Rebekah Bray

The images and news coverage from the early 2020 of devastated nurses and doctors, and the thousands of body bags and make-shift morgues in New York City, are burned in the memory of healthcare workers across the country. This is where those images will live forever. We are called heroes because of our dedication to our fellow man during a global pandemic, a global crisis that is likely to be the biggest disaster we will see in our lifetime.

Society frequently uses the phrase “new normal” to describe the state of affairs of today … with a hint of tomorrow. Those of us on the front lines likely struggle to understand what that means and how to make sense of our 2020 experience. Sadly, the drastic change in structure and disruption to routine for our residents and their families in skilled nursing facilities (SNFs), in all probability, has eliminated the consistency and structure that people with cognitive impairments desperately need.

Hard decisions

During this time, SNFs that experience a positive COVID case of a resident or staff are mandated to implement rigorous precautions as part of infection control measures to mitigate the potential spread of the virus. By following these mandates and continuing to educate ourselves on best practices, we contribute to the greater good of decreasing the spread of COVID. While our actions and dedication are deemed heroic by some and villainous to others, staff will always struggle with the paradox of promoting independence and well-being, while seemingly and nonintentionally isolating our residents and families.

Visitor restrictions began early this year. While this was an absolutely necessary action to take, staff, residents, advocates and loved ones were shocked and rightfully upset that it was happening. It was a regulation that was out of our hands, but it made sense and it was the right thing to do. Facility staff across the spectrum understood that the risk of exposure outweighed the reward of family visits and socialization, but still felt the emotional pain when they witnessed the isolation and decompensation of their residents.

This was a no-win situation, and it still is. We seldom think about how drastically the frail and elderly can change over the course of time; six months is a long time by most standards and some loved ones were left stunned when visitation finally resumed. Some loved ones finally saw our residents who may have lost weight since their last visit; other residents may no longer recognize their closest family. Sadly, some residents died alone.

No easy way out

COVID is undoubtedly an unprecedented event, meaning this is something that has never happened before, and no one expected it to happen to them. Nursing and clinical staff rely heavily on facts, orders, training and education; there is little room for interpretation. As issues will continue to arise relating to COVID, we as educated professionals are obligated to recognize such an event. We cannot simply say, “I don’t know what to do … This has never happened before.” We must force ourselves to have dedicated conversations with our teams and research community resources when we are lost for direction. Documentation has and always will be our first line of defense; everything we do, we do for a reason, and our documentation is our explanation. Lastly, we make the best decision we can based on our integrity and the information we have available in the moment.

As we approach the one-year anniversary of the coronavirus across the world, we are adjusting to the “new normal.” Most of us can anticipate major changes happening in phases, masks in public places are becoming second nature, testing methods and procedures will continue to evolve, and maybe in the near future we’ll see a vaccine. From a clinical perspective, facility staff will always follow clear directive from the governing body leading the charge. From the point of view of a nursing home employee, we continue to pray that what we are doing is right, meaningful and serves the greater good.

Rebekah Bray, MHA, is the assistant administrator and director of social services at Oneida Center in Utica, NY. She is a certified dementia practitioner as well as a certified sex offender treatment provider. She has seven years of long-term care experience including administration, social work and recreation.