We recognize that in the frantic pace of dealing with the Coronavirus pandemic there are many gaps in policies and interventions when it comes to Geriatric Care and more specifically Nursing home and post acute care. Consider this a specialty specific suplement to the more detailed information now available through the WHO, the US CDC, the MaineCDC, and the MHCA. 

• Tier One is done through Nordex in-house and usually takes less than 12 hours to results depending on the time received at the lab.

• Healthcare providers and critically ill patients at the hospital are considered tier one as of 3/23/2020 but there is talk of adding NHs.

• Nordex has been processing Nursing home patients as tier one, but they have not committed to doing so indefinitely. their last week letter to facilities didn't list nursing home residents as tier one.

• Tier two constitute the vast majority of testing done as outpatient, including when healthcare workers are tested in outpatient testing sites. The York hospital tent testing site sends all their tests to state lab in batches and the results take 5-7 days. The Portland testing drive-through site also takes days, NOT hours, to provide results.

• Tier two processed by Nordex are sent out to Quest diagnostics and they take 2-3 days to result, those are potentially some nursing home and assisted living residents that might be sent out if not considered urgent. (The writer has not had that happen in his own faculties thus far.) We encourage members to keep updating us on the situation in their building if different, better, or worse.

• The need to identify negative cases who can still work despite having a URI symptoms. Please also consider having a sticker that says "I tested negative" to reassure residents and other staff that the staff member who happens to be coughing etc. is not carrying the disease.

• The staff need to know that they are not taking COVID19 home from work. A negative test reassures many who can continue to work and serve the elderly.

• Healthcare staff are risking their lives working in such high risk work environment of scarce supplies, the least we can do is test them when they become symptomatic, so that they can take appropriate action if positive.

• We need to reassure the asymptomatic healthy staff that we are testing and identifying the positives to keep them safe.

• Getting a handle on the positive cases so that we can keep facilities open and able to take the pressure off hospitals if and when the surge of cases happen.

• Utilizing the scarce isolation equipment on positive cases only, allowing facilities to maintain basic standard of care despite the shortage.

• Given a mortality rate of 15% in our nursing home patient population as their average age tends to be above 80, we need to test to identify patients at risk who may need hospitalization at some point in their treatment. 

• A positive test refocuses efforts to manage other chronic diseases, like COPD aggressively and early.

• Reassures staff that we are controlling the situation and we are are guided by information on each symptomatic resident so they can take the necessary extra precautions when they need to.

• Last but not least, not knowing is not good enough for many of our families, and rightfully so.

• If we are screening visitors and staff for symptoms, then we should screen our admissions too.

• Hospital patients who have pulmonary symptoms suspicious of Flu should also be tested for COVID19, especially if they are going to be later introduced to  SNF, NF, or AL facilities.  

• The hospitals are currently more able to test than nursing homes and assisted livings, so if a patient might need testing, the hospitals should be more aggressive with testing before discharging. 

• The CDC recommends Respiratory Precautions (Meaning Negative pressure rooms, N95 masks, and Shields) "out of abundance of caution", but says that Droplet Precautions are adequate, except when intubating or performing certain procedures.

• Nursing homes have no capabilities for Respiratory Precautions, but are able to do Droplet Precautions if they receive adeqaute supplies of masks, gloves, and gowns.

• Nursing homes are receiving less now than before the pandemic, because of shortages at supplier level, and the usual deliveries are few and far between and, in many cases, non-existant.

• Many Facilities are yet to receicve their first allocated supplies by DHHS due to federal shortage.

• If you are getting donation of cloth Masks please be aware of material dependent efficacy and the need to either store them for a few days before use, or to wash and dry. Use as last resort and if possible as seconday protection.

• Be aware that the virus can be carried from room to room on your mask, so dont touch your mask and return to work, and defintly discard the masks used in rooms with COVID19 positive cases, unless its your last Mask.