Los Angeles,
06:30 AM

COVID-19: Supporting Skilled Nursing Facilities

When the COVID-19 pandemic overwhelmed nursing homes across the nation, Cedars-Sinai nurse practitioner Alexandra Eskin, MSN, worried about the staff members she sees every day at eight skilled nursing facilities near the medical center.

"They were hit pretty hard with COVID-19," said Eskin, who helps manage the care of patients discharged from Cedars-Sinai to partner facilities. "They didn't have all the personal protective equipment (PPE) they needed, and I wanted to help."

With the aid of her husband, Eugene Eskin, Alexandra bought a 3D printer and began making face shields that nursing home staff could wear as eye protection. These clear plastic screens, secured to the forehead with a crownlike headband, protect the eyes from droplets or splashes that could carry the novel coronavirus during close contact with patients.

Eugene, a financial executive and hobbyist, figured out online how to print and assemble the shields. He and Alexandra programmed their new 3D printer and loaded special plastic filaments into the machine, which slowly built individual semicircular crowns. They fastened an elastic band to the back of each crown and mounted a clear plastic screen to the front.

It took a couple of weeks to hone the process, but soon the Eskins had printed their first batch of 25 shields, which Alexandra delivered to The Rehabilitation Centre of Beverly Hills. They've since made 75 in total.

"When we brought in the face shields, the nurses were so happy. The amount of thankful text messages I received made it all worth it," said Alexandra. "These nurses are there eight hours a day or longer feeding patients, giving them medications, changing wound dressings and putting themselves at risk for getting the coronavirus. And these facilities are so often overlooked."

Cedars-Sinai works closely with The Rehabilitation Centre of Beverly Hills and seven other skilled nursing facilities to ensure that formerly hospitalized patients get the care they need. A team of nurse practitioners from the health system's Enhanced Care Program partners with Cedars-Sinai physicians to keep a close eye on patients who have been discharged from the hospital. The nurse practitioners, such as Alexandra, visit the facilities frequently.

The program helps create a smoother transition for complex patients who are often older and dealing with a variety of medical issues and taking many medications. A study published in The Journal of Hospital Medicine found that the 30-day readmission rate for Enhanced Care Program patients was 17.2% compared to 23% for patients discharged to the same nursing homes but not enrolled in the program.

Alexandra Eskin, MSN
These nurses are there eight hours a day or longer feeding patients, giving them medications, changing wound dressings and putting themselves at risk for getting the coronavirus. And these facilities are so often overlooked.
Alexandra Eskin, MSN

This close relationship between Cedars-Sinai and these eight facilities has become even more vital during the pandemic.

"Because Cedars-Sinai already had the Enhanced Care Program in place, it put us in a much stronger position to ensure that our patients received excellent care," said the program's medical director, Gary Gutkin, MD. "We also were able to quickly track new COVID-19 cases as they appeared at our partner facilities and gauge what was happening in this community. It helped us prepare to treat those patients at our hospital."

The Cedars-Sinai team also helped put nursing home patients and their families at ease.

"There are very few doctors physically rounding at skilled nursing facilities these days; almost all the visits are over video or the telephone. Our team members are continuing to visit our partner facilities and seeing patients while wearing the appropriate PPE," said Bradley Rosen, MD, vice president of Physician Alignment and Care Transitions at Cedars-Sinai. "Because these patients cannot receive visitors, it's a very lonely and isolating experience. Having our nurse practitioners face-to-face with patients and then calling the patient's family and speaking knowledgably about what's going on is tremendously beneficial for everyone."

The vast majority of skilled nursing homes are independently operated and tend to grapple with high turnover of clinical staff. They've faced even more challenges since the pandemic began: quickly changing public health guidelines, difficulty sourcing PPE and testing delays.

When The Rehabilitation Centre was waiting more than five days for COVID-19 testing results early in the spring, Cedars-Sinai started processing their tests and significantly reduced wait times.

"Imagine what that's like if you have symptomatic patients or staff members waiting eight to nine days to see if they're positive. It was very stressful," said Eldon Teper, executive director of The Rehabilitation Centre of Beverly Hills. "Now we're getting test results back within 24 to 48 hours, making the management of any potential cases so much easier."

The Rehabilitation Centre, which admits about 130 patients a month, treated 29 COVID-19 patients during the spring, according to Teper. He said they haven't had any new cases recently. It's been a challenging experience, but Teper and his staff are committed to their jobs.

"We all risk our lives every day to come to work and take care of patients despite all the chaos," he said. "This act of personal kindness by Alex and her family to take the time to ensure our nurses and staff were protected—those are the types of things that got us through this tough period."

Read more on the Cedars-Sinai Blog: How to Support Elderly Friends and Family During COVID-19