There is an expression used in economics: Never waste a crisis. It’s a concept that nursing home operators have come to appreciate.
From bolstering communications to supporting staff to stepping in to help residents in the absence of visitors, many providers around the country have used the COVID-19 pandemic not to merely maintain operations, but to improve them. And they are reaping noticeable gains from these actions in terms of staff, family and resident satisfaction.
Proper communication with families, residents and staff has been one of the biggest priorities for operators since the pandemic began. The time when just a periodic newsletter to families sufficed is gone, points out Janine Finck-Boyle, vice president of regulatory affairs for LeadingAge, an association of nonprofit providers.
“You need to get real-time information out as soon as there are positive cases … so it really gave nursing homes the ability to look at other means of communication,” she says.
Those other means largely focused on electronic communications — from website updates to blogging to Zoom video conferencing calls, she points out. Such tools have been a game-changer for facilities. “Everyone had to pivot a little bit,” she observes.
To keep families informed of the rapidly changing situation, the Hebrew Home at Riverdale by RiverSpring Health started holding one-hour webinars every week with families, says David Pomeranz, chief operating officer of the seniors care and housing operator in Riverdale, NY. About 100 families now dial in every week to the presentation, which features Pomeranz, along with the community’s medical director, vice president of nursing, director of social work and director of activities. As part of the webinar, loved ones can ask questions. “It’s really created a comfort to families that they have a live stream with the facility,” he says. “It’s like putting on a familiar TV show … We didn’t expect that. In a general sense, it’s been a chance to express their gratitude and appreciation for the work we are doing under extremely challenging circumstances.”
Communicating effectively with staff also has been key.
“From the very beginning of the pandemic, our response efforts included the widespread and consistent use of Zoom meetings for education, communication and leadership support,” says Cheri Kauset, vice president of customer experience and communications for Tampa, FL-based Mission Health.“We even implemented quick and easy ‘Leadership in a Minute or Less’ tutorials at the beginning of our weekly calls to help guide our community leadership through some of the unique challenges they’re facing.”
One of the most important messages many facilities had to express to staff was if they are sick, they must stay home.
“I think people’s nature is they want to help and push through it and be here serving our residents,” says Sondra Norder, president and CEO of St. Paul Elder Services, in Kaukauna, WI. “We have had to hammer it home that if you have one [COVID-19] symptom, we don’t want you there.”
To help staff feel better about their job security, St. Paul Elder Services, which has two campuses in and around Green Bay, made a major operational change: a no-fault absence policy. “At this point, we are not holding it against people if they are calling in and saying, ‘I have a sore throat and headache,’” Norder says. “That’s the biggest change in practice. In the past, if they had symptoms, they could be here with masks.”
Another communication piece for St. Paul Elder Services has been relaying the safer-at-home guidelines — a bit of tough love.
“Even though the rest of the world is going back to business as usual, we can’t do that,” Norder explains. “We have to keep ourselves safe, which means wear a mask in public, avoid crowds, no nonessential travel. We are telling staff we are not going to run surveillance on you and make sure you are not taking risk, but it’s on you. If this virus comes through our doors, the contact tracing is so good we will know where it came from. If you are going to take the risk, you have to accept the consequences.”
Such a difficult ask has an upside — staff know they are doing work most people don’t have the courage to do.
“I have made it a point to everyday send a message to our staff about updates, highlighting the enormity of the sacrifices they are making and acknowledging those, making it clear that they are the frontline defenders of this thing,” Norder says.
No matter too small
It’s the little things that can make a difference, and some facilities have found ways to brighten employees’ lives. When the Hebrew Home at Riverdale asked companies to make donations, they received a bounty of gifts for employees to take home after shifts. One goodie bag included an Estee Lauder makeup kit, bag of chips, hand soap and a book from the Metropolitan Museum of Art. “Companies were looking for ways to support people on the front lines,” Pomeranz says.
