Senior care communities were in the news early on. For a short period in February 2020, the epicenter of the novel (new) corona virus disease 2019 (COVID-19) nationally, could be found at the Life Care Center, a nursing home in Kirkland, Washington. Nursing home coronavirus safety was an immediate concern.
Since the first resident tested positive for the virus on February 19, it saw a disproportionate number of its residents affected by corona virus. Since that time, and as of this writing, 37 deaths have been linked to the COVID-19 outbreak at Life Care.
Understandably, the tragic deaths at Life Care Center, and the deaths in Florida at Atria Willow Wood which the governor characterized as “criminal negligence,” have given many Americans pause at the thought of placing or keeping their loved one at a senior care facility during the COVID-19 emergency. As of today, close to 150 skilled nursing facilities in 27 states have at least one resident with COVID-19 according to the Centers for Medicare & Medicaid Services (CMS).
Is it Safe to Move into a Nursing Home During a Pandemic?
Most often, the decision to move into a skilled nursing or assisted living facility is driven by health or isolation issues that just can’t wait, pandemic or not.
It is important to understand that while nursing home stories dominate the news during this coronavirus pandemic, there are over 28,000 assisted living communities across the U.S. The majority of communities had the time and the resources to react and isolate themselves appropriately. Your job as a responsible person seeking care for yourself or your loved one is to find out if the community or facility is prepared and likely to remain so until the crisis passes.
If you were considering moving yourself or a loved one into a senior care facility, you don’t have to put those plans on hold. However, you owe it to yourself to take the extra time needed to research their operations and find out what they are doing to prepare.
Nursing Homes vs. Assisted Living
It’s worth understanding the terminology here. The Life Care Center in Washington is what is known as a long-term care facility (a “nursing home”). These facilities care for the most medically frail seniors and are also among the most highly regulated.
By contrast, the term “assisted living” refers to various senior living communities where residents are generally younger, healthier seniors requiring less support. There are also continuing care retirement communities (CCRC) which provide a full continuum of care, starting with independent living in an apartment or stand-alone cottage.
A single location will sometimes contain both an assisted living facility as well as a nursing facility. It is common to see dedicated sections inside a building or grouped into separate buildings on a larger campus. These distinctions become important as one considers the ability of any facility to quarantine their residents. Can they prevent the exposure or spread of the COVID-19 virus?
Lessons Learned from Affected Senior Communities
A number of state and federal investigations have already been conducted at communities suffering extensive outbreaks, and some fact-based analysis and reporting has been possible. Investigators have found that several factors contributed:
- Early epicenters suffered the worst. In early February, the scope and urgency of the outbreak wasn’t clear to most people. If a facility was unlucky enough to be in an area like Seattle, where the virus had already been unknowingly introduced, there was ample time for it to spread. Many senior facilities saw increasing resident sickness but thought it was seasonal flu.
- PPE was not used initially. Reports indicate that Life Care in Washington allowed visitors into the facility unchecked, and staff treated at-risk residents without personal protective equipment (PPE) well into the outbreak, even while saying publicly they were complying with government guidelines.
- Existing state and federal guidelines were ignored. Federal regulators found that Life Care Center failed to rapidly identify and manage sick residents. They failed to notify the Washington Department of Health about the increasing rate of respiratory infections among residents. They also failed to have a backup plan in the absence of Life Care’s primary clinician, who fell ill.
- Poor staff training in infection prevention. Personnel in some care facilities were poorly trained in proper procedures for preventing the spread of infections. Health inspectors had cited Life Care for this in April of 2019, however they had instituted corrective measures and were re-certified in June. Nationally, failure to implement proper infection hygiene is one of the most common health department citations in the senior care industry.
- Lack of testing for COVID-19. The virus was initially misdiagnosed as seasonal flu. The lack of test kits made it difficult to know what was actually happening, but administrators did not react strongly enough to isolate their affected populations.
- Ignoring the problem. In the case of Atria Willow Wood, investigations showed that they failed to screen staff, cooks, or construction workers. The Florida Department of Health investigation revealed that the incidents were “avoidable.” They added that some people at the facility were “coughing up a storm” or going into work visibly ill.
