Focus turns to nursing homes regulations, task force BY JASON MILLER

The following article was published in the April 10th, 2020 edition of the Highland Community News in Highland, California.

On Tuesday, April 7, San Bernardino Public Health Director Trudy Raymundo clarified a previous directive by California Department of Public Health (CDPH) about the intake of COVID-19 patients into nursing home facilities stating that according to regulations nursing homes will take nursing home residents with COVID-19 requiring lower-level care, not COVID-19 patients from the general public.

The original letter, written and signed by CDPH Deputy Director Heidi W. Steinecker, directed nursing homes to accept people suspected or diagnosed with COVID-19, while taking “appropriate precautions to prevent the spread of the infection.”

Raymundo said, “The state order was needed because with the expected surge in demand for hospital beds, it was not desired for field hospitals to be the only alternative for COVID-19 nursing home residents being released from hospitals.”

This action, however, quickly raised local and state officials’ concerns; Highland Mayor-Pro Tem Penny Lilburn said when she heard about this “it pisses me off,” and said that these actions threaten the elderly population.

In an interview with the Highland Community News, Assemblyman James Ramos said, “We should care for our most vulnerable,” and that his office would look into the concerns that citizens and local officials have regarding the updated regulations.

The CDPH responded to another publication about these concerns, “We are all working tirelessly to protect the health and safety of California’s most vulnerable during the COVID-19 response. As you know, hospitals are required to properly care for individuals and discharge them to the appropriate levels of care when a patient is ready for release. This includes patients who may have entered with the need for acute care as a result of COVID-19, and are ready to be discharged. CDPH’s March 20, 2020, guidance, per All Facility Letter 20-25, was for skilled nursing facilities (SNFs) to be prepared to potentially start receiving patients who may require lower-level care, not acute care. For more details on CDPH’s guidance go to

All of these guidance documents are for the purpose of protecting patients, and ensuring California’s most vulnerable are cared for in the most appropriate setting and in a manner that protects their health and the health and safety of others.”

Raymundo also said that the “County Public Health and the [new] County Nursing Facilities Task Force would be the gatekeeper of any transfer that would take place under the state order,” and that “the only transfers that would take place would be nursing facility residents who are being released from temporary hospital stays.”

Acting County Public Health Officer Dr. Erin Gustafson provided the following statement on enforcement of the regulations, “This is a question we are actively addressing with our Nursing Facilities Task Force with guidance from CDC and CDPH. We will assess and identify the facilities that are best prepared to be designated as COVID-19 positive facilities. It is also important that healthcare facilities follow the guidance of the All Facilities Letter (AFL) from April 1, 2020, which includes:

* SNFs should prepare to receive patients that are clinically stable for discharge from hospitals in the following scenarios:

* Patients with no clinical concern for COVID-19 may be transferred from hospitals to SNFs following usual procedures.

* SNFs may not require a negative test result for COVID-19 as criteria for admission or readmission of residents hospitalized with no clinical concern for COVID-19.

* Hospitals are NOT required to perform COVID-19 testing on patients solely for discharge considerations unless they develop new respiratory infection symptoms, in which case the patient is not likely to be ready for discharge.

* Patients investigated for possible COVID-19, with negative test results may be transferred from hospitals to SNFs following usual procedures.

* Hospitals should conduct influenza testing as appropriate and communicate results and any indication for continued transmission-based precautions upon transfer.

* Patients with confirmed or suspected COVID-19 should not be sent to a SNF via hospital discharge, inter-facility transfer,or readmission after hospitalization without first consulting the local health department (LHD).

* SNFs can be expected to accept a resident diagnosed with COVID-19 and who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow Centers for Disease Control and Prevention (CDC) infection prevention and control recommendations for the care of COVID-19 patients, including adequate supplies of personal protective equipment (PPE).

* Local health department may direct placement of the patient at a facility that has already cared for COVID-19 cases, or that has a specific unit designated to care for COVID-19 residents.

* Hospital discharge planners should provide advanced notice to the SNF for any transfer of a patient with COVID-19. If transmission-based precautions have been discontinued patients’ symptoms have resolved, patients can be discharged back to the facility they came from, regardless of the facility’s PPE supply and ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients.

* Patients under investigation (PUI) for COVID-19, but test results pending: At this time, PUIs should NOT be transferred to SNFs until test results are available.

* Considerations for care of residents with suspected or confirmed COVID-19 infection who do not clinically require a hospital transfer

* SNFs should only transfer residents with suspected or confirmed COVID-19 infection to higher acuity healthcare settings when clinically indicated. Prior to transfer, SNFs must notify transport personnel and receiving facility about the suspected diagnosis. If clinically stable, residents with suspected or confirmed COVID-19 should remain at the SNF with appropriate infection prevention and control measures. Raymundo said, “Some nursing facilities in the county are asking to be designated by the county as “COVID-19 Centers of Excellence,” meaning they have the staff, training, equipment and facilities needed to care for COVID-19+ individuals and prevent them from infecting other people. The County Public Health and the County Nursing Facilities Task Force would approve transfers under the state order only to COVID-19 Centers of Excellence.

Further complicating the situation was the recent outbreak in an acute care facility in Yucaipa where two residents died from the virus, which affected 51 patients and six employees back on March 31. In another incident eight residents and seven employees at the Reche Canyon Rehabilitation & Health Care Center in Colton tested positive for coronavirus, after which one resident died, county officials said on Monday, April 6.

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