Rehab in a Pandemic: Managing Therapy During an Active COVID Outbreak
In late August and early September, many administrators were breathing a sigh of relief as it seemed that they had dodged a bullet in regards to COVID when rates were falling. However, communities that initially had zero (or very few) cases among staff and residents are now suffering with the recent rise in cases in their surrounding communities. As many of you face this new reality, I thought it was a good time to revisit how to handle therapy services and your therapy teams during this time.
While the initial instinct is to shut down and stop all activities, including therapy, one thing we learned during the initial wave is that there can be serious consequences to doing so. In fact, in buildings where therapy was stopped and teams sent home, they were soon overwhelmed with new cases of decline in mobility and ADLs, new onset falls, declines in cognition, weight loss, and higher rates of depression among residents. Clearly stopping all therapy is not the first choice, if avoidable.
Which leads to the common question: If we don’t feel comfortable with “business as usual” nor do we want to completely shut down, how do we manage to treat our residents and keep them safe?
Your therapy team members are experts at what they do. Through continual assessment of their patients’ conditions, complexities, rehab care plans, and discharge goals, they are able to determine when continued therapy may or may not be essential to meet each patient’s particular needs. In contrast, therapists are also able to determine when the plan of care could be modified or should be discontinued in order to prioritize the most essential needs of the patient. Let’s look at some of the options a little more closely:
When therapy is essential and the staff is able, consider allowing the therapists to perform in-room treatments to accommodate patient needs in cases where they are under isolation measures. We have provided resources to our In-House Therapy Alliance team therapists, and shared a blog post on our website last Spring that covers effective treatment ideas for in-room therapy.
If, however, staff cannot safely visit patients in person, then telehealth or on-site virtual visits can be considered. A true telehealth visit is considered an “in-person service” provided remotely via an audio-visual platform where the two parties are not in the same location. During the Public Health Emergency (PHE), therapists have been allowed to provide treatment via telehealth due to a waiver currently in effect until January 31st. If the patient and the therapist are both on campus, it is considered an on-site virtual visit and is billed like a regular therapy visit. Considering the population we treat, it is likely you need to have a helper in the room to manage the technology and assist with safety for either of these options. This can be a nurse, a CNA or even a non-clinical person. The visit can be managed over any audio-visual application, as the PHE waiver also means that the medium need not be HIPPA compliant. Therapists and patients can connect via Facetime for example, using an iPad, iPhone, or laptop. In a majority of cases, your Part A patients are covered for a skilled stay due to the need for therapy. These patients with acute cerebral vascular accidents (CVAs), hip fractures, and other debilitating injuries/illnesses really need their therapy in order to recover, so unless they are ill with COVID, every effort should be made to ensure the safe continuation of therapy.
For your Part B patients, assessment of the current risk should again be weighed against the need for therapy. Perhaps the patient’s need for therapy can be temporarily met by just one discipline, thereby lowering risk by reducing the number of people entering the patient's room. Perhaps telehealth or on-site virtual visits can be used to meet the needs of the most essential therapy cases. In other cases, where an individualized functional maintenance program may be able to temporarily meet the needs of the patient (at least keeping them from further decline until regular therapy can resume), then the patient could be temporarily placed on hold after training the designated staff members working with that patient to enact their plan.
Depending on your situation, if your therapy caseload is down as a result of an outbreak in your community and your therapy team is negative for COVID with extra time available, you may want to offer them the opportunity to work additional hours performing restorative programs or assisting nursing with delivering trays or feeding residents. Many communities are suffering with staff shortages so this can possibly be a temporary solution. One of many benefits to in-house therapy is that your therapists are already part of your facility’s team, so there is a sense of community and teamwork in a crisis.
We have educated our In-House Therapy Alliance teams on the proper use of telehealth and on-site virtual visits, as well as provided policies and procedures for telehealth that are able to be personalized for each organization. We are happy to talk through any of these options with you to help find the solution, or mix of solutions, that best fits your particular situation in order to keep your residents and staff as safe as possible.
Written by: Elizabeth Johnson, PT, CDP, RAC-CT
About Seagrove Rehab Partners
Our aim is to serve the therapy industry by providing a compassionate, people-centered approach to compliance and management support, including a proprietary solution for SNF in-house therapy programs. Our In-House Therapy Alliance not only helps our partners to be more compliant and profitable, but also puts the patient first. Mark McDavid, president, and our company associates are available to work with skilled nursing facilities, rehab agencies, and other healthcare providers at the client site, by phone, by email, by video conference call and through workshops and seminars.
