There is no shortage of heroes in long term and post-acute care. The moments they shine span from when a resident has a happy moment in their day to when a patient heads back home recovered.

The COVID-19 pandemic may be their biggest trial yet, challenging their super strengths personally and professionally. The leaders who stand with them have found creative ways to support them, encourage them, and cheer them on to the virus’ finish line.

An Unprecedented Time

Rosedale Green, a 176-bed nursing facility located in Covington, Ky., was hit hard by the COVID-19 pandemic before there was testing. It started when a patient returned from the hospital with some respiratory issues, and it ended up being COVID-19. “We assume that’s where the initial outbreak started,” says Londa Knollman, executive director of Rosedale. “Our Memory Support household was significantly impacted in a very short time frame. As staff members and residents became sick with COVID, we had several staff just walk out because they were afraid to be in this career.”

It was very scary in the beginning; no one knew anything about it, she says, “but we made it through on all this positive community support.”

Rosedale Green has been a staple of the greater Covington community for 50 years.

“We were overwhelmed by the encouragement we received,” says Knollman. “Our families, local hospital, and community at large supported our efforts in responding to the pandemic crisis.”

Sweeping Through

In Talladega, Ala., the virus started a little later at Rehab Select at Talladega, a 236-bed skilled nursing facility, but like Rosedale, it swept through quickly.

Rehab SelectAt the beginning of the COVID-19 pandemic in March, the center did not have any cases. After the July 4th holiday, however, that changed.

“We had a blossom,” says Suellen Tobler, administrator. “It just started going through the building. We wound up having quite a few residents who tested positive.” Tobler and her team opened an isolated COVID-19 unit. A smaller number of staff than residents also tested positive.

The center also opened a persons-under-investigation unit for those who are running a fever or who have been exposed; the team monitors and tests residents in the unit. “Once we had testing in place and these units set up, we were able to get it to where we could manage it,” says Tobler. In recent weeks Talladega has had four residents and three staff members test positive.

The community rate for COVID-19 in Talladega is high, at 11.8 percent. “Because of that, we are testing our staff twice a week, and that helps us identify anything quickly,” says Tobler. “Any staff members who may have caught it in the community, we can catch that and keep that staff member from coming into the building, so that also helps a lot.” The community rate for COVID is tested on a weekly basis, says Tobler, which then determines how often the center is required to test.

Screening processes are in place at the door, and any staff member who displays a fever or symptoms is tested and sent home. “The test goes out at 1 p.m. and the results come out by 3 a.m., so we get this back before the next day, within 24 hours,” says Tobler.

Those staff members who receive a positive result receive a phone call letting them know and begin a 14-day quarantine in which they are not allowed back into the center. The staff member is tested on day 14 and then 72 hours later, and both tests must be negative in order for the person to return to work.

Pay for Heroes

One way Knollman and her team helped staff was by offering Pandemic Pay, an additional hourly incentive, to all frontline workers. “This was to help staff with all they were dealing with—the amount of time they are putting on PPE [personal protective equipment], working with two and three layers of it on, in addition to the burden that some of them were staying away from their families or their families were staying in other places,” says Knollman.

“So we offered an hourly incentive for them dealing with all the emotional issues that were going on while they were working during the pandemic.”

Talladega also provides Hero Pay, an additional hourly incentive, for all staff and provides meals in house so staff members do not have to go out in the community. “We’ve also done staff education about community exposure to the virus and how to stay safe,” says Tobler.

Staff are asked to report back if they have attended events such as funerals or weddings or traveled out of town, and they are tested accordingly.

Community Steps In

Sundae barRosedale Green also provides staff with free lunches, and Knollman says Northern Kentucky community groups have overwhelmingly donated snacks, drinks, full meals, and even an ice cream sundae bar.

On Mother’s Day, the center hosted a family parade where a number of family members drove their cars by the center while residents looked on from their windows. Signs were posted in the windows allowing family members to find their loved ones and see where they were located. One of the residents had put a sign in her window that read, “Bring Chick-fil-A.”

The resident’s grandson snapped a photo of the sign, and it went viral, says Knollman. A mother’s group from the Covington community took notice and called Rosedale, sharing that one of their members had a connection with Chick-fil-A and wanted to help. The group then organized a complete line station that included a catered meal for every staff member and resident. The vendor community also wanted to step in. One vendor put together relaxation baskets for the staff, and a Mary Kay representative collected donations and presented staff with hand lotions to combat hand dryness from hand-washing, says Knollman. “It was really something to see how everyone rallied around the staff,” she says.

Staff also band together to plan activities to foster fun and relaxation during this stressful time. Rosedale has a Fun Bunch—a cross-section of employees who meet and plan activities for staff on an ongoing basis. One of those activities was Taco Tuesday where staff ate tacos from Taco Bell and enjoyed games with prizes.

