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Nursing homes continue to face uphill fight against COVID-19

Nursing homes continue to face uphill fight against COVID-19

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As COVID-19 gained speed in Catawba County, one of the first steps taken to limit its impact was closing nursing homes to visitors.

Long-term care facilities are where some of the most vulnerable people in the county live — the elderly and those with underlying medical conditions.

Even with restrictions, COVID-19 impacted the county's nursing homes. The first case reported in Catawba County was at a senior living facility. As of mid-November, there have been a total of 16 outbreaks in nursing homes and other congregate care settings, according to Catawba County Public Health.

Early on, the high level of spread in congregate care facilities locally and nationwide earned nursing homes and long-term care facilities a bad reputation, Trinity Village Administrator Marcheta Campbell said.

Over time, staff at these homes have learned to battle the disease and keep the coronavirus at bay, imparting lessons from the past and taking on hundreds of new recommendations over the past eight months.

Now, with increasing spread of COVID-19 in the community, Campbell feels safer at work than not.

“I want everyone to know I feel the safest inside our facility because of all the safeguards and protocols we have in place,” she said. “Members of the community should find comfort knowing we are doing everything possible to keep staff and residents safe.” 

Testing requirements put in place by the N.C. Department of Health and Human Services have played a big role in catching outbreaks early and stopping the spread of COVID-19 in its tracks, Abernethy Laurels Executive Director Amber McIntosh said.

“With the testing requirements placed on nursing homes throughout the state, any positive cases are found fairly quickly, especially with an asymptomatic employee,” she said. “Once a case is discovered, we can act quickly to inform employees to self-isolate until they are no longer contagious.”

Abernethy Laurels, a retirement community in Newton, has had three separate outbreaks reported, although only two are now classified as official outbreaks, according to Catawba County Public Health. The current outbreak is largely in staff members, with 17 cases in staff as of Tuesday, according to NCDHHS. 

In August the state put new testing requirements in place for long-term care facilities. Everyone in every facility statewide was tested. From then on, staff were required to be tested every other week, according to NCDHHS guidance. The rules have caught COVID-19 cases early, before there is significant spread, McIntosh said.

“... We have found these measures, along with the enhanced infection control measures, social distancing as possible and consistent use of masks has kept outbreaks limited," McIntosh said.

The facilities also now isolate new residents until receiving a negative COVID-19 test result, she said.

At Trinity Village in Hickory, Campbell found that intense screening has helped limit the spread of COVID-19. Every resident’s temperature is taken three times a day and every staff member’s temperature is registered when they arrive at work. Staff members are also asked about other symptoms. Residents also have their oxygen levels tested and they are checked for coughing and shortness of breath regularly, Campbell said.

If a staff member does have symptoms, they’re required to be tested at Trinity Village or by their doctor, Campbell said. They are not allowed to return until they are fever free and without symptoms for 72 hours without medication or until they test negative. “Our goal is to stay ahead of the virus through new protocols, screenings and behavioral changes of staff,” Campbell said.

Keeping residents in their rooms has helped both facilities limit the spread. At Trinity Village, staff are also limited in their movement when a case is reported. Areas of the facility are closed off, and staff working in those areas aren’t allowed to leave until their shift is over. “They eat lunch and take breaks in the hall,” Campbell said. “All necessary items are delivered to them. This way, they are not moving throughout the facility.”

While the restrictions and protocols work, both Campbell and McIntosh say it is a challenge to keep up with the changes and new rules added.

“It seems once we grasp the changes we need to make, new guidance is issued within a day or two, which creates more change,” Campbell said. “The staff is tired. Putting on PPE during an outbreak every time they enter a room is tiring. I am extremely proud of how they are handling it and our leadership team has worked hard to recognize burnout and also give recognition to those who are going above and beyond.”

The guidance comes from local, state and federal agencies, and can often conflict, making it difficult to follow every recommendation, McIntosh said. “It is hard to describe the amount of work that has been put into place to change how we operate almost daily with the constant barrage of recommendations and requirements from many regulatory agencies at all levels,” she said.

The regulations also pose a challenge for residents and their families. Only recently were these care centers allowed to offer outdoor visitation between residents and families. Residents can also feel isolated and out of touch, McIntosh said.

“Our team continues to utilize technology the best way we can, however even the best of technology can’t replace a hug or hand,” she said. “Since outdoor visitation is now permitted, this has helped. But even with outdoor visitation there are numerous safety measures in place and distancing is a requirement.”

Explaining the need for restrictions to families can be difficult,  she said.

Abernethy Laurels and Trinity Village adjusted their social activities to try to keep residents active and safe. Bingo has moved to the halls, so residents can participate from their rooms. At Abernethy, church services are held in the halls, as well, and meals are eaten in rooms, McIntosh said.

Trinity Village started celebrating anniversaries, birthdays and special occasions with window visits and video calls with family, Campbell said. The creative celebrations and social events could be around for a while. She doesn’t see COVID-19 restrictions going away until the coronavirus is under control. “Until COVID is a thing of the past or until a vaccine is discovered to reduce the number of cases, we will continue to operate in our current state of increased infection control protocols and maintain all the other procedures we have implemented to keep everyone safe,” Campbell said.

McIntosh said the leaders at Abernethy Laurels are looking at ways to improve the air quality, which could help with infection control long term.

Although the first cases at Trinity Village brought anxiety, they’ve made it through weeks of active cases, with an active outbreak affecting mostly staff. As of Tuesday, Trinity had 11 staff cases, according to NCDHHS.

“Staffing is a challenge,” Campbell said. “... We had to work even harder to fill the spots on the schedule.”

McIntosh said the community can play a role in the protection of residents by practicing COVID-19 precautions, as well. If there is less community spread, staff members would be less likely to bring the virus into the homes.

“We want the greater community to know that they can play a huge role in helping prevent the spread of COVID-19 by following these same guidelines (staff members do) as recommended by public health officials,” she said.

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