What we’ve done across the United States to protect patients, residents and our staff:
When the outbreak began in China, our senior management team and clinical leadership immediately began meeting regularly to address concerns about the potential for a pandemic. Upon the outbreak’s spread to the U.S., we fully mobilized in crisis response mode.
We have been following recommended protocols and guidelines from the Centers for Disease Control and Prevention (CDC), and Centers for Medicare and Medicaid Services (CMS), often getting out in front of them.
Sent out our first communication to all of our centers in preparation for an outbreak.
Formed a formal coronavirus task force, including senior leadership, clinical leadership, and Chief Medical Officer.
Started monitoring standard facemask inventory and acquiring additional personal protective equipment (PPE), such as isolation gowns, eye protection and N95 respirators, in anticipation of an outbreak in the United States.
Ensured all centers had availability of masks, N95 respirators, and fit testing kits for the respirators. Centers were required to fit test N95 masks on key clinical personnel in each building.
Started a PPE inventory management process across the organization to determine where we had excess inventory and where we could divert PPE to centers with lower supply.
Posted signs discouraging visitors if they had symptoms, had been exposed to someone with COVID-19, or had travelled to a COVID-19 outbreak area. Also, began daily temperature assessments of all residents.
Directed all visitors and employees to enter through the front entrance ONLY to ensure everyone entering the building is screened by the receptionist for attestation of travel history, no known exposure to someone with COVID-19, and no symptoms of fever, sore throat, sneezing, cough, or shortness of breath.
Also, mandated enhanced screening in outbreak areas of all visitors and employees including direct assessment of temperature readings.
Fully implemented active screening and mandatory temperature checks for all entrants, exceeding CMS March 9 guidance that visitors could be offered temperature checks.
Implemented a no visitation policy for areas with community spread of COVID-19.
Centers in areas of community spread of COVID-19, as defined by local public health authorities, were required to restrict visitor access per CMS guidelines. Also, implemented the cancellation of non-urgent outside appointments in communities experiencing community spread of coronavirus.
Early on March 13
Implemented twice daily resident screening for temperature, respiratory symptoms (cough, shortness of breath), and pulse oximeter (blood oxygen level) readings.
Late on March 13
CMS issued further guidance for Restricted Visitation, which we had already fully adopted, and active Patient Screening without specified frequency, which we had already exceeded.
In addition, we fully adopted CMS guidance to cancel communal dining and all group activities, such as internal and external group activities.
We also implemented video conferencing capabilities to support family engagement.
Communicated new guidelines regarding the reuse of facemasks and extended use of gowns, given the national shortage of PPE.
All consultant pharmacists were directed to perform consulting functions remotely, to further reduce the risk of virus entry to the building.
Upon our first confirmed COVID-19 case in a Genesis center, implemented a structured and standardized process for managing potential outbreaks, including:
Full infection precaution review
PPE inventory review and procedures for urgent shipment of additional supplies
Contact tracing and risk assessment
Mandated standard facemask reuse throughout the system to preserve supply.
Staff were directed to leave mail entering a facility untouched for 24 hours, and follow appropriate sanitary protocol while handling all mail and packages.
Implemented universal mandatory use of facemasks and eye protection in outbreak hotspots.
All centers were provided with primary care telehealth capability. Also, virtual wound care by specialists was initiated.
All staff in patient care areas began wearing universal facemask and eye protection at all times, across the entire system.
Also, the frequency of patient screenings was increased from twice daily to three-times daily monitoring of temperatures, blood oxygen levels, and any new respiratory symptoms.
CMS first issued guidance for universal facemask use, which Genesis had already fully implemented between March 23 and March 26, 2020.
Introduced an Enhanced Clinical Review process, utilizing a standardized pre-acceptance screening tool for all potential admissions into Genesis facilities, to reduce the risk of an outbreak.
Introduced Genesis Palliative Care Resource Team to assist centers in meeting needs for palliative care consultations and peer support.
Designated an Infection Prevention (IP) Designee for every shift in every center, to ensure 24x7 focus on adherence to infection prevention practices.
Worked with state and local officials to develop our first COVID-Only Dedicated Facility at PowerBack, Piscataway, in NJ.
Procured reusable, washable cloth gowns to ensure that staff and residents were protected, as single-gown use became hard to procure.
Established our second COVID-Only Dedicated Facility at PowerBack, Center City serving the Philadelphia metropolitan area.
Released the Genesis Advance Care Planning Guide, a conversation guide to support health care providers when assisting patients/residents and their families to make informed decisions about future care.
Established three additional COVID-Only Dedicated facilities at Canyon Transitional Rehabilitation Center in Albuquerque, NM; PowerBack, Voorhees, in Voorhees Township, NJ; and PowerBack, Lakewood, in Lakewood, CO.
Established Admission Quarantine Units in order for admissions and readmissions to be under infection precautions and observation for 14 days, prior to being transitioned to the general patient population within the facility.
Patients requiring medically necessary transfers out of the center for outpatient procedures (dialysis, chemotherapy, etc.) were also placed on the Admission Quarantine Unit.
After acquiring significant additional supplies, eliminated the need to reuse standard facemasks over multiple shifts.
CMS issued further guidance for centers to separate patients who leave the center for appointments, by placing them on a unit for at least 14 days, reinforcing a policy that we had already fully adopted on April 20, 2020.
Established our sixth COVID-Only Dedicated facility at Loch Raven Center in Baltimore, MD.
CMS and CDC announced the Long Term Care Facility COVID-19 Module for reporting case data. We began work immediately to automate fully transparent data collection and reporting for all Genesis Centers.
CDC issued guidance for cohorting nursing home residents in Centers where COVID-19 is present, mirroring Genesis policies that had already been adopted on April 9, 2020.
Recommended testing of all staff at the beginning of an outbreak, and periodically thereafter, at a frequency based on community prevalence. Centers in communities with high coronavirus prevalence were guided to consider weekly re-testing of staff.
Completed an analysis of 189 Focused Infection Control Surveys conducted during the pandemic by state and federal officials at Genesis centers throughout the country, achieving a 96% zero-deficiency rate.
CMS suggested that nursing homes consider adopting an Infection Prevention designee for backup during all shifts, which is a practice that Genesis had already adopted on April 6, 2020.
Genesis enrolled all Centers in CDC NHSN infection tracking and began data transmission, including optional historic data from the beginning of the pandemic.
Implemented procedures to safely allow for outdoor visitation, use of central showers, communal dining, and outdoor facility access, subject to state approvals.
June 11, 2020
Despite wide variation in state requirements, implemented a testing policy until coronavirus is effectively eliminated from each center’s surrounding community, for staff re-screening every 1-4 weeks, depending on community prevalence and results from prior screening.
CMS issued guidance recommending universal eye protection for staff, mirroring Genesis policies that had already been fully adopted by March 26, 2020.