Wednesday, May 13, 2020
Could Residents in Nursing Homes, Assisted Living Facilities and Personal Care Homes be "Canaries in the Coal Mines?"
Coronavirus infection rates at nursing homes are hot news, and getting hotter each day. Some see this as evidence of substandard care. I had been holding hope, frankly, that when I read another horrific story about a specific nursing home with xxx cases, high death rates, or a staff decimated by infections, the explanation could be as simple as negligent care.
But, what if that isn't the reason? What if facilities are employing best available practices, but the "best available practices" just are not good enough in the context of congregate care settings for this complicated disease? Frankly, state of the art models for long-term care are ones with strong behavioral programs, where quality of daily life is as important as protection against risks. Interactions, engagement, exercise, activities are what make those programs "best available."
A few days ago a friend sent me a news story about an assisted living facility where approximately 50% of the residents have recently been diagnosed with Covid-19 infections -- and where a first Covid-19 related death has occurred. I was startled, because I recognized the name of the facility.
Less than four weeks ago, the testing at that facility had shown no patients or staff members to be positive for the coronavirus. Early in March, the pro-active managers instituted "no visiting" rules for family members and other outsiders, along with other strict precautions. The facility even made arrangements for nearby housing for staff members -- at no cost to the staff -- to make it easier for them to separate themselves from cross-infections in their own homes during the quarantine. The staff continued to involve residents in daily activities, recognizing that engagement was a critical part of care, especially without family and friends visiting.
I'd been hoping that the early reports of "no virus" were testament to the fact that best practices can be employed successfully to keep fragile elders or disabled adults safe without locking them in their rooms. But, that apparently proved not to work out at this very careful facility. I've heard critics say the solution is for elders to be "at home," But "keeping your loved one at home" often won't be a practical solution, especially if the needed care is complicated, often requiring more than "just" family.
Because this facility was where each of my parents lived during their last weeks, I saw first hand just how diligent and how careful that staff is about infection.
We are all gaining a stronger understanding of how complicated care is even without this particular, terrible new disease. The disease has also run rampant through many jails, prisons and commercial food plants, all additional examples of congregate settings. But if dedicated care communities with good ratios of professional staff and very good records on quality of care are struggling to prevent Covid-19 infection, what is the real message the canaries are singing?