How Ready is Your Skilled Nursing Home to Address COVID-19 Surge?

Our country now has the distinction of having the most COVID cases in the world.  Our response as a nation is a stress test that has exposed our lack of a coordinated system of health care in this country.  In my community, there remains a shortage of naso-pharyngeal swabs, a public expectation of easy access to testing (County Public Health Department can do 100-120 tests per day), and many facilities still don’t have real-time access to adequate PPE.  Because of the lack of PPE and nasopharyngeal swabs, testing in some facilities for influenza/RSV/Other viruses is not being done. There appears to be an over-reliance on quarantine of residents with respiratory illness as well as shelter-in-place strategy to keep their facilities COVID-naïve.

This inertia needs to change.  In California, we are experiencing a significant uptick in COVID-19 cases with some occurring in SNFs.  Now is the time to revisit the POLST/PIT (Preferred Intensity of Care) forms to make sure that residents with serious respiratory illness and poor prognosis illnesses have the option for care in the facility, such as a do-not-transfer order.  This will avoid further overloading our acute hospital partners and allow a selective or comfort focused care approach in a familiar setting. This recommendation also applies to residents living in assisted living, memory, and independent living settings. 

If a cluster of respiratory illness develops, your local public health department should be contacted ASAP.  They likely can help with PPE, testing, and critical guidance. In addition, now is the time to partner with your local hospitals and public health department to share current supply concerns and develop protocols for effective and consistent management of respiratory illnesses.  

CALTCM’s President-Elect, Dr. Albert Lam, facilitated communication between the Palo Alto Medical Foundation (PAMF) and their SNFs, which has resulted in the guidance, attached below.  

Dr. Karl Steinberg, CALTCM BOD member, and the incoming president-elect for AMDA:  The Society of Post Acute and Long Term Care Medicine, has also been a part of the San Diego County COVID taskforce on SNF preparedness, which created a document for clinicians who see patients in nursing homes.  (See attachment below.)

In my community, Dr. Gary Johanson, a well-known and respected palliative care physician is coordinating a similar effort in partnership with our public health department's chief medical officer and staff..  

Given what we have seen in Washington State and New York City, we must move rapidly to prepare for surge of COVID disease that may overwhelm our current health systems.  

CALTCM is committed to your success through these hard times.  Please visit our COVID-19 webpage for state-specific resources and guidance, including our free and excellent weekly webinars which are all available on demand at

Referenced Attachments

PAMF Coronavirus Letter to SNFs.pdf

San Diego COVID Taskforce on SNF Preparedness

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