Table 2.
Main Actions to Respond to the COVID-19 Pandemic Within the PAC Facility
| Area | Goal | Action |
|---|---|---|
| General | Coordination and roles | Constitution of a COVID-19 committee, daily meetings, definition of roles |
| Transmission control | Patients' protection and increase capacity | Fast-track discharge of existing patients able to receive care at home |
| Early diagnosis | Timely screening of all patients and staff with PCR | |
| Minimization of contacts with potential vectors | Lockdown to visitors (exceptions for last days of life or severe delirium) | |
| Closure of outpatient centers and rehabilitation day hospital | ||
| Care of patients with COVID-19 | Organization of designated COVID-19 wards physically separated | |
| Care of patients without COVID-19 | Protection of non-COVID wards: rapid PCR, lockdown of common spaces | |
| Staff | Staff protection | PPEs and training modules. Patients with COVID-19 wear masks during visits |
| Reorientation of roles where usual tasks could not be done | New tasks (eg, occupational therapists undertook video calls between patients and family/friends, an important therapeutic role) | |
| Patient care | Holistic assessment and prognosis | Situational diagnosis through short Comprehensive Geriatric Assessment (CGA) and Clinical Frailty Scale as a prognostic tool |
| Avoidance of ageism and overtreatment | Advanced care planning based on CGA + frailty: the desirable intensity of care (scale 1–5) is reflected in the Health Electronic Records | |
| Acute care for COVID-19 | Provision of reasonable acute treatment options for COVID-19 | |
| Right care for older adults | Prevention and management of geriatric syndromes (delirium, immobility) | |
| Palliative care | Implementation of early palliative care | |
| Post–COVID-19 phase | Rehabilitation and reablement | Mobilization in the room after hyper-acute symptoms (PCR+ patients) |
| Fast-track rehabilitation (7–10 days, resistance + respiratory training) (PCR−) | ||
| Conventional geriatric rehabilitation if needed (PCR−) | ||
| Discharge | Discharge protocols include predischarge contact with primary care | |
| Communication | Internal-external communication with families | Provision of clinical information and shared decision making (phone) |
| Proactive contact between patients and caregivers (phone, video) | ||
| Ethics | Guide decisions | Adoption of a reference ethical framework |