Apply strategies for long-term success
While it is common for LTACs to care for patients with respiratory issues, both chronic (e.g., COPD) and acute (e.g., pneumonia), patients recovering from COVID-19 frequently suffer severe, long-term respiratory complications that may require significant intervention.
“Post-COVID lungs look worse than any type of terrible smoker's lung we've ever seen,” as described by a Texas trauma surgeon. “And they collapse. And they clot off. And the shortness of breath lingers on... & on... & on.”
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Conventional oxygen therapy strategies employed by LTAC clinicians may not be adequate when caring for COVID-19 patients, as the National Institutes of Health states in its COVID-19 Treatment Guidelines:
“In adults with COVID-19 and acute hypoxemic respiratory failure, conventional oxygen therapy may be insufficient to meet the oxygen needs of the patient. Options for providing enhanced respiratory support include high-flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), intubation and invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).”
For those COVID-19 patients discharged from the ICU into a LTAC facility, adoption of ICU-quality ventilation equipment is required to provide this level of respiratory support. Facility administrators should evaluate their site’s mechanical ventilators to ensure they have lung-protective tools and weaning support methodologies that facilitate recovery and prevent the need for costly hospital readmissions.
Prior to the pandemic, LTAC facilities often strive to keep patients out of the hospital. In 2019, 73 percent of SNFs subject to the Center for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Value-based Purchasing Program received a penalty for poor 30-day hospital readmission rates.
Additionally, patients with severe cases of COVID-19 “should be monitored closely for worsening respiratory status because some patients may progress to acute respiratory distress syndrome (ARDS),” according to the National Institutes of Health. In LTAC facilities, where patient-to-nurse staff ratios are typically much higher than in the ICU, reliable monitoring equipment is critical to keeping patients safe.
The road ahead
While vaccine roll-out is a significant step in the right direction, the reality is that LTAC facilities may well be caring for COVID-19 patients for quite some time as surges continue to push hospitals in hot spot areas beyond capacity.