New Pathways: Creating a Geriatric Fellowship Curriculum and COVID-only Skilled Nursing Facility

Background: With the second surge of the COVID-19 pandemic in the NY metropolitan area, inpatient hospital wards have again become occupied by those with severe disease Many are older adults (OA) with baseline frailty and impaired function who originally resided in a skilled nursing facility (SNF) or sustained hospital- acquired disability (HAD) and now need nursing and rehabilitation before returning home A significant number of these OA are medically stable but remain COVID-19 positive, preventing transfer to SNF Academic medical systems have redeployed residents and fellows inpatient to cover COVID-19 patients In an effort to prevent HAD and iatrogenic complications a large health system has taken the innovative step of designating one of its SNFs as a “COVIDPositive Only” facility This presented an opportunity to develop a novel curricular experience for geriatric fellows and improve care of a vulnerable population Methods: The Division of Geriatrics and Palliative Medicine (GAP) collaborated with administration in a clinical initiative to deploy geriatric fellows to assist in covering the facility Results: Within seven days a schedule was developed spanning 3 months and a curriculum drafted The facility medical director (GAP faculty) is the site rotation director Fellows rotate in pairs for two-week blocks and observing ACGME and NYS work hour restrictions Within the first week of deployment, the team admitted 97 patients to the 120-bed facility, an average of 13 9/day 3 1% were transferred back to hospital within 6 days 17 5% were COVID negative on admission and able to be discharged 86% lived at home prior to index admission Fellows and faculty meet weekly to review progress, revise curriculum and address issues Fellows are gathering clinical metrics on this population, including change in COVID-19+ status, readmissions, and functional status as a clinical initiative/scholarly project Conclusions: The COVID-19 pandemic has created a unique opportunity to develop a novel model of care within a geriatric fellowship program with implications for training, scholarship and public health policy Data on curriculum innovation and patient outcomes will be presented