Letter: Skilled nursing facilities a resource
To the editor:
The expanding coronavirus crisis lays bare the concerns about the capacity of our health system to care for all who require acute medical care. Gov. Andrew Cuomo recognizes his state's looming need for hospital beds and has been working diligently on establishing makeshift hospital capacity by utilizing the expertise and resources of FEMA and the U.S. military to deploy resources to places like the Jacob Javits Center, Westchester County Center, and facilities available throughout the SUNY system.
Another recognized resource which may ultimately prove essential in this battle are the specific components of skilled nursing facilities known as short term rehabilitation units. These units ordinarily serve a role to enable hospitals to discharge patients who are not yet ready for discharge to home, to receive continued skilled care that would otherwise be provided in a hospital setting. In many cases, these patients are recovering from elective orthopedic, cardiac, and other surgery. Additionally, patients recovering from exacerbations of chronic medical conditions such as congestive heart failure, chronic obstructive pulmonary disease, or, perhaps more importantly, new acute illness such as pneumonia or other infection, will have been stabilized through their hospitalizations and then referred for continued care in these settings.
These units operate through the collaborative efforts of a skilled nursing staff along with a medical director and engaged medical staff. These individuals bring expertise from past experience with acute hospital care, infection control, wound management, and community-based homecare and are well suited to serve a role in this current healthcare crisis. Along with availability of ancillary services of laboratory services, diagnostic imaging, and intravenous fluid and medication therapy, care in this setting approaches that which is available on a general medical floor of many hospitals. It will be essential, however, that the individuals we receive from hospitals not inadvertently introduce Coronavirus to the individuals already within the walls of these facilities. If rapid testing for Coronavirus proves effective, then we will have a means to assure ourselves of safe transfers from hospital settings. Increased surveillance testing is a must, we should all demand no less.
As a medical director of a skilled nursing facility, I have long advised the organizations with whom I am associated of my belief that actively managed short term rehabilitation units would one day come to represent a more cost-effective alternative to inpatient hospital care,. Little did I realize how soon the day would arrive when this model of care might be employed not as a matter of cost, but as a matter of necessity.
Daniel E. Wollman, M.D., PhD,
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