April 7th Non Post

I didn't post yesterday, but I was contacted to be on CNN with Anderson Cooper today, so I spent the night working on my talking points!  Here's what I had last night:

Anderson Cooper is inquisitive, give him room to restate what you say, and then say "That's right, Anderson, my response was an emotional one, knowing that nursing homes can be an "Accelerant” for the COVID19 infection.  Our system is hospital focused, and few policy makers are paying attention to nursing homes.

Talking points:

1. There’s a reason they’re called nursing homes.  They are “home” to many vulnerable individuals.  There’s also a reason people are there. Half of them have dementia, and moving them can create a lot of problems. Only a small percentage, generally not more than 10-20% would normally be able to be taken care of at home.

2. With that said, if you’re going to bring Grandma home, you need to have stellar infection control in your home and your family needs to have been self-isolating for two weeks, otherwise, you risk exposing Grandma to the virus anyway.  Families also don’t have the necessary caregiver training to deliver the type of care that nursing home staff provide.

3. At the same time, and this is our “catch-22,” nursing homes aren’t adequately prepared to face this virus, which to a large degree isn’t their fault.  We haven’t provided adequate PPE or testing to nursing homes. This has greatly hampered our ability to effectively fight the virus in nursing homes.  

4. California's leader for quality care in nursing homes, CALTCM, has actually put together actionable plans for more effective infection control practices.  It is my belief that in the middle of a crisis the focus needs to be on education, not just of nursing home caregivers where we've had a lot of grassroots education, but of state representatives, policy makers, public health departments, and health care systems whose decisions have powerful effects.  This virus moves too quickly to be wasting time on ineffective approaches.

5. This is a medical emergency.  Geriatricians and experts in post acute and long term care medicine MUST be in the room as local, state and federal government officials make policy decisions. There have been poor decisions made across the country, such as mandating that nursing homes accept COVID patients.  Such mandates are wrong for obvious reasons.  If my mother was in a nursing home and the government was forcing that home to accept COVID patients, of course, I’d take my mother out in a heartbeat!

6.  Since this is a medical emergency, it is critical that we engage the medical directors of every nursing home in the country.  AMDA has been asking CMS for the names of every medical director for a few years.  If we’re to prepare these medical directors to help fight this virus, we need those names so that we can provide actionable education and training to them.