In the recent JAGS article- Montoya A, Jenq G, Mills J, et al. Partnering with Local Hospitals and Public Health to Manage COVID-19 Outbreaks in Nursing Homes (J Am Geriatr 2021; 69(1):30-36), a COVID-19 outbreak investigation in Michigan skilled nursing facilities was the spark for a collaboration of interest to our members. Following the outbreak, testing was performed to determine the in-house prevalence of COVID-19. Residents testing positive for the virus were then divided into cohorts in COVID-19-dedicated units. The article shows the importance of investing in stakeholder relationships and open lines of communication. California health systems should anticipate requests for help from SNFs, and should proactively reach out in response. SNF leaders and staff have experience in providing care for medically complicated elders with functional and cognitive support needs. In turn, SNFs would greatly benefit from help provided by local health systems in terms of infectious disease experts, personal protective equipment (PPE), access to testing, and clear communication protocols during transitions to and from nursing homes. In addition, the importance of integrating nursing home data with other healthcare data is emphasized. Examples of best practices to mitigate the impact of COVID-19 on SNF residents, as described in this article, should inspire healthcare stakeholders to create meaningful, mutually beneficial relationships across settings to improve patient care. 

There are several examples of partnering in California:

1. Contra Costa County public officials asked John Muir Health, a community hospital system, to provide emergency staffing and infection control training for a nursing home with a large outbreak. The Muir CEO asked all relevant departments to contribute immediately, foregoing concerns about competition, finances, or politics, all of which could be sorted out later. Beyond nursing, an array of departments pitched in, including medical staff, laboratory, purchasing, palliative care, and the family medicine residency program. my GeriPal blog.
2. John Muir Health and Kaiser Permanente began working together on another outbreak, this one in an assisted living facility, after which all hospitals in the county agreed to a division of responsibility for proactive outreach to all 32 nursing homes in the county, followed by a similar approach to the much larger number of assisted living facilities. 
3. Early in the pandemic, Dignity Health partnered with Health Services Advisory Group (HSAG) to host COVID-19 post-acute care coordination webinars in ten counties for SNFs, hospitals, home health agencies, and other community-based providers and stakeholders. The purpose of these rapid-paced, huddle format webinars was to centralize and coordinate the information flow between hospitals and their post-acute providers, and to present updates and discuss emerging needs and challenges. Discussion items included topics such as COVID-19 data, PPE, staffing shortages, and best-practice sharing such as setting up COVID-positive units, and education needs of the providers.
4. Over 1,000 California nursing homes are participating in the ECHO National Nursing Home COVID-19 Action Network supported by the by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with the Institute for Healthcare Improvement (IHI), HSAG, Stanford School of Medicine, and the Alzheimer’s Association. The network offers a 16-week training and mentorship program to help nursing homes advance improvements in COVID-19 preparedness, safety, and infection control. Since November 2020, HSAG, Stanford and the Alzheimer’s Association have been facilitating over thirty (30) Zoom video conference calls per week to engage nursing homes in peer to peer learning and sharing of best practices on topics such as personal protective equipment (PPE), cohorting, testing, vaccinations, infection control practices, and managing social isolation during COVID-19.  For more information on this national program visit https://hsc.unm.edu/echo/institute-programs/nursing-home/pages/; www.hsag.com/echo; or echonursinghome.stanford.edu. Please contact Jennifer Wieckowski, [email protected] for more information.

Special thanks to Terry Hill, MD and Jennifer Wieckowski, MSG.