03. How do criteria differ for discharge destinations other than home?

Discharge Criteria Key Clinical Questions

03. How do criteria differ for discharge destinations other than home?

a. HOMERuN institutions

While these depend on the criteria of the receiving facilities, some hospitals use the CDC criteria for removal of quarantine as the default, with the following additional themes: 1) when facilities are willing and able to accept patients with active COVID-19, then criteria resemble those of discharge to home or even earlier (e.g., still requiring supplemental oxygen), although some still required 3 days of no fever and 7-10 days since symptom onset; 2) other hospitals had much stricter criteria for discharge to skilled nursing facility (SNF) or long-term acute care (LTAC); and 3) some hospitals reserved their strictest criteria (e.g., two negative COVID-19 results) for patients being discharged to congregate settings such as group homes or for homeless patients, with the latter generally recommended for discharge to a respite facility, field hospital, or other facility. We recommend customizing these guidelines based on the capabilities and requirements of local facilities.

b. What is Known

Many of these criteria are based on practical issues, first principles, or the nation’s experience of the spread of COVID-19 in nursing homes and other aggregate living settings.

c. What is Not Known

To our knowledge, there are no studies evaluating the validity of these criteria.

d. Spring 2021 Update

  • Different communities developed different solutions for caring for COVID-19 patients with homelessness, including field hospitals, hotels, and buildings run by religious and community organizations to care for patients during the period of isolation. This allowed for more options for these patients while they were in place
  • Skilled nursing facilities generally became more available over time, but availability has waxed and waned depending on the community