systems that went to the lengths we went to. We were updating (the playbook) almost daily.”

They were able to, at times, transfer residents directly from long-term care facilities to an intensive-care unit without activating the 911 system.

“That’s unheard of. That’s monumental,” said Jonathan Sague, chief operating officer at UH St. John Medical Center.
By not going through the 911 system, the hospital was able to remain in control and determine where patients were sent, Sague said, as well as limit exposure for emergency responders.

UH and other health systems began to work with state officials to figure out how to more systematically handle the spread of COVID across the state. The Ohio Hospital Association paired hospitals with nursing homes in their areas, and those systems became responsible for sharing infection-control policies, conducting walk-throughs, assisting with PPE supplies and helping with resident placement after discharge, said John Palmer, an OHA spokesman.

“The rationale was to pair hospitals with nursing facilities within their area to collaborate on various response and preparedness efforts related to the pandemic,” Palmer said.

“It was truly a community benefit to make sure we continued to put water on the fire, and not let it get out of control,” Sague said.

Working so closely with nursing homes and responding when they needed help created “an immediate rapport and respect with one another that would have taken years and years to establish,” Cannone said.

“It dramatically accelerated our relationships with the post-acute care facilities in a very, very good way,” Cannone said.

Hospitals’ relationships with one another also improved. By working together to respond to the pandemic and keep the state’s health system from getting overwhelmed, Ohio hospitals that normally compete became allies, Cannone said. CEOs talked regularly. They collaborated to focus on each system’s strengths to aid in the pandemic response, he said.

“I don’t think the relationship will ever be the same to be honest with you,” Cannone said.

While there will be friendly competition, “I honestly think this has changed that dynamic,” he said.

Even now, systems are working together to handle vaccination efforts. UH is working with the state on nursing home visitation guidelines.

He said it’s hard to give advice to other systems on how to prepare going forward because he doesn’t have the answers.

“You just need to be innovative and solve,” he said.

But Sague said systems need to plan. The pandemic has shown that any kind of preparation that systems can do in advance—from strengthening internal communication, to stockpiling supplies, to building external relationships—will better enable them to respond to the unexpected, he said.

“We know these things are real threats, so we have to live a culture of preparedness,” Sague said. “As a country, we were not prepared to do this.”