The community has also had food trucks and didn’t charge for food in the cafeteria for months “to make them smile,” Pomeranz says.
Mission Health, which has more than 50 facilities in seven states, found that offering programs to ease pressure for employees has gone a long way.
“By offering flexibility in PTO hours, prioritizing the implementation of an employee relief fund and creating a Curbside Groceries program, we have been able to alleviate some of the stressors unique to essential staff during COVID-19,” says Rosie Cronin, communications coordinator. “We also added a robust set of resources pertaining to COVID-19, mental health, benefits and more to our newly launched Employee Resource App, which helps us get information directly into the hands of our teams.”
Sun Mar Healthcare, based in Brea, CA, has paid for COVID-19 testing for employees, and hotel stays to quarantine, if necessary.
The company also wrote letters to employees and sent gift cards thanking them for their service. In May, it teamed up with the burger chain In-N-Out to honor its 4,000 employees on the front lines to host cookouts for employees throughout the month. For about a three-week period, In-N-Out sent cookout trucks to each facility and provided lunch to staff members. The cookouts also featured giveaways for employees — including a “Superheroes Wear Scrubs” T-shirt.
“We felt this was a big moment for staff and families to experience our company as partnering with them,” says Nathan Ure, chief operating officer for the chain, which has 24 skilled nursing facilities and one assisted living facility.
One task that proved particularly challenging to providers around the country was communicating about infection control. Agencies were bombarding them with various, sometimes conflicting, signals regarding protocols.
“There were so many mixed signals from different agencies,” Ure recalls. “We said, ‘What is the most prudent way of operationalizing all of this?’”
One way that the community has helped to instill confidence in staff and families in its infection control protocols is the creation of the Infection Prevention Strike Force. This dedicated crew, which rides in a truck labeled “Infection Prevention” and wears neon green golf shirts, will visit each facility several times this year and is dedicated to teaching them about infection prevention. This education includes everything from proper use of personal protective equipment to how to handle linen.
“More than just owning up, we needed [employees] to know we had a standard of environmental cleanliness and safety that was uniform everywhere,” Ure says. “The only way we could do this was to have a team that collaborated with facility personnel themselves, work with them, and make sure they have everything they need.”
Perhaps no area showcases nursing homes’ operational strengths than resident engagement. From holding doorway bingo to mobile happy hours, facilities have had to step up like never before to help keep residents’ spirits up during what for some has been an incredibly lonely time. St. Paul Elder Services invested in additional full-time equivalent employees so there would be staff to provide in-room dining, virtual visitations and extra TLC, given the absence of family visitations.
“Our staff are stepping in as surrogate family members. There’s no doubt about it,” Norder says.
Mission Health has kept its residents busy, organizing parades for them and enlisting them in creating Facebook content. This included Sharing Our Wisdom messages in coordination with National Skilled Nursing Week, public service announcements about COVID-19 safety and joyful videos made in tandem with staff.
“It’s more important than ever to find unique ways to empower and entertain our residents and patients, and we’ve done that by ensuring they are involved in our new programs,” Kauset says.
During COVID-19, the Hebrew Home at Riverdale created a morning talk show, “Good Morning Hebrew Home,” a half-hour segment that features people on staff, such as Pomeranz, and highlights topics such as the weather, sports, and lively chit-chat.
What will be the future of such innovative ideas?
“Everything we’ve done we’re going to stay with,” Pomeranz notes. “I don’t think we’re going to change anything. We’ve learned a lot of ways to do things that provide a lot of value.”
In that way, COVID-19 has been a blessing, Ure of Sun Mar says.
“This terrible crisis has elevated skilled nursing to a level of importance and level of public awareness that I never could have hoped for,” he says. “As awful as the crisis is, I’m glad people know there’s a difference in quality. All of the small efforts add up to safety and quality and I’m so grateful my CNAs get the respect now for the quality. They can see what they do saves lives, and it matte