Concerns for the frailest nursing home patients are on the rise after the coronavirus has taken the lives of four nursing home residents in Washington state.
But despite confusion and anxiety related to fears of a potential pandemic in the U.S., some long-term care communities are banding together to update health policies and offer support amidst a scare that is most troubling for the elderly and infirm nursing home residents.
To date, more than 100 people are infected in the U.S., with more 12 states showing signs of a community-based outbreak — including the increasing numbers of residents and staffers associated with the Life Care Centers of America-operated nursing facility in Kirkland, Wash.
The operator confirmed that local hospitals are treating those with the virus, as well as residents showing respiratory symptoms, according to a statement from Life Care Centers.
Residents at the property are being closely watched signs of the virus, which includes a spike in temperature, trouble breathing, and cough; residents who are experiencing these symptoms are isolated.
“Associates are screened prior to beginning work and upon leaving. We are also following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns, and gloves when caring for any symptomatic patients … and all visits to the facility from families, volunteers or vendors are not allowed,” the company said in a statement. “The facility has also placed a hold on admissions, to fully focus on our current residents and associates.”
Ensuring that infection control protocols are enforced is a priority for the almost 200 nursing homes and 300 assisted living facilities in Washington state, Robin Dale, CEO of the Washington Health Care Association (WHCA), said.
In particular, Dale pointed to the Centers for Medicare & Medicaid Services’ (CMS) latest emergency preparedness guide effective November 16, 2019, with a special focus on virus outbreaks and infection control pertaining to pandemic influenza and the Ebola virus. Similar protocols have been recommended for coronavirus, and the WHCA and the American Health Care Association (ACHA) have recently trained thousands of health care workers with the new regulations prior to the coronavirus scare.
“It’s a robust program. It requires an infection control specialist to be at the facility,” Dale said, although he couldn’t confirm if every nursing home had one on the premises to date.
Because so many common protective medical supplies are made in China — and due to individual buyers taking over some of the market — a shortage of supplies has plagued Washington state, Dale said. But help was on the way in the time when a nursing home needed it most.
Pointing to a temporary and local supply shortage before Saturday, WHCA sent out a notice to their members to ask if “they had spare gloves, masks, gowns, gel — and then if they did, we were able to at least get some of those supplies to the facility,” he said, which helped protect residents and staff.
“The facility indicated that they’ve got enough supplies, and so they don’t need extra from the community now,” he said.
Admissions remain intact, and there are no rumors of people moving out of Washington-based nursing homes — and on top of that, health care workers continue to show up to do their job as if it’s any other time.
“What I’m hearing is that staff are on site and they are committed to patient care. What I want people to know is that the skilled nursing facilities are focused on following their infection control protocols,” Dale said. “And they’re absolutely focused on resident care. We’re not seeing any kind of panic among caregivers, They’re there at their jobs and doing what they’re supposed to be doing. And you know, thank God for that.”
David Gifford, chief medical officer of the American Health Care Association (AHCA), warned that sick employees should stay at home, and indicated that facilities need to ensure a consequence-free environment for health care workers who fall ill.
Employees potentially feeling pressure to come to work is a common issue that comes up during illness outbreaks.
“Certainly one of the best practices is not to recommend people needing to go get a doctor’s note, because you don’t want to force them to have to go out and spread the virus elsewhere if they are sick,” Gifford said during a conference call with reporters on Monday.
Sue Boyd, a clinical consultant for the Minneapolis-based operator and consulting firm Health Dimensions Group agreed with the need to be flexible in difficult times.
“If the person is on their last leg of being terminated, and they don’t want to call in, but they’re sick,” that situation needs further discussion, Boyd said.
Supply chain education
The Society for Healthcare Organization Procurement Professionals (SHOPP) is working to help nursing homes approach the use and distribution of protective gear with more care during the coronavirus scare, according to Ari Stawis, director of professional services and development at consulting firm Zimmet Healthcare Services Group.
SHOPP was created with leaders at Zimmet and Prime Source GPO, a group purchasing organization, and launched with professionals working in the post-acute procurement space, serving almost 150,000 nursing home beds.
Stawis and SHOPP co-founder Josh Silverberg said they have heard some anecdotal stories about price increases in the wake of the COVID-19 outbreaks, with one operator reporting that a medical-surgical supplier doubled the price of a box of 50 masks from $15 to $30.
However, major suppliers such as Medline, McKesson, Twinline, and Cardinal Health have not increased pricing yet, he said, though there are no guarantees that the trend will continue.
Most products are readily available, although since the virus originated where many manufacturers of the merchandise are located, it may become a bigger problem because many factories in China are still closed — and those that are open may not be shipping to the United States.
Currently, SHOPP is assured that there are enough supplies for now, but that could change — and Silverberg emphasized the importance of educating procurement staff and nursing home operators at large on how to properly manage tight inventories of medical gear, a topic that the group plans to cover at its symposium in May.
“Some manufacturers have told me that if this continues, they’ll be out of stock of everything by April or May time,” Silverberg said.
Taking care of complex patients
As nursing homes continue to take on more complex residents, ventilator patients are at high risk, and may exhibit symptoms that are similar to the coronavirus, based on their pre-existing breathing problems.
“Even right now, I’m actually at a facility with a lot of ventilator patients, so they [some nursing homes] take a lot of people with respiratory issues and have had respiratory failure,” Boyd, of Health Dimensions Group, said.
Even with reminders of the flu, it’s important to place signs on the doors warning people not to visit those experiencing flu symptoms, and update staff on policies about calling in sick, she said.
And although visitors are still allowed in many nursing homes, Boyd suggested that operators should discourage visits from people who have had contact with infected patients, or those who have traveled to areas with more widespread COVID-19 outbreaks.
“Because I think it’s going to come. I don’t know that it will be widespread, but you’ll have pockets of community outbreak,” Boyd said.