How do we find a way to do better?
The COVID-19 pandemic has been hard on everyone, but nowhere more so than on Skilled Nursing Facilities (SNF), Assisted Living (AL) and Rehabilitation Centers. I know wonderful people who work in these communities and this has been an incredibly difficult year for them and the families they serve.
Linda Mundie is Director of Business Development for The Gardens at Monroe, a skilled nursing facility and short-term rehabilitation community. I know Linda through Caring Connections, a non-profit organization that is focused on educating seniors and their families and connecting health professionals.
The Gardens at Monroe is a close-knit community of staff and families. Before the coronavirus hit, families were always on site eating lunch and dinner with loved ones and socializing with other residents and their families in the lobby. If a regular visitor did not show up, staff would call and ask, “Where are you?” If they were unable to connect, they would call the family emergency contact, “Dad did not come to visit today, is everything OK?”
In addition to no more family visits, the lockdown during pandemic required a huge shift in how the staff worked while adjusting to new, daily, safety guidelines. Creating COVID isolation units, step-down units, multiple COVID-19 testing protocols and accessing personal protective equipment (PPE) required all hands on deck. At the same time, phone calls were made every day to families to explain what was going on despite having limited information from the state. Rules for how to conduct business and keep people safe changed daily.
No one wants our seniors to be isolated from their families, but these types of congregate living house our most vulnerable population. Great care is taken to keep them from getting sick, which means government rules for this population are much stricter than those for the general public.
Here is how it works.
With little warning, the Center for Disease Control (CDC) issues new guidelines. The New Jersey Department of Health (NJDOH) as the governing body over SNF’s, AL’s and Rehab communities determines how to implement CDC guidelines. This dual oversight role has caused endless confusion for communities, families and the general public.
When the CDC issues new guidelines for say outdoor visitation, NJDOH determines the rules communities must follow for outdoor visitation. To ensure the highest level of caution and safety, what is happening in each county dictates what a community can and cannot do. For example, a community in one county may allow visitors because the county infection rate falls between X and Y. A community in another county may not allow visitors because the infection rate rises into Z. You can see how hearing on the news that the CDC is allowing visitors and then being told you can’t see your loved one because of infection rates can cause confusion.
Even when visits are allowed, the community is required to ensure rules are followed, often with little notice. Last year on the Friday before Father’s Day, communities were told they would be open to outdoor visits for the holiday. Great news for everyone, but it meant The Gardens at Monroe had to first understand the rules, clearly much of which is written in legal jargon. Then within 48 hours, visitation protocols and the actual space for outdoor visits had to be set up and communicated to the families. Linda and the rest of the staff are masters of the “pivot.”
Now what happens if between Friday when the public is told outdoor visits on Father’s Day are allowed and an employee or a resident tests positive for COVID-19?
Testing is ongoing at all communities and the NJDOH has strict testing rules. Staff is tested twice a week and if anyone tests positive, residents are tested twice. If a resident comes back from the hospital, they are quarantined for 14 days, tested twice and must go into a step-down unit before returning to their regular unit. In addition, The Gardens at Monroe administers a rapid test right in the lobby to anyone who comes into the building for any reason (e.g., hospice nurse, physical therapist or family member).
Today there is a real effort being made to ensure that families can visit. Indoor visits are suspended in the case of an “outbreak”, which the NJDOH defines as two positive staff members or one positive resident. If two staff members or one resident test positive, the state must be informed and the community shut down to indoor visitors for two quarantine weeks. However, in the case of an outbreak, outdoor visits are still allowed. So that inside visit you were planning may need to be outside, subject to weather conditions.
A positive test also impacts programming. Currently, The Gardens at Monroe is in a “no outbreak” status. Residents are allowed small gatherings within the same unit, therapy is in small groups, along with small group activities and small group dining for one meal a day. Everyone is masked, but small group access can be modified at any moment.
I asked Linda if she could sit down with the powers that be if she had suggestions for how to handle things differently. “I do believe everyone did the best they could in the moment. No one was prepared for this type of care. How do you predict the unpredictable? Everyone had to scramble for PPE and many state organizations, like the Office of Emergency Management, were amazing. Certainly, lessons were learned. Now we are required by law to have enough PPE on hand for a certain amount of time. But the volume of need is hard to predict. One patient can use up to 20 sets of PPE in a day with all the staff that has to interact with them – from housekeeping to nurses and aides.”
Linda is a daughter as well as a healthcare worker and her mom resides in an Assisted Living community. “I wish they could have figured out a better way for families to visit. As a daughter, I saw my mom for the first time in 13 months. It was heartbreaking to see the decline in all the residents. But even being a daughter unable to visit her mother, I really believe that keeping her in assisted living is the best decision for her. There are just no good choices.”
I asked Linda what she would want the families and public to know. “We need to be kinder to one another. When you get mad at us, know that we are doing our best. We are not just a nursing home, we are a family too.”
Like Linda, I don’t have an answer to the question of how we do better. But I am glad that professionals at all levels are studying the problem and look forward to having a national conversation and implementing ideas. We don’t need another study that languishes on a shelf somewhere, we need action. Please leave a comment if you have a suggestion for how we can do better.
Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.
Deb is available as a caregiver consultant. She will answer the question: “Where do I start?” and find the resources to alleviate your stress. If you would like to invest a half hour to learn how she can help you, please contact her at: Free 30 minute consulting call
Deb is the author of “Your Caregiver Relationship Contract.” This book explains how to have an intentional conversation and the how unspoken expectations can cause problems. Click here to learn more about Your Caregiver Relationship Contract