At Talladega Rehab Select, Tobler puts on Fun Fridays every week to recognize staff for their hard work and dedication. It’s complete with giveaways, prizes, and encouragement to show staff they are appreciated. “We had fortune cookies Friday and talked about how fortunate we are to have the staff,” says Tobler. “This is really about letting the staff know that we’re here, we know this is hard, and we are going to help them through it.”

Getting Better

In a world where the COVID-19 pandemic is a terrifying reality, some things have gotten better for staff, says Knollman. The availability of COVID testing has made a big difference. Whereas in the past staff would try to determine if a resident had COVID or some other condition, such as allergies or the flu based on symptoms, now testing is readily available in Kentucky.

“The state of Kentucky is paying for all of the testing for us right now, and we are very fortunate,” says Knollman.

“Today, we can test quickly and receive results in less than 48 hours.” For staff, testing is completed and delivered to a lab that runs the test and provides the results.

Testing occurs every week for staff, and new hires, essential medical personnel, and others allowed in the building must go through the center’s testing procedures first. “Anyone who hasn’t been a part of our weekly testing we test in advance before they are allowed in,” says Knollman.

Recently, Talladega adopted the Rapid Test, provided by the Centers for Medicare & Medicaid Services (CMS). Instead of sending the test to a lab and waiting for a result, the swab used in the test is placed on a card, and after 15 minutes, the result appears.

Rising to the Occasion

Staff at Rosedale not only rose to the challenges brought on by COVID but asked what else they could do.

“When you go through a crisis, you really figure out where your team is,” says Julie Price, community relations director at Rosedale. “People who would stay normally until 4 p.m. or 5 p.m. would stay till 9 p.m. or 10 p.m. just checking in on others. Our governor’s tagline through this entire time was, ‘We will get through this together,’ and we certainly adopted that here. We had Kentucky blue t-shirts that featured the quote made for all staff members.”

For a period of time, Price was mostly focused on doing thoughtful things for the staff. This included finding a cartoonist to draw portraits of the staff as superheroes. It was a superhero-themed day featuring snacks, lunch, and other activities. Staff were surprised to find Healthcare Hero signs in their yards at home.

Rosedale hosted wellness events for staff that offered information on how to deal with stress, focus on one’s own needs, and other self-care topics. A walking program was also created, and staff could log their miles in an app and enter to win prizes for their progress.

Becoming Everything

“Through all this, a couple of the staff members all of a sudden become your everything, and they are there to do whatever you need them to do,” says Knollman. “It’s those staff members who, when they are done with their shift, are standing outside your office asking, ‘What else can I do so you can get home, too?’”

Taco TuesdayLike many centers, Rosedale now manages a majority of doctor visits via telehealth platforms, and it’s been an adjustment for staff. Social visits with families take place online, too, and Rosedale purchased additional iPads with a grant from CMS.

“Coordinating these visits became pretty much everyone’s role,” says Knollman. “If you were going into a resident’s room, you were likely going to be using an iPad and FaceTime.”

Keeping Up the Momentum

Being a health care superhero comes at a cost, especially when taking extreme precautionary measures with the most vulnerable people and going the extra mile are the new normal. Questions arise, such as how a leader helps to keep the momentum going. Knollman says it takes leaning on the leadership team.

“This affects everyone, including leaders,” says Knollman. “We all have down moments, which is why it takes recognizing that you have to lift each other up and look out for each other.

“That could be a nurse saying, ‘OK, this is going to be my down day,’ or ‘John needs a down day.’ Or it could be an administrator who says to a staff member, ‘I’m going to ask you to stay home so that you can be a cheerleader tomorrow.’

“When everybody is going 24/7 at 115 miles an hour, everyone’s going to get burned out at the same time. What we have to do is look out for each other and say, ‘As much as I know it’s going to be hard for you not to be here or to leave early, you are tired and you need to go rest.’”

Tobler sees parallels with COVID-19 and HIV, and staff need ongoing encouragement. “There’s a little bit of fear that echoes back years ago when we dealt with AIDS and HIV,” she says. “So we are out front with education and communication. If someone tests positive, we say it. We encourage them to keep up the great work with handwashing and using PPE. We always say, let us know about any issues, no matter what they are. It’s making sure that the staff know that knowledge and communication are powerful, and these things are here to protect you.”

The best advice Tobler has is to keep up the communication with staff on changing regulations and praise for staying on top of it all, because it’s a lot. “We recognize when cases are identified, when people recover, everything,” she says.

“We say, ‘Great job on disinfecting those high-touch surfaces, on wearing your PPE.’ It’s staying on top of their progress and letting them know they are doing a good job.”

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