Inside Skilled Nursing Facilities During COVID-19

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This article, which originally appeared on Advocate for Mom and Dad, provides insight on the safety measures long-term care communities have implemented to keep residents protected through the pandemic. Used with permission.

Changes in agency home care, assisted living, and skilled nursing facilities are on the horizon.


Through my work, I know many eldercare professionals that work in skilled nursing facilities (SNF’s). They are some of the most caring people I have ever met. They are heartbroken by the toll COVID-19 is taking on their residents and staff.

The projections for loss of life across this country are staggering and our elders are taking the brunt of it. I’m not going to try and deconstruct why this is happening. More qualified people than I will do so when there is a moment to breathe. But there is no doubt in my mind, or any other elder care professional, that COVID-19 has changed the landscape of caring for our elders.

What I can tell you is the staff and administrators in skilled nursing facilities care more than you will ever know and they are working under awful circumstances, trying their damndest to keep your loved one healthy and connected to their family. Every SNF has had to adjust to a world where the coronavirus is a harsh reality. There is no such thing as “business as usual,” and their resident population is particularly vulnerable. They are finding ways in which to keep families involved with their loved one, keeping both residents and staff safe, and spirits up.

Care facility employees are considered essential, so protocols are in place as outlined by the CDC and state government. Protocols may vary slightly but in general, during check-in at the start of each shift, every employee is asked a series of questions, their temperature is taken, and they sanitize hands prior to starting work. If an employee leaves the building during the day, they must go through this process again before being allowed back to work. But we know it is not a foolproof system. You can ask the question, “Do you have a cough?” and you must trust the answer.

If an employee works in more than one place, additional screenings are required. There are tracking systems in place for these employees to see if they work in a facility where they might have been exposed to the virus. If there is a risk of exposure, employees are sent home.

But the problem for the healthcare industry and the general public is the asymptomatic individuals who unknowingly come to work infected. We are still in cold and flu season and now allergy season has started, complicating everything. The only recourse facilities have is the same recourse we have as individuals--social distancing.

Social Distancing
Social distancing in a care center is complicated. Healthcare providers, like doctors, are coming in only when absolutely necessary. Hospice nurses who would normally come in and out of the facility as needed are no longer allowed in because they see multiple patients.

New admissions are tested for the virus before they are accepted. In addition, they go into isolation for two weeks before being assigned to a wing. Patients that have health needs beyond a facility’s capability, like wound care or IV therapy, are sent to the hospital and then isolated upon their return. These types of controls are a hardship, but easy to manage.

Less easy to manage are the residents who struggle with social distancing rules. Deep friendships have developed over the years. Residents are like family to one another and they are used to seeing each other. Because they don’t understand the need for social distancing, it is a constant task to keep them out of each other’s room and six feet apart.

Programming for residents requires even more creativity. For example, if a common room like a dining room does not allow for six feet apart, events are being done in residents’ rooms. One facility ran a fashion show, and it required some creativity. The hallway became the “runway” with two people walking it six feet apart and stopping at rooms for anyone who could not sit in their doorway. These types of events lift everyone’s spirits, but it is getting harder and harder to accomplish.

Keeping everyone mentally healthy
For residents in many parts of New Jersey, the uncertainty and measures being taken are heartbreaking reminders of hurricane Sandy and its aftermath. For them, it brings back issues and a big concern is keeping everybody emotionally OK.

“We are finding that people are not able to cope with the situation as time goes on. Everyone talks about our ‘new normal’, but our folks are not getting used to it. They are feeling sadder and sadder as the distancing goes on. As a result, the staff has to work harder at helping people feel connected every single day,” says a SNF communications director.

Families are struggling as well. The staff is asked all the time, “When will I be able to see my mom? It’s going on two months and it’s getting harder and harder the longer this goes on.” In addition to visiting, some families are used to bringing their loved one food and taking care of their laundry, all of which are not allowed for the foreseeable future.

Staff tries their hardest to give everyone a feeling of normalcy. A family might call and say, “Mom loves Asian pears and I can’t bring any to her, can you help me?” Food service will do their best to honor the request. Even if they can get the item, it’s not the same as a beloved grandchild proudly handing it to them during a visit.

Keeping families connected
Recreation therapists and social workers have added social media mavens to their job description. Using laptops, iPads, and even their own phones, they are connecting families over Facetime, Skype, Zoom, or any of the other video chat applications available. Sometimes staff initiates the contact with the family and sometimes the family calls and requests time with their loved one. Making these connections, even if it is just a phone call, increases their daily tasks, but it is important to everyone that they occur.

Supporting the staff
Training for staff is ongoing and includes everything from the proper way to wash hands to why hand-washing is better than using sanitizers. Based on daily information from the CDC and state and local government agencies, there are daily updates on how to stay safe and information--including the number of new positive cases. All facilities are in competition to purchase supplies, everything from masks to enough single-use gloves, and they are often difficult to find.

In addition, management teams are working hard to address staff concerns and keep them as safe as possible. Staff are pulling together to do what is best for the residents, adding new and different duties to an already full day. Like the rest of us, they are working to get through this together.

The challenges facilities are undergoing are many of the same challenges families face when aides come into their home. Unless you have a live-in aide, the person walking into your home has cared for other families. You don’t know where they have been and you are competing for supplies like gloves along with everyone else. Because of this reality, many families have chosen to take on the caregiving role without help, even if it means taking time off from work with no backup system in place.

I don’t have an answer to these problems facilities and families are facing. I only know that each is doing the best they can under awful and frightening circumstances. The coronavirus will bring fundamental and long-lasting changes to our healthcare system. I am eager to see what that looks like. I hope and pray it is for the better.

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