Important COVID-19 Information

I have been an licensed Administrator in senior care facilities for 43 years, having worked in Connecticut, New Hampshire, Oregon and California.  My background in social work led me to an industry where I felt I could make a positive impact on people’s lives.  Early in my career I worked for and with a community of caregivers with these same sensibilities and motivations.  Over the last handful of decades I have sadly seen a shift in focus and prioritization from that of resident care to one of profit motive. 

I have always specialized in seeking out those facilities that needed to be overhauled from the ground up in order to not only meet, but to exceed the quality of care offered to its residents.  There are far too many facilities that are not meeting State and Federal regulatory standards on a consistent basis, and thus not providing even the bare minimum of proper care for our most vulnerable citizens.  While there are multiple reasons for what I will call distressed facilities, it often comes down to lack of proper funding and inadequate training and protocols of care.  The goal should not simply be to meet a set of imposed standards, but to create a nurturing environment which allows residents to live happy, fulfilled lives with positive human interaction and a feeling of being loved and cared for.  The problems that I have seen all too often are now being exacerbated with the COVID-19 pandemic.

It is quite evident to me why the virus is spreading so rapidly through senior care facilities resulting in needless pain, discomfort and even death of not only residents, but potentially caregivers, family members and the surrounding community.  With the right systems in place, this did not have to happen.  Here are some of my thoughts on what systems and safeguards need to be considered.

  • Lack of Personal Protective Equipment (PPE)

It would be easy to assume that obtaining these crucial supplies is as easy as a facility’s central supply procurement employee picking up the phone and ordering what the facility needs.  Unfortunately, far too many facilities do not pay their bills or have a consistent history of being late on their bills.  With shortages in supply of PPE, these items are naturally finding their way to those facilities with the ability to pay, or even more distressing to the highest bidder.  This process has resulted in prices many times higher than normal market value.

  • Employees are working two or more jobs 

Due to inadequate pay rates for employees, caregivers and nurses are forced to work two and sometimes three jobs while potentially cross-contaminating among multiple facilities.  Employees are not changing their clothing or shoes from one job to another for several reasons.  They are rushing from one job to another and need to punch in and out by a certain time in order to get a full paycheck.  Directors of Nursing and Staff Developers are not taking the time to educate employees on the importance of changing their clothing to prevent cross-contamination.  Charge Nurses, whose job it is to supervise caregivers, are too busy with their own daily tasks.  Caregivers and nurses who are working double shifts suffer from caregiver burnout which directly affects patient care.

  • Not enough staff

The vast majority of facilities and communities do not allot enough staff for the best quality of care.  Staffing is based on the budget and not on the acuity of the residents, as it should be. With this model, call lights do not get answered in a timely manner, or at all, leaving the residents in jeopardy.  There are more falls, decubitus, and other negative outcomes.

  • Inappropriate admissions

The industry encompasses a wide range of facilities all specializing in different levels of care and resident focus.  The most important factor with respect to admissions is fitting a potential resident’s care needs to the types of support and medical services offered by a given facility.  As important as what is offered is what is not offered.  Inappropriate admission decisions can not only adversely affect the resident being admitted but can introduce undue risk to the other residents.  Admission decisions should include input from both the Director of Nursing and the Administrator of the facility.  This decision making has, for the most part, shifted purely to a Sales and Marketing approach (often devoid of input from those on the front lines of care), where the goal becomes simply “Can we fill a bed in order to generate revenue?” rather than “Is this particular potential resident’s care needs the right fit for the type of care provided by this facility?”.

  • Lack of training and accountability of Charge Nurses

During the orientation period staff is taught about the importance of hand washing and are shown the proper way to do it.  Additionally, staff are required to wear gloves when taking care of residents.  As mentioned above, procurement of supplies is sometimes problematic.  Additionally, Charge Nurses tend to concentrate more on their paperwork and charting than being supervisors to the caregivers.  Unfortunately, this gives caregivers free reign to take short cuts.

  • Lack of updated and relevant Fire and Disaster plans to include Pandemics

All facilities are required to have Fire and Disaster manuals to include various situations such as active shooter, fires, earthquakes, scabies outbreaks, and other potential disasters.  I have only worked in one community that had a disaster manual that included Pandemics, and that is because we were required to take part in the county health department’s disaster drills.   Going forward all facilities must have this training.

  • CMS 5-Star rating system

Nursing Homes overall quality rating on Nursing Home Compare (www.medicare.gov) is based on its ratings for health inspections, quality measures and staffing.  Ratings for each domain and the overall rating range is from 1 star to 5 stars.  In theory the more stars the better overall quality of the facility. Many facilities use their 5 star rating in their marketing materials, as if to say “we are the best.”  Low scoring facilities may have inconsistent surveys, high staff turnover, unclear guidelines.  It is not always the same person who is compiling the information for the report therefore using different information.  Facilities proudly post their 5 star rating certificate in the facility lobby and in their promotional materials.  This gives false hope to all families who are expecting exceptional service because of this rating and in reality they don’t get it. Too much is made of the 5 star rating system in terms what is really happening in a nursing facility.  It is not something for families to rely on.  They must rely on what they actually see in the facility and what kind of care their family is receiving and if the care is not what is expected they must be encouraged to meet with management.

  • Staffing Audits

Staffing audits are done annually to assure that the mandated staffing ratios are being maintained.  With the staffing crisis in the industry these ratios can be difficult to maintain, especially when Nursing Home companies historically do not pay competitive wages. Many nursing homes cannot meet their staffing requirements leaving residents uncared for.  Some staff who have just come from another job, take advantage of the situation and sleep on duty. Nursing homes must remedy this situation by raising the pay scale for all Caregivers and licensed staff.  Additionally, they need to hire enough staff in the first place.

  • Care Conferences

Facilities are mandated to conduct Care Conferences that include the families, and staff members from each department.  Each discipline presents information on the progress or decline of the resident.  As a result of these Care Conferences, Care Plans are updated to reflect the progress or decline of the resident.  The Care Plan is a working document that needs to updated, as necessary. Unfortunately, this does not always take place sometimes due to staff turnover, short staff or lack of Administrative oversight to assure that this vital process takes place.

  • Mandatory Communication Meetings

Communication with staff, residents and families are critical, especially during the deadly COVID-19.  Generally facilities have a monthly mandatory staff meeting and Resident Council meeting to in order communicate important information.   This would be especially important during the pandemic in order to share information and protocols related to the disease.  Without information, staff and especially residents are left scared and vulnerable. Family Council meeting are another very important means of communication to the families.  During the COVID-19 outbreak when families are not allowed visitation it is essential that staff have open communication daily via phone or text with the families to relay necessary information.  During this very challenging time, families need to hear from the facilities and not the media.