Dr. El

Last week I listened to a webinar on protecting residents of nursing homes from pandemics, hosted by STAT News and sponsored by AARP. The three medical experts on the call offered a multitude of recommendations, some of which will no doubt be familiar to long-term care leaders, while others may provide new avenues for thought and direction. 

The specialists discussed the importance of consistent access to personal protective equipment and the use of universal precautions, noting that the experiences of nursing homes around the country show that “we can’t worry about keeping the virus out, we have to figure out how to live with it” — a sobering comment that rings true to me. 

The physicians emphasized the importance of hiring infection control specialists and of having clear, standardized infection control guidelines. Consistent guidelines increase the ability of staff members to learn and practice them and, from a psychological perspective, they reduce the anxiety that staff members feel when they discover that last week’s rules are no longer in effect. (“Did I inadvertently transmit or catch the virus by following last week’s recommendations?!”) In a relatively low-paying and now more dangerous field with ongoing staffing shortages, we should make every effort to reduce staff anxiety regarding infection control. 

Frequent COVID-19 testing with rapid results for both visitors and staff was seen as essential, because test results that take days leave a large window of opportunity for the virus to enter facilities. They additionally recommended outdoor visits with family members and gradations of visiting policies depending on the level of community spread. 

Based on the webinar recommendations, other information sources, and my observations of the emotional and practical impact of a highly restricted visitation policy, I don’t think we can wait until this is over in order to resume family visits. It may not be safe for a long time and things will probably never go back to the old normal, just as we never have boarded an airplane the same way after 9/11.

We, therefore, ought to develop reasonable Plan B options. Creative ideas include a “happiness bubble,” where friends and family members can see loved ones separated by a clear plastic wall, and a “hug tunnel,” which allows visitors to hug their loved ones through a plastic shield. 

We need to develop alternatives when outdoor visits aren’t feasible. A section of that beautiful lobby or impressive entryway may have to be turned into a safe visiting area. It might not look as attractive, but this is a time to forego visual appeal for the sake of emotional necessity. 

Another consideration emphasized in the webinar was that nursing homes should partner with local hospitals since they serve a shared population. It was further recommended that facilities become “learning organizations.” This concept includes not only the suggestion to collaborate with academic settings for increased access to well-informed and innovative professionals, but also a rethinking of the punitive culture of nursing homes.

When the ‘bad cop’ looms over

The punitive culture begins at the top, they pointed out, with the survey process leading to citations rather than being viewed as an opportunity for teachable moments. This style can also be seen on the floors of facilities, when an incorrect action by an aide leads to being chastised and/or “written up.” A learning organization and system, by contrast, would evaluate an incorrect action to determine what resources are needed to correct the problem within the nursing home and the system. This is an important distinction, so I’ll elaborate.

Take, for instance, a facility that isn’t providing staff with enough PPE. Rather than a citation and penalties, the surveyor would evaluate why there wasn’t enough PPE and assist in addressing the problem. Furthermore, the surveying process would consider the possibility that if one nursing home didn’t have enough PPE, other organizations might be having similar difficulties, requiring a coordinated, systemwide effort to resolve.

A single facility is likely to find many teachable moments each week. For example, if an aide was found to be re-using linens, there could be many reasons for this. Even one possibility — insufficient linen supplies — could mean a problem with the vendor, the laundry, purchasing, distribution or the discarding of torn, substandard items. A lack of supplies could even be due to residents hoarding items in their rooms and there would be reasons for that, too. All of these possibilities would be lost by simply chastising the aide rather than finding out the “whys” behind her actions. 

In addition, whatever the cause, if one aide is reusing linens, it’s probable that others are as well, suggesting a need for staff training in infection control. Moreover, there might be consideration of why the aide didn’t alert a supervisor. Are workers expected to figure things out on their own? Is teambuilding needed? Is there an unapproachable nurse who would benefit from additional supervision? A learning culture examines all these alternatives and more, leading to stronger, healthier organizations.

The takeaway from the webinar was that long-term care needs to adapt to a new reality that won’t go away after the COVID-19 pandemic is over. The silver lining, if there is one, is that there’s great interest in our field right now and a recognition that, as we knew, our work is essential and deserves more support. With webinars like this one, it appears that some of the necessary support is forthcoming. 

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.