PERSPECTIVE

Bridging the Divide Between Acute Care and Skilled Nursing Facilities

Rodney Koenig , PA-C

Director of Recruiting and Retention, Advanced Providers

Published March 11, 2021

Advanced Providers work together to support Skilled Nursing Facilities.

When California and subsequent states went into lockdown last year to prevent the COVID-19 virus from spreading, my advanced provider colleagues and I were expecting an intense period of work—perhaps several weeks, and at most two months—spent helping to treat moderately to critically ill patients and educating our local community on practical tips to avoid contagion. Little did I know the pandemic would still be raging a year later, and that my skills and resources would be tested like at no other time in my career.

Not only that, but my operational and logistical acumen would also be utilized and put to the test in a complex effort to help lead skilled nursing facility (SNF) outreach support teams across Riverside County in Southern California. These “SOS teams,” as they came to be called, gave me a chance to use my entire skill set as an advanced provider to serve my community at such a time of need.

Protecting Our Most Vulnerable Post-Acute Patients

SNFs are a critical piece of the American healthcare system, often serving patients who don’t need long-term care but are impacted in their day-to-day movement and functionality, such as post-surgery rehabilitation. However, most SNFs in Riverside County also include long-term nursing home residents. When the pandemic first struck, these patients were considered especially vulnerable due to close living quarters and elderly population.

My Vituity colleague, Michael Mesisca, DO, came to me with a proposal in April, shortly after one SNF in our region was forced to evacuate 80 patients in a matter of hours. Several of their colleagues had recently contracted COVID-19, and the rest of the staff was afraid of passing along the disease to their families and friends. Dr. Mesisca asked that I join him in an ambitious multi-agency county effort to support and educate the staffs of SNFs, assisted living facilities, and behavioral health facilities across Riverside County as they fought the pandemic.

Advanced Providers Leading the Charge

Our challenge was daunting, with many issues to be addressed. How could we effectively support and educate SNF teams without encroaching on their well-established routines and expert roles as care providers? The concern of interfering with routines also applied to the nursing home residents, who might be frightened by new and unknown people in their bubble environment. This dilemma called for a form of organizational “soft power.” Instead of charging into these facilities with the aim of fixing perceived shortcomings and then departing as new challenges arose, we needed to collaborate with staff members to make them feel comfortable and set them up for success in what could and indeed would be a long road ahead during a pandemic with no end in sight.

"At Vituity, physician leaders recognize that advanced providers excel at adapting to ambiguous situations and solving problems in pressure-cooker environments."

Rodney Koenig, PA-CDirector of Advanced Provider Recruiting

Our teams hit the road and began visiting many SNFs in our large and sprawling county. On the ground, we quickly determined our most pressing need. Since many previous employees had left during the first COVID-19 surge, new staff members needed to be quickly educated on how to properly don and doff personal protective equipment (PPE), like gowns and N-95 masks.

We were also assisted on-site by a behavioral health nurse or therapist. All employees were under an inordinate amount of stress, and some facilities had experienced the trauma of large viral outbreaks. Our teams were committed to providing a holistic approach to support them and their well-being.

To ensure consistency in our approaches and memorialize training methods for the long term, the SOS team in Riverside County distributed a playbook to each facility outlining PPE utilization and information regarding the COVID-19 virus. Riverside has vibrant Latinx communities, and so the playbook was also translated into Spanish.

Perhaps most important, we made a concerted effort to make consistent and repeat visits to facilities, building relationships with staff members. These connections ensured that their safety and their patients’ safety would remain priority number one throughout the ordeal.

Administrators gained trust in our teams’ methods and didn’t hesitate to bring us in whenever they onboarded new staff, developed new protocols, or simply wanted to provide a site with a morale-boosting repeat visit. Over seven months, SOS teams conducted more than 1,200 site visits. Group homes and homeless shelters were eventually added to the vulnerable populations under our care and support.

Bringing Acute Care to Our Community

The program became so successful that it was replicated in nearby San Bernardino County. In late 2020, my fellow Vituity advanced provider, Dennis Tankersley, PA-C, and his team received an award from San Bernardino County for their work at Arrowhead Regional Medical Center.

This experience proved to me the value that advanced providers bring not just to the acute care setting but also to the operational healthcare setting. At Vituity, physician leaders recognize that advanced providers excel at adapting to ambiguous situations and solving problems in pressure-cooker environments. The acute care and operational hurdles that COVID-19 created have offered providers like me opportunities to demonstrate empathetic leadership and expertise to the communities in which they live and serve.

Partnering to improve patient lives

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