Year in Review: COVID-19 hit post-acute care perhaps the hardest

The oft-overlooked post-acute care sector came under the microscope in 2020 as the novel coronavirus took hold. The congregate living setting made nursing homes and assisted-living facilities easy targets for the virus to spread. On top of that, older people with comorbidities have been found to be more vulnerable to the disease.

Throughout the pandemic, about 40% of the deaths from COVID-19 have been in nursing homes, although nursing home residents only represent about 8% of the country’s overall COVID-19 cases. As of Nov. 22, there had been 354,313 confirmed COVID-19 cases, 169,733 suspected cases and 72,642 deaths among nursing home residents, according to CMS.

To combat the spread of the virus in post-acute care settings, the federal government issued guidance and a series of orders on infection control, visitation restrictions and testing in nursing homes and sent funds and point-of-care tests to facilities across the country. Yet providers, struck by lower census numbers and increased costs for staffing, testing and infection control, said these measures weren’t enough.

At the same time, families chose to care for loved ones at home to avoid the perceived dangers of long-term care facilities, aided by loosened restrictions on telehealth in home care settings. A study by healthcare consulting firm Avalere shows that hospital discharges to home health increased 4.6% year-over-year in June, while discharges to skilled-nursing facilities were down 25.4% compared to 2019.

Heading into the winter, COVID-19 cases in nursing homes reached their highest levels yet in the pandemic, leaving leaders worried about how to manage the virus as community spread outside facilities skyrocketed.

When nursing homes shut down in March, they had to get creative to keep residents engaged and prevent isolation. Some held group workout classes in the hallways, so residents could participate from their rooms. Others employed companions, whose job was to socialize.

With restrictions on indoor visitation, facilities found new ways to connect residents to their family, friends and loved ones. They set up visitor drive-by parades; created outdoor living rooms with clear dividers; and let families stand outside residents’ windows and call them on the phone.

May 8: CMS started requiring nursing homes to submit facility data to the CDC on COVID-19 cases.

Aug. 26: CMS required nursing homes to test residents and staff based on community spread levels, which created a backlash because of the limited supply of tests and turnaround times.

Oct. 29: CMS makes telehealth changes permanent for home healthcare that include coverage of telehealth services under Medicare.