The Department of Veterans Affairs is telling its hospital network leaders to prepare for "a significant surge" of COVID-19 patients who will need major rehabilitation care after being hospitalized.
In a memo to Veterans Integrated Service Network (VISN) leaders this week obtained by Connecting Vets, the Office of Deputy Under Secretary for Health for Operations and Management Renee Oshinski said VA networks should expand their surge plans to include "creating and/or converting beds for post-acute care for COVID-19 patients."
Post-acute care is the recovery and rehabilitation stage. The memo said VA hospital networks should plan for recovery space that can provide "pulmonary rehabilitation" and other services to "convalescing COVID-19 patients" because of serious health conditions arising from the virus and intensive care treatment required.
Experiences at three VA networks so far "and other projections suggest that a significant surge in the demand" for rehabilitation care following patient hospitalization for the virus "is on our horizon," the memo said. Those networks were VISN 2, 10 and 16, which include VA hospitals in New York, New Jersey, Ohio, Indiana, Michigan, Louisiana, Arkansas, Mississippi and parts of Texas -- among the areas veterans were hit hardest by the virus.
And rehabilitation options "are already limited" because of "high demand and restricted admission policies due to concerns of facility infection risk," the memo said.
Patients who have been infected with the virus may require longterm rehabilitation care after being hospitalized and VA "estimates suggest three to four weeks or longer recovery," according to the memo.
Patients recovering from the virus are facing serious, complex health conditions that will require significant care after they leave the ICU, VA said.
Patients recovering from COVID-19 have "several debilitating complications from ICU/intubation such as delirium and encephalopathy; cardiopulmonary limitations; neurological limitations; renal failure and need for dialysis and decreased muscle strength -- and these symptoms have been found to last beyond the expected acute hospitalization stages," the memo said.
Initial models suggest 30 percent to 50 percent of all COVID-19 patients treated for the virus in intensive care units will need rehabilitation care.
Once VA hospital networks identify "potential shortage" of rehabilitation beds, networks should find ways to "expand, convert or repurpose space to support" recovering patients, the memo said. Network leaders also were told to consider how to use home-based care and other "alternative settings" for particularly vulnerable patients "to reduce demand."
VA officials have repeatedly refused to provide information on VA's capacity, arguing such information is "sensitive in nature" but refusing to cite any specific statute or rule keeping that information from the public.
As of May 1, at least 8,798 VA patients tested positive for the coronavirus and 512 had died. Over the previous five days, VA added more than 2,000 cases and across April, VA added 459 deaths.