Handling COVID-19 in nursing facilities: AMDA offers lessons from New York State

A leading physicians group has compiled best practice recommendations for reducing the spread of COVID-19 in skilled nursing facilities, based on lessons learned in New York State. 

The guidance, from American Medical Directors Association, comes from a group of certified medical directors experienced in managing the disease. 

“The time has come to consolidate our learnings as a field in terms of caring for at-risk elderly … especially as we prepare for a potential second wave of infections in the coming months, as well as for future pandemics,” writes Paula Lester, M.D., FACP, a geriatrician at NYU Winthrop Hospital and corresponding author. 

Among the recommendations (further detailed in the report):

• Creating COVID-specific units
• Twice-daily residents screenings
• Discontinuation of drug delivery modes that might spread the virus (such as nebulizers) 
• Reviewing do-not-intubate and do-not-hospitalize advance directives with patients and families

Protocols for staff include:

• Serial COVID-19 testing (three tests, one week apart) to enable identification of newly infected staff
• Assignments to specific units to permit easier contact tracing
• Staff assigned to COVID-19 should not work elsewhere in the facility

Other guidance covered includes management of COVID-19 positive and presumed-positive cases, communication during an outbreak, management of admissions and readmissions, and providing emotional support for staff.

The report is available online in JAMDA.