The first COVID-19 shock to Americans happened in late February at a nursing facility in Washington state. With vulnerable populations in a communal setting, nursing homes could potentially be one of the most dangerous environments for the virus, and in fact, clusters have recently been found facilities in Louisiana, West Virginia, and Tennessee.
With this in mind, Tuscaloosa-based NHS Management, which provides administrative services for nursing facilities across the south, is taking the situation very seriously.
"We began to keep a close eye on conditions as soon as we saw the outbreak in Washington," said Nick Beckham, Regional Administrator at NHS. "There were almost immediate directives from CMS. And with the rapid progression of the virus, the Alabama Department of Public Health, CMS and the CDC are continually learning and updating guidelines so we are adapting quickly.
"We believe it is critical to closely monitor our residents. We are monitoring every day, sometimes multiple times a day, looking first for cold and flu symptoms. Fever seems to be an early indicator. We are taking residents' temperature, checking for respiratory symptoms, and looking for shortness of breath or headaches."
One of the more dangerous aspects of COVID-19 is that contagious people can be asymptomatic for up to 14 days, so a visitor who feels healthy can potentially infect elderly residents. Because of this, NHS has enacted a strict visitation policy in its facilities, locking doors so that there is only one entryway. Everyone at the entrance has to have their temperature taken and answer a questionnaire that asks whether the visitor has traveled to any virus hotspot recently; whether they have had contact with anyone who has tested positive, among other things. If they have a fever or fail any part of the questionnaire, they are not allowed into the building.
When family members come to see end of life patients, NHS tries to be as considerate as possible, while maintaining safety. These visits are limited to two guests at a time. Visitors wear a mask and go directly to the patient's room, and go straight out when they leave.
"We are doing everything possible to keep our residents safe," Beckham said. "We have cut out anything we deem non-essential. We're keeping important doctor visits for patients, but if something can be postponed, we do it. We have discontinued communal dining and various group activities. And we're keeping residents six feet apart.
"If there is any risk of exposure, we make sure that employees and visitors wear a mask, which presents a secondary problem in that we need to ration masks and other personal protective equipment (PPE). Since we manage a large number of facilities, we have the ability to send PPE to facilities that are experiencing a problem, if necessary."
NHS is also working to coordinate with hospitals to try to keep as many hospital beds open as possible. In order to facilitate this, Medicare recently waived the three-midnight stay, a rule that has required patients to stay in the hospital for three consecutive midnights in order to transfer to a nursing facility with continuing Medicare benefits. The purpose of the rule was to keep patients from being rushed to a nursing facility before they were stable, but with the possible tsunami of patients expected to hit hospitals, the suspension of this rule will hopefully keep more hospital beds available.
"I've seen one silver lining in all of this," Beckham said. "It's the unity of everyone pulling together to help healthcare workers get the job done. It's been difficult for many of our employees who not only have to deal with the daily struggles of this pandemic and worry about whether or not they will be infected, but who also have to find child care for their kids who are out of school, and who may have family members who have lost their jobs. It's been overwhelming to see the commitment and dedication of these healthcare providers."
