COVID-19 Lessons from a nursing home operator: What we learned, and must do better
Here we are again. The red flags are reappearing.
After an incredibly difficult spring and a summer, we are seeing an increase in the number of coronavirus cases here in Connecticut. This fall and winter promise to be very challenging months.
Nowhere has the impact of coronavirus been felt more than in our nursing homes. Nursing home residents and workers represent nearly 40% of all coronavirus deaths across the country.
Athena Health Care Systems has felt this impact acutely. We operate more than 48 nursing homes across Connecticut, Massachusetts, and Rhode Island. We are devastated by the loss of all those under our care — including residents and staff. That is why we conducted a full review of our preparation and response to the pandemic in order to understand what happened, what we could have done better, and what changes we and our state must make to better protect our community.
In order to protect people moving forward, we must first look back. Here’s what we learned.
Nursing homes are the front lines of this pandemic, and must be treated as such.
The first lesson is the most basic one. Nursing homes and our health workers are every bit a part of the front lines of this pandemic as our hospitals, and must be treated as such.
This was not the case last spring. When the pandemic hit, nursing homes were classified as Tier 2 facilities by the Centers for Disease Control and Prevention. This was an unacceptable error with deadly consequences — particularly when it came to testing and PPE.
This classification meant that COVID testing of those in nursing homes was not a priority, and given the lack of tests early on, many residents and staff were not able to be tested. Instructions from the federal government compounded the problem. The Centers for Disease Control (CDC) did not initially include recommendations to test people without symptoms, even at nursing homes, largely because testing wasn’t available.
We know now that 32% of our positive residents were asymptomatic and 33% more had minor symptoms. Yet we were not even allowed to test asymptomatic roommates of infected patients. It was a monumental error with catastrophic consequences. So too was the initial prohibition of nursing homes testing our own staff. They were referred to their primary physician to be tested.
Nursing homes also were not prioritized for Personal Protection Equipment, with hospitals receiving the bulk of state and national resources because of their Tier 1 status.
This prioritization has changed, but more must be done to provide nursing homes with the same basic protections afforded acute care hospitals. We need mandated and funded weekly testing of all patients and staff. And nursing home staff should receive the same levels of PPE supplies as hospital workers. They must be treated as a priority — not an afterthought.
Outpatient services must be strictly monitored
We surveyed our facilities to determine how each building’s first COVID-19 patient may have contracted the virus (some call this person Patient Zero). What we found, while logical, is alarming nevertheless.
According to our data, 55% of all outbreaks originated with a patient who was either admitted directly from a hospital for a short-term stay, or left the facility for a short-term hospital stay or for dialysis or other out-patient services and then returned back to the nursing home. This is a statistic that cries out for attention and action. It is clear from the data that limiting patients off-site activity is critical to reducing the likelihood of outbreaks in the nursing home setting.
The fact is that with every patient’s exposure to an outside setting is a risk to them and to every other resident and staff in a nursing home. We must mitigate those risks as much as possible, and we encourage other providers to explore how they can limit exposure by providing these services in-house as well.
Recovery centers work
One of the great things Gov. Ned Lamont and the state of Connecticut did to combat this virus was creating life-saving Covid-only Recovery Centers.
We were proud to work with the state to open two previously shuttered nursing homes — one in Torrington and one in Meriden — and to transform two of our existing buildings to act as safe places to receive discharged hospital patients. These recovery centers provided relief to hospitals, support to patients needing continued care, and also protected staff by providing them with the knowledge that the patients in their care did in fact have COVID-19.
Staff knew they were dealing with the virus and acted accordingly. This reduced the PPE “burn rate” because it took away the need for frequent change, and it allowed us to better treat patients. We are proud to report a 10:1 recovery rate in the Recovery Centers compared to the 3:1 ratio at conventional nursing homes across the state.
One thing we recommend against repeating is the move to create COVID-only centers by transferring residents from currently operating facilities. Transferring residents from our centers — their homes — was extremely taxing to residents, families, and staff, and we would not participate in such an effort that created so much disruption and chaos.
If we learned anything thus far, it is that that stand-alone recovery centers work. Connecticut should do all it can to maintain these existing centers and identify additional locations if possible. This model should be the gold standard for care across the country, but we should not wait until our hospitals are overwhelmed to set up these sites. In fact, we are working now with the state to re-open Westfield Speciality Care Center in Meriden for November 16 to provide relief to nursing homes, assisted living centers, and of course, hospitals.
Use the National Guard
Another innovative model that worked well was Massachusetts’ use of the National Guard to provide needed support to long-term care facilities.
In four of our centers in Massachusetts, the National Guard came in to provide expedited testing of our residents and staff. When this testing identified a number of asymptomatic staff who were required to quarantine, the Guard remained to provide temporary staffing. This was a voluntary program that Massachusetts Governor Baker and the Guard developed to help nursing homes complement their existing teams for a finite period of days. We commend Massachusetts for this model and recommend its implementation in neighboring states.
There is no question we are in for some incredibly challenging months ahead. But I believe these are challenges we can, must, and will meet.
I know this because I have seen our outstanding nursing home health workers come to work every day as the unsung heroes of this pandemic – putting their own health and families at risk to help others.
And I know this because we have seen what didn’t work over these past months, and what did work. Only by learning those lessons, and acting on them, will we truly live up to the sacred trust we have to care for those who need it most during these difficult times.
Larry Santilli is CEO Athena Health Care Systems that operates more than 50 nursing homes, assisted and senior living solutions, and home health and hospice service groups across Connecticut, Massachusetts, and Rhode Island.
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