Senior living communities that had more time to react, or that were better managed and staffed, had better results. “In most of the big cities, facilities did plan for backup. The challenge for this is that it’s going to be ongoing—not what anyone had supplies for and it’s evolving day by day,” said Lisa Mayfield, a certified care manager and past president of the Aging Life Care Association board (source).
How Are Senior Care Communities Managing the Outbreak?
We spoke to Elizabeth P. Andersen, corporate director of compliance and risk management at United Methodist Communities (UMC), a non-profit senior living and care organization, operating nine senior living locations and a home care agency across New Jersey. Despite being in one of the hardest hit areas of the country, UMC has not had any residents test positive for COVID-19 in any of their four assisted living/skilled nursing communities. Nor have any of their five affordable senior housing communities across the state as of April 7, 2020.
“As soon as we saw what was happening in Washington, we began limiting visitation to our communities,” says Ms. Andersen who directed efforts across the company to define and institute comprehensive COVID-19safety measures. “The severity of the steps we took escalated rapidly but by the time cases started to appear in our area, we had already instituted major restrictions on visitation, and screening of all residents and associates for symptoms, as well as obtaining masks and other PPE equipment.”
UMC’s Safety Measures Include:
- Severely limiting entry into communities yet providing creative ways for residents to be in visual contact with loved ones.
- All associates are monitored daily upon entrance with an infrared thermometer.
- All residents have temperature taken twice per day with an infrared thermometer.
- Designated areas set up for isolation and care should anyone become infected.
- Mandatory hand sanitizing throughout the day for aides and residents combined with increased disinfecting of the entire facility.
- No residents are allowed to leave their campuses except for medical emergency. Residents who choose to leave may not return until further notice.
- Social distancing in strict force, all common areas closed, all social gatherings and outings cancelled.
- Careful monitoring of supplies across the communities. Masks, gloves, and gowns are available and generous volunteers and residents who can sew are making masks.
- Maintenance of an adequate and committed staff sufficient to provide care in all facilities.
Despite these precautions, no health care professional would claim that they can fully protect the population of a senior community in the wake of a pandemic. Instead, potential residents should consider not only their current case exposure, but their ability to quickly isolate and safely care for those who may become affected.
Using Technology to Combat Social Isolation
While thorough safety protocols are a necessity, the isolation inherent in COVID-19 responses extracts a particularly heavy toll from seniors. Those with Alzheimer’s or Dementia for instance, often rely on regular visits from family to maintain their connection to memory. Feelings of loneliness can be strong in the absence of family or immediate social contact. Technology can help seniors in general, but particularly with nursing home coronavirus safety.
According to Elizabeth, UMC and many other senior communities are using technology to a greater degree than ever before to keep people connected:
- Aides help residents facilitate the hygienic use of computers, iPads, and phones. They connect with others using ZOOM, Skype, Facetime, and other apps.
- Making videos and sending them to loved ones.
- Encouraging and teaching seniors to use Facebook and other social media to stay in touch with family.
- Residents who sew can be put to work making masks (cloth mask effectiveness).
- Hotlines and web-based information can be provided to residents and families through frequent communication over social media, email, text and phone calls. This keeps families informed and calm.
Stories abound about aides and staffers going to heroic lengths to help family members. They visit through windows or from a safe distance. Bands have been hired to play in the parking lot. Grandchildren decorate the windows of Nana’s apartment with loving messages from the outside. Socialization like this takes work and supervision by the staff so it can be done safely.
Nursing Home Coronavirus Safety Conclusions
It would be fair to say that assisted living facilities understand the extreme responsibility they have during the coronavirus outbreak. Most are doing the right thing, and many are erring on the side of extreme caution.
Still, if you were considering moving yourself or a loved one into a senior care facility, take the time to research their operations and find out what they are really doing. Look at their public health inspection records to find out what their history of health violations looks like.
Remember that you are not looking for perfection here. Many facilities will have been cited for something or another at some time. You are looking for the frequency of violations, the severity of violations, and whether they are cited in successive years for the same violations. That’s a sign of bad management, poor staff training, or both.
But in general, a good senior community, obeying strict COVID-19 screening processes, that is supplied with PPE, and has isolation capability, is safe for the care of seniors.