The Ongoing Battle Against COVID-19 In Long Term Care Facilities

As nursing homes and assisted living communities continue to battle COVID-19, facilities leadership still face tough challenges.

By Andrew McGuire, CEM, EMT-P and Darren Osleger

The COVID-19 pandemic has put an unprecedented amount of strain on the healthcare industry, particularly ravaging one of the most vulnerable segments of our population. As long term care facilities such as nursing homes and assisted living communities continue to battle COVID-19, overwhelmed facilities and leadership still face debilitating challenges.

long term care facilities
Photo: Jensen Hughes

We cannot ignore the most obvious and long-standing concern — the continued struggle to attain Personal Protective Equipment (PPE). Many facilities were not prepared or stocked with the proper equipment and, due to resource shortages and burn rate, are still unable to maintain necessary supplies. Critically low supplies of masks, gowns, gloves, PPE equipment, and other resources continue to put residents and staff at risk while also increasing the risk of exposing family, loved ones, and colleagues to a potentially deadly disease. During the height of the crisis, some facilities resorted to using trash bags in place of gowns or donated ballpark ponchos sourced from community partners.

In an effort to continue to isolate and limit the transfer of the virus, designated spaces or “wings” remain in place for both confirmed COVID-19 cases and non-affected residents and staff. Residents confirmed to have COVID-19 are moved to an area of the facility to be treated and remain until they can be released. Staff that are exhibiting symptoms, but are still well enough to work, asymptomatic or recovered from the virus are limited to this COVID-19 confirmed ward as well. Non-affected staff and residents must remain in a designated area and both are prohibited from entering the COVID-19 confirmed area. As more widespread testing of residents and staff occur, we will see an even higher number of positive cases amongst residents and staff. In turn, these high numbers will increase the residents placed into COVID-19 positive units, the adherence of isolation precautions, and ultimately the consumption of PPE.

Even before COVID-19, facility leadership often struggled to retain healthcare workers. But this crisis has strained the workforce to its breaking point, leaving some facilities unable to provide enough staff to support the elderly resident’s level of care. Long term care facilities have been hit hard with infections and increasingly large number of staff testing positive despite being asymptomatic. Current CDC Guidance mandates that an asymptomatic staff member that tests positive be out of work for 14 days before returning to work, or at least seven days symptom-free since the onset of illness and at least three days fever-free without the use of fever-reducing medications. These infections and isolation cases along with other challenges mean even greater staff shortfalls as more employees call in sick or are unable to retain childcare.

Additionally, healthcare staff already experience the highest rates of workplace violence in the industry. As more long term care facilities make the news for reports of shockingly large numbers of COVID-19 positive staff or even deaths, resident’s families are looking for answers. Now, as they battle COVID-19, healthcare workers are at increased risk of experiencing on-the-job violence, PTSD-like effects and debilitating burnout, making this even more complex.

Shore Up Resilience At Long Term Care Facilities

We still have a long way to go until this pandemic is behind us and healthcare facilities can return to any sense of “normalcy” that existed prior to COVID-19. So, how can long term care facilities begin to overcome this crisis? What steps can they take to make their facilities more resilient?

  • Put your Event After Action Report (AAR) into practice. AARs are an opportunity to review and analyze your response to an incident objectively. Not only are these reports critical to re-assess decisions and consider possible alternatives for future scenarios but will also likely be mandated soon. How AARs are handled vary across organizations but all will answer questions such as: How was your response to the COVID-19 crisis? What were your strengths and weaknesses? A detailed report will help identify any necessary plan or process improvements and will help develop an Improvement Plan.
  • Lean into the use of technology. The need for real-time coordination, communication and response is critical. Technology solutions for emergency management, surge assessments and even staffing can minimize response time and boost communication speed and accuracy.
  • Connect with community partners and other healthcare facilities to secure resources. Mutual Aid Plans (MAP) and Healthcare Coalition organizations can link facilities together to provide a real-time view into where supplies are located, the quantity of available resources and which facilities are struggling to secure the resources needed to provide adequate care and safety.
  • Ensure staff are protected and supported as they do the most difficult of jobs. Mitigate employee burnout by implementing programs that help employees manage the PTSD-like effect of a crisis and implement critical security measures to protect staff, giving them the confidence to do their job safely.

At minimum, these steps can help ensure your facility recovers as quickly as possible and will better prepare you for the next challenge.

McGuire is a fire & emergency management consultant at RPA, a Jensen Hughes Company. He has been with the company since July 2014 after working for 11 years as a hospital emergency manager. He has coordinated comprehensive healthcare emergency management programs involving all aspects of preparedness, mitigation, response and recovery. Andy co-founded the Healthcare Caucus of the International Association of Emergency Managers (IAEM) in 2008, served as President of the New England Region of the USA Council of IAEM and achieved the prestigious designation as a Certified Emergency Manager (CEM) by IAEM in September 2018. With over 30 years of experience in Emergency Medical Services, he managed a private medical transportation service for five years and continues to practice as a paramedic in Westchester County, NY.

Osleger is a fire & emergency management consultant at RPA, a Jensen Hughes Company, where he has worked since 2007 after serving as a casualty adjustor for an insurance adjustment service. He currently focuses his time on the prevention and suppression of surgical fires, as well as supporting the healthcare mutual aid plans with his involvement in regional and statewide disaster exercises and site visits for evacuation and influx of patients. In 2000, Osleger completed a certificate program in Emergency Response to Terrorism with the National Fire Academy, and in 2006 earned an additional certificate from the Department of Homeland Security for his study of the National Incident Management System. He has also provided lectures at the Association of periOperative Registered Nurses (AORN) Congress and for VHA on surgical fire prevention and suppression.

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