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“It is like you are in a science fiction movie and you don’t know how it will end or where the script is going.”

 

Nobody will have trouble understanding what that sentence relates to, given the complete fixation on the coronavirus (COVID-19) seen the world over since word first broke from China of an eventual pandemic infecting millions and killing tens of thousands of people.

It is also not surprising that sentence was spoken by a long term care provider, the profession on the frontlines of the battle to prevent and contain COVID-19’s spread among residents of skilled nursing and assisted living communities, the most prone to dire health consequences if infected.

The quote, says David Gifford, MD, chief medical officer and senior vice president of quality and regulatory affairs for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), was told to him by an association member in March when COVID-19 started to take hold of the nation, and also after a skilled nursing center in Washington state became the epicenter for infections.

Since then, Gifford says, weeks have seemed like months, with each hour bringing more news and developments and each week seemingly chock full of fresh federal and state directives, guidance, and steps for providers to follow in order to protect residents and keep staff healthy.

“We hope all of these steps lead to better conclusions in the next two to three months as we try to keep the number of infections low and, when inside a building, keep it from spreading,” he says. “We are also learning from data that even if you do all the appropriate steps, it is very, very hard to control the spread to staff and residents if the virus gets in.”

Over the first month or so of the virus being a pandemic, steps were taken by the Centers for Medicare & Medicaid Services (CMS) to bar all but essential staff and operational workers from facilities, revamp the survey process to focus on COVID-19, and put many new rules in place to distance residents and isolate them, if necessary, among a slew of actions.

The goal, Gifford says, is a shared one between providers and the regulators, which is to save lives and maintain resident care. “I cannot say enough good things about CMS, the Centers for Disease Control and Prevention [CDC], and the Department of Health and Human Services [HHS],” he says. “When we raise things with them, we get instant replies.”

Among the tasks at hand for both providers and their advocates is to lessen any confusion over new CMS rules and regulations, develop ways to segregate any potential COVID-19 cases from the general resident population, secure supplies of personal protective equipment (PPE) like masks and gowns, and devise new ways for families and friends to communicate with residents during this health emergency, such as using social media or real-time video like Skype.

It is new ground for everyone, says Mark Parkinson, AHCA/NCAL president and chief executive officer. 

“There has never been a crisis like this in the long term care sector. We are in uncharted waters on a whole bunch of issues,” he says.

When the news from China started coming out on how lethal the virus was to older people, Parkinson said it was apparent “we had a national and international crisis on our hands.”

In response, nursing facilities and assisted living communities across the country could tap into their existing operational plans, while the association looked to take its work in new directions to guide providers through the early stages of a world-changing situation.

“First of all, the good news is that every skilled nursing facility has an emergency preparedness plan and infection control plan already in place,” he says, offering some structure to what has taken place in terms of response. As for AHCA/NCAL, the crisis raised a question about what the role of an association is at times like these.

“Is the role simply to help the members comply with guidelines from the government or is its role to issue its own guidelines,” Parkinson says. The decision by the AHCA/NCAL boards was to move ahead on guidelines in order to do everything to keep COVID-19 at bay. This decision by AHCA to issue initial parameters to screen visitors in early March was followed by CMS taking similar action, before CMS enacted a total ban on all but essential staff later in March.

Reflecting on what has transpired this far on COVID-19, both Parkinson and Gifford say the response from facility staff to the challenges of showing up for work, and putting their own health at risk, has been inspiring.

“Let me say this about staff,” Parkinson says. “I have heard from our providers across the country about how committed their staffs have been during this crisis. They want to come in to work, and they don’t want to avoid buildings over fears of COVID-19. These people are heroes all the time, and certainly they are showing this at this time.”

Never has the profession of caring for the nation’s frail and elderly been more important, he says, pointing to what will be a long road ahead before any new normal is established when it comes to operating long term and post-acute care facilities.

“If we make the right decisions and do the right things in our buildings, we will save lives. So as challenging as this time is, we have never had a better opportunity to help people, and we just have to keep remembering that,” Parkinson says.

Patrick Connole