By Deborah Jeanne Sergeant
Are nursing homes really a safe place for seniors to live?
According to a Sept. 18 article by Judith Graham published by Kaiser Health, a lot of older adults are rethinking their final planning and considering other options than going to a nursing home or assisted living facility should they need help with activities of daily living.
The article cited a survey in August by the National Investment Center for Seniors Housing & Care that 74% of senior housing executives said families have expressed concern about safety amid rising COVID-19 cases.
To assuage these concerns and to keep residents safe, the industry in general is responding, according to Timothy Holahan, doctor of osteopathic medicine and assistant professor of medicine at University of Rochester Medical Center. He is also medical director for The Hurlbut, Penfield Place and Woodside Manor.
“We’re doing a lot,” he said. “Part of how we’ve handled this isn’t just as individual nursing homes but the Department of Health and the local community have been active to change infection control now that we know how the disease spreads.”
Ramping up measures to quarantine ill residents, limit the contact of all residents with potential sources of infection, using personal protection equipment more, and testing staff for COVID-19 weekly have helped curtail the virus’ spread.
Holahan hopes that as a silver lining to the pandemic, facilities will have improved their protocols for the outbreak of any illness regarding preventive measures, acquiring and using PPE, and stocking necessities.
“COVID has been very difficult on patients, families and staff,” he said. “When we come out of this, we’ll be able to do to things better. This is an opportunity for that. We are now better prepared for further outbreaks in nursing homes or other infectious diseases, like flu or RSV. We’ll be able to prevent those.”
For those with the means to do so, choosing home health may help reduce the population of people living in nursing homes to a safer capacity. Some estimate that a rate of 80% capacity helps prevent the spread of COVID-19. But it is difficult to tell what level of care one will need in 10 or 20 years. Those who will choose home health care may need to make some adjustments in their home like installing lift chairs and accessible bathroom fixtures.
“As much as people try to predict whether or not they will need nursing home care, a lot of people will,” said Nate Sweeney vice president skilled services at St. John’s Home in Rochester.
According to AARP, 52% of people turning 65 years old will need long-term care at some point in their lifetime. AARP further states that more than half will need care for more than two years.
“For the folks who do need it, we went to create the safest environment possible with their choices and preference in consideration,” Sweeney said. “We have added more private rooms than we had before.”
In addition to increasing cleaning protocols, technology like ultraviolet radiation machines can help the dedicated cleaning staff disinfect surfaces that are more difficult to disinfect, like upholstery. Today, there are many upholstery companies that offer medical friendly upholstery services, which are now widely available.
Sweeney said that the rules about visitation continue to evolve, but the amount of space at St. John’s helps with social distancing.
All the changes taking place have cause caregivers to reevaluate how they operate.
“All of our protocols are constantly being looked at and updated,” Sweeney said. “We have a great interdisciplinary team that comes together from different perspectives to look at anything COVID related. That process has been very beneficial for us. You make the best decisions when it’s a variety of diverse perspectives.”
He believes that the pandemic has encouraged cross-discipline collaboration among long-term care providers and greater agility to adapt when unexpected emergencies occur.
At St. Ann’s Community, physician Kim Petrone, medical director, has seen similar types of protocols become the new way of providing care for seniors who are in assisted living, long-term care, memory care and short-stay rehabilitation.
“Each of those places has implemented extraordinary number of measures to keep the virus out of their member population,” Petrone said.
Because of the pandemic, “we’re seeing more caution on the side of seniors and they’re more hesitant to consider senior living environments,” she added. “We’re seeing a minor decline in assisted living” as a choice.
Assisted living facilities aren’t seeing a decrease in interest because they’re typically medically necessary unless individuals can afford in-home care. But Petrone said that nursing home care is also “the most highly regulated environment.”
That has fostered more measures that address the spread of infection, such as limiting visitors to certain areas and only if the facility has had no infections for 14 days; requiring weekly testing and daily screening of staff; and testing residents weekly for two weeks if a staff member or resident tested positive.
“We have been monitoring them for temperature daily and oxygen levels daily, and if you’re new to our environment or you come from the hospital, you’re on a quarantine for 14 days isolated to your room,” Petrone said. “If you come from a hospital, we require a negative COVID test before you come.”
The facility also keeps the same staff in the same parts of the building to limit the possibility of widespread transmission.
Although no one wants to go through a pandemic, Petrone said that providers like St. Ann’s have learned from the experience. One lesson is that isolation can curtail disease. She has noticed that since St. Ann’s had no visitors from March through September, the number of communicable illnesses plummeted.
Along with isolation came the challenge of loneliness. St. Ann’s created a “buddy system” which assigned staff members to each elder so they spend casual time together doing what the resident wants, such as playing cards, chatting or assisting with technology. The positive feedback to the buddy system has made it clear that it could offer benefits anytime.
As an organization, the pandemic “has made us nimbler,” Petrone said. “We’ve learned how to plan in a very quick way. It makes us more sensitive to others’ jobs as we’ve had to cross-train. If we had another catastrophic event like this, we’re now more able to cope.”