Skilled Therapy Need During the PHE

Providers are now tasked with the responsibility of mitigating the risk of virus exposure in their facilities which, unfortunately, sometimes requires preventing some staff from entering the building. At times the staff being turned away has included therapists. Lack of detailed guidance early on during the PHE created an environment in which key long term care decision-makers such as administrators were left to interpret regulations as best as possible until further clarification was received. However, thanks to the numerous studies recently published in 2020 and clarification from the CDC, it has become clear that providing early and consistent rehabilitation care throughout the SNF stay is important for successful outcomes.

Long-term negative physical, cognitive, and psychosocial effects for those not receiving the caliber of care required to meet their individualized needs are now evident. Furthermore, on March 19, 2020, a Memorandum from the Department of Homeland Security stated that therapy practitioners are critical health care workers and need to be a part of the treating team.  Simply put, if a patient requires skilled level of care, that service must be provided. If services required to rehabilitate the patient back to a prior level of function are not being delivered, this puts the facility at risk for substandard quality of care.

The CDC has also now provided guidance. When asked “should any diagnostic or therapeutic intervention be withheld due to concern about transmission of COVID-19?” The CDC answered by stating patients should continue to have the opportunity to get any interventions they would normally receive as a standard of care. The Journal of Physical Therapy Science recently published research study findings to further support this claim. The purpose of the study was to recommend methods of respiratory rehabilitation and psychotherapy for patients in different stages of the coronavirus.

“Physical therapy of COVID-19 patients will not only reduce the mortality rate of patients, hospital admission time, and medical expenses, but also save medical resources, reduce personal and national economic losses, and the probability of adverse social stability events such as medical collapse. Therefore, physical therapy should be introduced into the mainstream treatment of COVID-19 patients as early as possible.”

Although this example depicts the critical nature of service delivery from a physical therapist…occupational therapists and speech-language pathologists also play a pivotal role in patient rehabilitation. With respiratory distress comes a myriad of potential complications including insufficient breath support for communication and/or swallowing as well as the inability to complete one’s daily tasks due to insufficient pulmonary capacity required to complete the activity. The bottom line remains that therapists are highly skilled healthcare professionals that play a significant role in the rehabilitation of patients.

In order to further support HTS therapists, resources, and tools were created to not only educate on infection control but also to facilitate best practices in these unprecedented times. Check out the list below for just a few examples of recently created materials:

• Breathe: A Pulmonary Intervention Program
• Therapist Treatment Hierarchy Delivery Chart
• Dining Assistant Emergency Program Toolkit
• HTS Annual Training: COVID-19 Supplement
• Teletechnology Quick Reference Tools
• Virtual Home Assessment Tool
• Waiver Related Claim Guidance

Written by: Sheena Mattingly, M.S., CCC-SLP, RAC-CT, HTS Director of Clinical Outcomes

Sources:

• “Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community” Retrieved from: Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response (cisa.gov)
• J Phys Ther Sci. 2020; 32(8): 545–549. Published online 2020 Aug 8. doi: 10.1589/jpts.32.545