








key: cord-270254-dp7z1kla
authors: Inzitari, Marco; Udina, Cristina; Len, Oscar; Ars, Joan; Arnal, Cristina; Badani, Hugo; Davey, Vanessa; Risco, Ester; Ayats, Pere; de Andrés, Ana M.; Mayordomo, Cristina; Ros, Francisco J.; Morandi, Alessandro; Cesari, Matteo
title: How a Barcelona post-acute facility became a referral center for comprehensive management of subacute patients with COVID-19
date: 2020-06-11
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.06.015
sha: 
doc_id: 270254
cord_uid: dp7z1kla

Abstract The COVID-19 pandemic’s greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become a site to treat COVID-19 older patients. Referrals come from the emergency department (ED) or COVID-19 wards of the acute reference hospitals, nursing homes or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, healthcare, communication, psychological support and ethical frameworks. We believe that the strategies we employed and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.

Brief Summary: The paper describes how a large post-acute care facility in 23 Barcelona, was adapted at the outbreak of the COVID 19 pandemic to become 24 a polyvalent reference center for older COVID-19 patients assessed as not 25 requiring intensive care. 26 Key word: COVID-19, post-acute care, older adults, geriatrics, geriatric 27 syndromes, palliative care 28 Funding source: This research did not receive any funding from agencies in 29 the public, commercial, or not-for-profit sectors. 30 Acknowledgements: We acknowledge the staff working at Parc Sanitari Pere 31 Virgili during the COVID-19 pandemic, including healthcare professionals as 32 well as support staff and central services from this and external institutions. Table 1) . The facility receives around 75% of admissions 99 directly from the ED or wards of two major acute university hospitals (Vall 100 d'Hebron and Clinic hospitals, serving around 900.000 inhabitants), and 25% 101 from primary care.

PSPV was adapted to admit acutely ill patients in response to the pandemic. from PSPV with other specialists (infectious diseases, oncology) from Vall d'Hebron University Hospital. Nursing staff ratios were increased through 106 internal reorganization ( Table 1) 

Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19) -United States

Articles estimates of the severity of coronavirus disease 2019: a model-based analysis

COVID-19 and older adults: what we know

The geriatrician: the frontline specialist in the treatment of COVID-19 patients

Cross-country comparison of case fatality rates of COVID-19/SARS-COV-2. Osong Public Heal Res Perspect

Coronavirus Disease 2019 in geriatrics and long-term care: the ABCDs of COVID-19

Editorial: COVID-19 and older adults

COVID-19 in older adults atypical COVID 19 presentations in frail older adults

The course of geriatric syndromes in acutely hospitalized older adults: the Hospital-ADL Study

Dementia care during COVID-19

Risk factors and outcomes of delirium in older patients admitted to postacute care with and without dementia

Age, complexity, and crisis -a prescription for progress in pandemic

Epidemiology of Covid-19 in a long-term care facility in King County, Washington

Postacute care preparedness for COVID-19

Frailty, severity, progression and shared decision-making: A pragmatic framework for the challenge of clinical complexity at the end of life

Proof of concept: nursing home specialist in action. The impact of full-time physician services in postacute care

Geriatric screening tools to select older adults susceptible for direct transfer from the emergency department to subacute intermediate-care hospitalization

Rehabilitation profiles of older adult stroke survivors admitted to intermediate care units: a multi-centre study

Hospital-athome integrated care programme for the management of disabling health crises in older patients: comparison with bed-based intermediate care

The Catalonia WHO demonstration project of palliative care: results at 25 years (1990-2015)

Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care Skilled Nursing Facility

Comprehensive geriatric assessment for older adults admitted to hospital

A global clinical measure of fitness and frailty in elderly people

Management of avoidable acute transfers from an intermediate care geriatric facility to acute hospitals: critical aspects of an intervention protocol

Good care of dying patients: the alternative to physician-assisted suicide and euthanasia

COVID-19 in Italy: ageism and decision making in a pandemic

The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease)

Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a Randomized Clinical Trial

Consideracions Sobre La Limitació de Recursos i Decisions Clíniques En La Pandèmia COVID19.; 2020

Asymptomatic spread of COVID'19 in 97 patients at a Skilled Nursing Facility. JAMDA 2020. In press

Presymptomatic SARS-CoV-2 infections and transmission in a

Policy Recommendations regarding Skilled Nursing Facility Management of COVID-19: Lessons From New York State



