It was the call that every post-acute care operator most feared and that many ultimately received since early March — multiple positive results following housewide COVID-19 testing of residents.
That call came to me on a Friday evening. Despite following all the guidelines from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), the virus had made its way into our 83-bed skilled nursing facility located in an urban Midwest setting. Fourteen initial COVID-positive residents would quickly accelerate to more than two dozen, as well as nearly that many staff impacted.
Since February 2020, our organization had been preparing for this day while providing leadership and support to the many health care communities under Health Dimensions Group (HDG) management. Countless hours of planning with focus on federal, state and local rule and policy changes, waivers, surveillance, communication, workforce education and deployment, finances and purchase of personal protective equipment (PPE) were about to pay off.
COVID-19 rapid response team deployment
One of the most important decisions made by HDG very early in the planning stages was to assemble a COVID-19 rapid response team that could quickly mobilize and respond to an outbreak. The goal was to provide an added layer of support to a community’s leadership structure should caregiver resources become so depleted that non-clinical community managers would be needed to provide hands-on care.
The rapid response team comprised more than a dozen clinical and non-clinical home office senior leadership members, many of whom worked in a post-acute executive role over the years. CMS issued waivers providing flexibility to nursing facilities for caregiver hiring and training during the COVID-19 emergency. Under the umbrella of these waivers, HDG trained and competency tested most of the rapid response team, as well as many of each community’s department supervisors. This training and preparation proved invaluable.
As a member of the rapid response team, I was requested to deploy to the community the next day. By the time I arrived on Saturday morning, the community’s leadership had already moved COVID-positive residents into a newly designated COVID-positive wing. By Monday, five additional rapid response team members were on the scene.
As a licensed nursing home administrator who has been out of practice for a few years, I found it rewarding to make a difference on the front lines fully donned in PPE and working side by side with nursing assistants and housekeeping staff. It gave me a refreshed perspective on how difficult the work can be —especially during a pandemic.
The spirit of both the residents and staff that first morning was a pleasant surprise. Having heard all the stories coming from the media, I prepared for the worst. Instead, what I found was a remarkable group of residents and a resilient, but depleted, team of caregivers.
From the first day, I knew communication would be a key element of our recovery strategy. We needed to be totally transparent and provide responsive updates to families, staff, and state and local health officials. We had candid phone conversations with the state health department’s chief administrator about conditions in the community. I can’t overemphasize the impression it made for them to receive a real-time firsthand accounting of the impact COVID-19 was having in the community and how we collectively, as an entire organization, responded.
During the first two weeks after the initial COVID-positive resident, there were isolated flare-ups that required us to establish a second active COVID-positive wing. With some creative office and resident room moves, in concert with gaining consent from local fire officials to create “air barriers” in corridors, we were able to keep the risk as isolated as possible.
The community’s operations began to stabilize after about two solid weeks. After four weeks, I was able to gradually reduce the time I needed to spend at the community as staff and residents began to recover and the workforce stabilized.
My key takeaways as I reflect on the experience are:
- Detailed planning has no substitute. The events of each day move so quickly, especially the first two weeks of an outbreak, that you have virtually no time to think and strategize. You need a plan that contains all the variables that may be encountered so you can mitigate the loss of precious time each day.
- Check in on every resident at least twice a day. This human interaction helped me, and I am certain the residents appreciated it as well (most, anyway). I enjoyed making new friends and have great memories of the time we spent together.
- Where there is a lack of communication, inaccurate information begins to spread. Our organization is blessed to have a very strong communications department that played a pivotal role assisting with content and infrastructure support to keep messaging to all audiences near real-time.
- Rest when you can and encourage others to do so. Outbreaks are marathons. You can’t contribute if you are exhausted to the point of becoming ill.
Darrin Hull is Health Dimensions Group’s executive vice president of consulting. He is also a licensed nursing home administrator.