COVID-19: AMDA Offers Real-Time Guidance

AMDA is staying on top of the news and updates on COVID-19 and sharing them promptly with our members. Practitioners and their teams are frontline heroes in efforts to address this pandemic, and we want to ensure you have the guidance and support you need. Among the many resource available are three cutting-edge AMDA On-The-Go podcasts addressing COVID-19—two programs on COVID-19 in Post-Acute and Long-Term Care and one on Mitigating Emotional Impact of COVID-19.

The first two podcasts feature Swati Gaur, MD, MBA, CMD, chair of AMDA’s Infection Advisory Committee. In the first program, she observed, “As medical directors and other medical professionals, we are caring for a vulnerable elderly population; and we have to address the delicate balance of strict infection control/precautions with quality of life.”

Dr. Gaur noted that AMDA and its members responded quickly when news of COVID-19 came out. “We understood the seriousness of the situation early on,” she said, with a fatality rate that is significantly higher for frail elders than for younger, healthier patients. AMDA and its Infection Advisory Committee saw the need for prompt guidance. They “worked day and night” to develop guidelines addressing different scenarios and how to deal with COVID-19 quickly and effectively. “We created different scenarios and developed frequently asked questions for areas where there is community spread and those where there isn’t,” Dr. Gaur said.

Job one should be to keep COVID-19 out of the facility, and Dr. Gaur addressed this at length in both podcasts.  “We need to understand that there is no treatment so far, so it is critical for us to be able to do everything we can to keep the disease out of our buildings,” she said. She observed that there are three ways the coronavirus comes in: via visitors/volunteers, staff, and new admissions. Having a sign posted at all entry points can help, she suggested. However, she stressed the importance of screening visitors and staff alike. “People who are healthy may have a mild case and not know it. It is important to make sure we are screening for fever and respiratory symptoms,” Dr. Gaur said.

In general, Dr. Gaur emphasized, all facilities regardless of community spread should restrict visitors. She also noted that there should be no communal activities, including meals and events such as Bingo. AMDA, said Dr. Gaur, has recommended screening of staff in a tiered accountability model and active screening of all residents. The Centers for Medicare & Medicaid Services (CMS) has released similar recommendations.

Dr. Gaur also addressed the challenges of testing and isolation. “I believe that some states have been able to get test kits, but that is not the case in most places.” As for isolation, she noted, “The CDC [Centers for Disease Control and Prevention] recommends use of standard airborne and contact precautions—including the use of negative pressure rooms.” However, she added, “CMS released guidance earlier this month saying that in the absence of negative pressure rooms, you can still keep patients in the facility if you take care of all other infection control practices and other elements of isolation and protection recommended by the CDC.”

AMDA is constantly updating its guidance, Dr. Gaur stated, adding, “A lot of changes are happening, and we’re trying to keep it current in our FAQ guidance. We are absolutely aligned with CMS and the CDC.”

The third (and most recent) podcast features Lea Watson, MD, a board-certified adult and geriatric psychiatrist, and Richard Juman, MD, national director of psychological services for TeamHealth.  “The first thing we have to do is acknowledge our own anxiety. There is such a great amount of uncertainty right now. We know the fear cycle is contagious. We need to take a deep breath and recognize we are not immune to this anxiety, Dr. Watson said. “We need to be in the moment in a human way more than we ever have. We are all in this together.” She further noted, “A key consideration is staying calm and being willing to admit when we don’t have all the answers. Now is the time to get ourselves together.”

Dr. Juman stressed the need to step back and put the current situation with COVID-19 into a larger context. “Nursing homes have to treat both the medical and the emotional needs of our residents. This is actually a mandate from CMS,” he said, suggesting that psychiatric illness—including depression and substance use issues--increasingly is the “norm” in this setting. He suggested, “The quality of medical care provided is significantly better than ever, but I don’t think we’ve kept up on the behavioral health side.” Efforts to address COVID-19, he said, follow the same paradigm.

“There is not enough attention to residents’ psychological well-being,” Dr. Juman said. “We need to make sure we do everything to mitigate the emotional impact of COVID-19 which could be significant as well.” Among the strategies for mitigating the emotional toll of COVID-19 discussed are creating and sharing a consistent community message, making alternative arrangements for family visits, and maintain—as much as possible—a normal routine for residents.

Click here to listen to these podcasts, as well as to access other resources on COVID-19.