Opportunities for Overcoming Challenges Caused by COVID-19 — Annals of Long Term Care
By Jim Love, President, Omnicare
January 2021
There’s no denying the tremendous challenges that the COVID-19 pandemic has posed for all long-term care (LTC) facilities – from keeping residents safe from potential exposure, while avoiding any disruptions in the standard of care, to dealing with loss of revenue and critical staff shortages. In fact, skilled nursing occupancy levels dropped by 41 basis points to 74.8% during the month of June as a result of the COVID-19 pandemic – a record low, according to data released in September by the National Investment Center for Seniors Housing & Care (NIC)1.
I began my current role as President of Omnicare, a CVS Health company, in early April of 2020, just as quarantine was beginning in the United States and before we really knew what effect the pandemic would have on the world. What we did know right away, however, was that our role as the industry’s leading pharmacy services provider, would be critical.
The facilities we serve rely on us not only to deliver prescriptions, but to serve as a true partner by providing clinical support and pharmacist consultations, as well as educational resources and medication management tools. Our goal is to allow physicians, nurses and all other providers to focus more of their time and energy directly on patient care, which has never been more critical during this unprecedented time.
As COVID-19 cases and deaths reach all-time highs, health care systems across the country are being overwhelmed once again, leaving ICU beds scarce and forcing physicians to make impossible decisions when it comes to patient care. The only way to resolve this and keep facilities afloat is to curb the continued spread of COVID-19 through social distancing, mask-wearing, testing, and vaccinations. All long-term care facilities should have a plan in place for how to enact these guidelines within their community and that plan should include protocols to slow the spread of COVID-19, proactive plans for distributing flu and COVID-19 vaccines to residents and staff, and innovative ideas for streamlining operations and creating efficiencies within the day-to-day workflow to free up more resources.
Protecting Against COVID-19 and Flu
The U.S. Department of Health and Human Services (HHS) announced in October that CVS Health would be a key partner in the distribution of COVID-19 vaccines within LTC facilities, as well as to the general public. Since then, more than 40,000 long-term care facilities have selected CVS Pharmacy as their COVID vaccine provider and now that vaccines from Pfizer and Moderna have been authorized by the FDA for emergency use during the pandemic, distribution to long-term care facilities is well underway. Our team at Omnicare has been communicating with these facilities to make the roll-out as seamless as possible, and while there have certainly been some learning curves, we are continuing to do our best to ensure long-term care residents and employees are able to get vaccinated as quickly as possible through on-site clinics coordinated by Omnicare and staffed by CVS Health professionals and CVS Pharmacy team members who are primarily administering the vaccinations.
While this is without a doubt an exciting step in the fight against this pandemic, we can’t rely on the vaccine alone to keep residents and staff safe. To reduce the spread of COVID-19 within LTC facilities, the first line of defense is testing to identify positive cases early on so individuals can be quarantined appropriately. The CDC advises that viral testing of residents in nursing homes, with authorized nucleic acid or antigen assays, is an important step for preventing the virus from entering nursing homes, detecting cases quickly and stopping transmission.2 Testing, however, should complement other recommended infection prevention and control (IPC) measures, such as educating residents, health care personnel and visitors about COVID-19, implementing source control measures and making proper personal protective equipment (PPE) available.3
CVS Health sees COVID-19 testing as a critical service and has launched more than 4,700 locations testing sites across the country, including drive through testing services and rapid-result test sites at select CVS Pharmacy stores. In addition, Omnicare has been providing flu shots at long-term care facilities through an on-site vaccination program that has been in operation since 2016, filling a critical need in the LTC space. In 2020, we completed flu vaccine clinics at an estimated 8,000 facilities, while CVS Health as a whole anticipates administering more than twice the number of flu shots this season. Flu shots are available at CVS Pharmacy and MinuteClinic locations nationwide.
When it comes to individuals getting the flu vaccine, they’re not only protecting themselves against the seasonal flu, but they’re also helping their communities. There were more than 400,000 hospitalizations for flu during the 2019-2020 flu season.4 Minimizing flu hospitalizations this year will leave more health care resources available to those battling COVID-19.
Extra attention must also be given to those who have direct contact with LTC residents, given that influenza vaccine efficacy is generally lowest among the elderly. Keeping staff safe is also essential so as not to take time away from patient care for necessary quarantine periods.
Freeing up Staff from Administrative Burden
As a secondary impact of the pandemic, LTC facilities are being strained by declining occupancy, staff shortages and other financial pressures, which have led heightened levels of stress. Nursing staff and physicians need and want more of their time spent on direct resident care and less time dealing with administrative duties that, while necessary, divert attention away from one-on-one care. It’s important to find ways to free up staff from these types of duties and streamline workflow and authorizations so they can focus on what matters most: continuous patient care and safety.
One of the most efficient ways to do this is to increase medication availability by making timely and complete pharmacy orders, which will help avoid unnecessary delays and disruptions to care. As a trusted pharmacy partner, Omnicare has put a tremendous emphasis on this, and since March, we have reached best-in-class standards for on-time and completion rates.
Another way to save time and money is through automation. Smart technologies that streamline ordering or dispensing can enhance patients’ overall well-being, keep facilities in compliance with regulations at every level, and usher in a more comprehensive approach to medication management. Similarly, technology and innovative practices can help ease the burden of submitting prior authorization (PA) requests, which are often time-consuming. For example, electronic prior authorizations (ePAs) and collaborative practice agreements (CPAs) can reduce wait times, improve compliance and reduce the amount of work for on-site staff.
Finally, choosing a long-term care pharmacy with a robust supply chain management approach may increase the likelihood that medications are available for residents when they need them. By anticipating which medications might be in demand among patients and specific facilities, pharmacies can place orders with outside vendors or create a back-up supply in times of potential or already-existing shortages, which are especially likely during times of crisis like the current pandemic.
Looking Ahead in 2021
When creating a plan, it is essential to look at the big picture too and consider what’s on the horizon for both the industry and the world. From crises like the pandemic, natural disasters and other severe weather events to a volatile economy and political/social atmosphere nationwide, 2020 proved that you need to plan for the unpredictable. In 2021, we will apply what we’ve learned and continue to be nimble.
Operations in the coming year are going to focus heavily on administration of COVID-19 vaccines. All facilities should be prepared to get the vaccine to residents – as well as to staff and their families, which is equally as important.
In these uncertain times, we must also find ways to navigate challenges with as little disruption to patient care as possible, whether that’s by adopting new technologies, streamlining workflows, implementing COVID-19 and flu protocols, or ideally, a combination of these things. Clinical partnerships are a great way to help with this. They are becoming increasingly popular due to the immense value they provide and opportunities that arise when internal resources are freed up for other tasks.
Footnotes
1 https://blog.nic.org/pace-occupancy-decline-slows-in-skilled-nursing
2https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html
3https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
4https://www.cdc.gov/flu/about/burden/2019-2020.html