​Gail Sheridan, RN, chief clinical operations officer and one of the principal owners of Tealwood Senior Living based in Bloomington, Minn., is responsible for the company’s clinical care systems, quality improvement, regulatory compliance, and more.

She says that, in addition to the changes based on guidelines and policies to protect individuals, communication and education have been the hallmarks of what her staff have focused on for not only those receiving palliative care, but all patients and residents.

“We always had ongoing communication and education for tenants, staff, and families before COVID-19,” she says. “But the frequency and amount of needed communication since this all began has been ongoing and ever-changing. It has taken an enormous amount of time and commitment.”

Topics focused on what the center was doing more of and doing differently in order to protect everyone, for example, with increased personal protective equipment (PPE).

“I think the visitor restrictions were the right thing to do, but it clearly was another extreme step away from the normal,” says Sheridan. “With everyone using PPE it is the new normal. While it will get better over time, it does lead to this underlying feeling of discomfort, if you will. So we have had many conversations with families about all aspects of keeping everyone safe and following the guidelines from the Department of Health and Human Resources and CDC [Centers for Disease Control and Prevention].

“This has really created a whole different level of communication.”

The New Normal

Screening visitors frequently has changed the daily norm, too, and made everyone step away from what was familiar to a new normal under COVID. “We have to still do what is needed and necessary, plus more for engagement and comfort with all the levels of protection,” says Sheridan. “I think we’ve done a good job of teaching and being transparent with not only our staff but also our families and our residents, while providing care comfort as well.”

Still, families get frustrated and sometimes they just want to talk to the person giving the communities direction. “Sometimes we’re the sounding board for a family member, and they ask for direction on what they should do,” says Sheridan.

“Other times families just are angry at the situation, the restrictions, and the virus. They need to vent and have someone listen to their frustrations, and that is okay. We listen, and by the end of the call they are better for just being heard,” she says. “I am very proud of our staff who have consistently put the residents first and have fulfilled our mission of ‘enriching the lives of those we serve.’”

Rethinking Advance Directives

Many residents who receive a palliative type of care in Tealwood’s skilled nursing and assisted living centers have chronic conditions, heart conditions, congestive heart failure, diabetes, and chronic kidney issues. “Some do very well in terms of managing their conditions,” says Sheridan. “But early on with COVID we were learning the symptomology begins to change.”

Sheridan’s team did some significant training regarding residents with chronic conditions, knowing that they are at a higher risk and emphasizing that any change could impact a chronic condition, such as congestive heart failure, for example, especially if it is a COVID-related change.

While several individuals have their advance directives completed with what they want in terms of treatment, Sheridan and her staff took the time to reaffirm with them in the new environment of COVID. This took talking to patients whenever possible and reviewing their goals of care. “It’s important we know what they want, and certainly if they were to get COVID, I think many will think a little bit differently now that COVID is the new norm,” she says.

For example, if a patient has chronic kidney disease and is on dialysis, a lot of people choose that yes, they want to maintain it. “But in light of COVID, there will be more individuals who look at their advance directives differently and say, ‘Yes, I want to remain on dialysis, but if I get COVID, let me go.’ I think the conversations will become easier because of COVID,” Sheridan says.

“It’s a national conversation,” she says. “For everybody 65 and older with chronic diseases, I think a lot of families have sat back and said, ‘We have to get our lives in order.’ That may be the only positive in all of this that it does give us pause to think differently and really ask, what would I want if it were me?”