Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID‐19 pandemic on skilled nursing facilities

Abstract

On February 29, 2020, the Centers for Disease Control and Prevention (CDC) reported that the first patients in the United States hospitalized for coronavirus disease 2019 (COVID-19) were located in King County, Washington, in a single skilled nursing facility (SNF). Investigation and contact tracing among the ~130 SNF residents and 170 health care personnel was initiated. There were 81 residents, 34 health care personnel, and 14 visitors who tested positive, and by March 27, 2020, there were 23 deaths. Americans were given the news the COVID-19 pandemic had reached the United States through a nursing home near Seattle. In New York State, COVID-19 was soon detected, and at least 6400 people died in SNFs and long-term care nursing facilities (NFs) by summer. Overburdened hospitals in New York lacked options for where to discharge patients with COVID-19. Unable to admit new patients because of capacity issues, acute care hospitals were instructed to discharge patients to SNFs. In late March 2020, NY SNFs were issued an administrative directive by Governor Andrew M. Cuomo. This order mandated SNFs to accept COVID-19 patients despite reports of inadequate personal protection equipment (PPE) and insufficient staff to provide care. The impetus was to free up hospitals for fresh waves of COVID-19 patients. Family members and nursing home staff feared that sending those patients to nursing homes would create a dangerous environment that allowed the virus to quickly spread. The outcomes of this directive were controversial but clearly demonstrated the enormous role that SNFs and NFs play in the U.S. health care system. As these events unfolded, physiatrists caring for patients in SNFs were instantly thrust into Ground Zero of the U.S. COVID-19 pandemic.