I’m reaching out to see what is happening about the multitude of test kits that were supposed to be sent to the LA Jewish Home that were then to be used to test nursing homes throughout the city and county? The LAJH simplified a complex process and a system was set up. We have already had initial success in identifying a couple of outbreaks, from the first set of testing kits received, which have allowed those facilities to react accordingly. The LAJH must receive an adequate number of test kits so that they can assist in carrying out everyone’s collective goal of testing every nursing home in the city and county. I, and others, have been warning about the rapid escalation of outbreaks for some time. We need to do this testing in order to respond appropriately.
I’d also like to take this opportunity to reiterate some of the key points that I’ve been making to State and Local officials for the last 5-6 weeks. Like Dr. Marco, I’m tired of getting the run around. People are dying and the experts in geriatrics and long term care medicine are being “listened” to, but we’re not being “heard.” We need to be “in the room” going forward, starting today. Nursing homes can not function as they do traditionally and expect different results. There are four things that form the base of the pyramid for fighting this scourge. To make this clear, CALTCM has developed the COVID-19 Long Term Care Quadruple Aim:
1. Stellar infection control is an absolute requirement. In order to achieve this, every nursing home must make their already designated Infection Preventionist (IP) full-time. It is beyond difficult for a traditional nursing home to provide stellar infection control without a full-time IP. We’ve been trying to get the Governor to mandate this for the State, however, there’s no reason that LACDPH can’t mandate it for the County! Once this is done, CALTCM and HSAG (the QIN-QIO for CA) will willingly collaborate to provide ongoing education and training for the IPs in conjunction with state and county efforts.
2. Abundant personal protective equipment (PPE) is critical in order to battle COVID-19. We can not depend on facilities to provide this. This takes the full resources of the government to make sure that every nursing home, assisted living facility and group home has an abundant supply of PPE. There shouldn’t be questions about how to get PPE. There can’t be delays in assuring that the long term care continuum is completely supplied with this literally life saving equipment. I have already reached out earlier this week with an opportunity from a trusted and reliable source to bring 10 million units of PPE to the State or County within 10-14 days. I wish I could pay for it, but at least we can help the County access this important equipment quickly. I’ve yet to hear back. PPE is essential to put a “moat” around our nursing homes, assisted living facilities and group homes. We can’t wait for it any longer.
3. Readily available testing is very important to know what you’re dealing with. All staff in a nursing home must be tested in order to know what the facility is up against. Residents must be tested if anyone is suspected of having the COVID-19 infection. Hence, our request to let the LAJH do the job it was tasked to do and ready and willing to carry out! Please do everything in your power to get us the test kits to disseminate!
4. Finally, every nursing home in the county MUST be operating under an incident command structure. They all have the emergency preparedness policy and procedure that tells them how to do this, but only a very few are actually operating under this model. We advise that they all watch the webinar that CALTCM had on March 25th (https://vimeo.com/400847523/dcff9a483e)
3. Readily available testing is very important to know what you’re dealing with. All staff in a nursing home must be tested in order to know what the facility is up against. Residents must be tested if anyone is suspected of having the COVID-19 infection. Hence, our request to let the LAJH do the job it was tasked to do and ready and willing to carry out! Please do everything in your power to get us the test kits to disseminate!
4. Finally, every nursing home in the county MUST be operating under an incident command structure. They all have the emergency preparedness policy and procedure that tells them how to do this, but only a very few are actually operating under this model. We advise that they all watch the webinar that CALTCM had on March 25th (https://vimeo.com/400847523/dcff9a483e)
Also, you MUST immediately stop any plans to designate COVID-19 positive SNFs, and immediately forbid interfacility transfers. It is time that the experts in Geriatrics and Long Term Care Medicine be consulted before any such decision is made. The wrong decision in this regard will cost many more lives than necessary. I’m attaching the final version of a White Paper that we've been developing over the last three weeks with experts around the country. We plan to post it on the CALTCM website later tomorrow, but I feel it’s important enough to share here, so that you can have a full appreciation of the amount of thought and work that has gone into everything that I’ve put into this email.
Finally, I’ll repeat this one more time, Please get the LAJH enough test kits for us to disseminate those kits to every nursing home in the city and county of Los Angeles. Time is of the essence. We have already wasted enough time. The window is closing on our opportunity to stem the tide of this virus here in Los Angeles. We don’t have to be New York and New Jersey. We don’t have to be Italy and Spain. We are better than that!
Sincerely,
Michael Wasserman, MD, CMD
President
California Association of Long Term Care Medicine
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