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Coronavirus in Florida

Ron DeSantis enacts new emergency rules on senior COVID-19 patient transfers

Earlier policies resulted in Florida hospitals being filled with long-term care residents.

Even as Gov. Ron DeSantis continues to tout the state’s efforts to contain COVID-19 in nursing homes, his administration has enacted new emergency rules designed to more easily shift elderly patients from hospitals back to nursing homes and assisted-living facilities.

The Agency for Health Care Administration published an emergency rule Thursday that makes significant changes to what has been the policy for transferring long-term care residents back to nursing homes or other senior centers.

The emergency rule allows hospitals to use a symptom-based or test-based approach to confirm that long-term care residents are negative for COVID-19. The rule also gives hospitals the green light to discharge residents with an unknown COVID-19 status to nursing homes, as long as the facility has a dedicated wing or building with designated COVID-19 staff.

In a phone call with nursing-home and assisted-living facility providers on Thursday, Agency for Health Care Administration Secretary Mary Mayhew said that the new emergency rule “supports timely and appropriate discharges from the hospitals to ensure that individuals are being cared for in the most appropriate settings.”

The emergency rule replaces a prior emergency rule that required two negative tests 24 hours apart before a patient could be returned to a long-term care facility. Under the latest emergency rule, hospitals can return long-term care residents if it’s been 10 days since COVID-19 symptoms appeared, the patients have seen improvements in their breathing and they have been fever-free for three days without the use of medication. The symptom-based approach is based on guidance issued by the Centers for Disease Control and Prevention, Mayhew said.

“We want to make sure that individuals are able to get back to their homes and your nursing homes our assisted living facilities are able to support people in the most appropriate level of care,” she said Thursday.

Nearly half of Florida’s more than 4,800 coronavirus-related deaths are associated with long-term care facilities. As of Friday, there have been 2,302 deaths of residents or staff of long-term care facilities

DeSantis on Friday, without mentioning the new rule, contended that Florida’s hospitals still have enough capacity to handle any surge of coronavirus patients. He said that 21 percent of hospital beds remain available statewide.

The Governor has routinely bragged that his administration was progressive in working to prevent COVID-19 from spreading throughout the long-term care industry.

Early in the pandemic, issues arose between hospitals and nursing homes regarding the transfer of residents back to long-term care facilities after they had been hospitalized. The state eventually intervened and required two negative COVID-19 tests within a 24-hour period before residents could be returned to the facilities.

State officials also mandated that nursing homes that could not provide acute care to residents infected with COVID-19 or isolate them in a separate wing or building transfer the infected residents to hospitals. The state even received approval from the federal government to reimburse hospitals for providing care to the nursing-home residents.

But the policies resulted in Florida hospitals being filled with long-term care residents.

Hospitals have complained that it’s difficult to obtain the results of two COVID-19 tests within a 24-hour period.

There have also been questions about whether the testing policy applies if long-term care and nursing-home residents don’t test positive for COVID-19 when they are initially hospitalized. AHCA addressed that question in an advisory sent to hospitals and long-term care providers Thursday.

In the advisory, AHCA stated that hospitals must test all residents before discharging them to a long-term care facility. But residents can return to a home before the results come back, the agency said. Residents can be released to a nursing home or assisted-living facility after being tested but they must be isolated for 14 days or until their test results come back.

“Around the state and in each county, we are trying to support the system’s capacity to respond,” Mayhew said, describing the policies. “We are trying to make sure that our nursing homes and assisted living facilities are receiving all the resources and support to protect the most vulnerable. We wanted to make sure we were providing very clear communication on that front.”

AHCA also continues to boost the number of dedicated COVID skilled-nursing facility isolation centers. As of Friday, 19 facilities across the state had dedicated more than 1,200 beds for the treatment of COVID-19 infected patients.

Hospitals have been transferring COVID-19-infected patients who still require skilled-level care to the facilities.

Nursing homes and ALFs that cannot isolate their residents or provide the level of care required can also transfer patients to the facilities in lieu of hospitalization, Mayhew said.

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Republished with permission of the News Service of Florida.

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