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Imagine if you will -- a Covid-19 do-over

b2bailey

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This topic is specifically related to Seniors who were housed in care homes of any type.

Knowing what we do, what could/should have been done to better control the loss of life? And I'm talking about things that could actually have been implemented, not just wishful thinking.

What role did existing Advance Directives play?

Personally, one of my best friends has been confined in long term care for 2+ years due to mental issues. Physically, at 67 she was one of the strongest there. On March 11 she died suddenly of a heart attack. I have to be honest and say I was happy to hear the news. (We shared the same faith, so that is a large piece of my joy.)
 

Paumavista

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We originally started isolating with my daughter's family & it was really good sharing the experience since we were all aligned with following a strict isolation protocol (they have a beautiful home, large yard, pool, etc). Now we are home in our own large home and I told my husband the other day that I wish we had isolated here with a larger group (I know how difficult that can be with people having to work...and personalities, etc.) But it has been relatively easy to order food on line & we have a big house in the country. I can not even begin to imagine how difficult it is for a family in a small apartment or condo or even a home with little or no outdoor space. I wish I could have shared.....
 

Tacoma

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In Canada around 80% of our deaths have been in care homes. Far too many are for profit but even our government ones have had too many issues with this pandemic. Many caregivers work in 2-3 homes to get enough hours, so first and foremost more full time workers instead of part time would help. They are now stopping caregivers from going to multiple homes and spreading the disease. Hospitals pushed older people back to their care homes to free up beds for the virus but that pushed the virus back into the care homes. I find hositals regularly push for seniors to go back to their homes knowing they will likely die there. With that population being the most at risk it backfired. Pay the people at these homes more. Many quit during the pandemic due to fear etc. I can't really blame them. I hope what comes out of this is better treatment of our seniors.
Joan
 

cman

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Here are a few items that come to mind. I believe all are feasible, and can be implemented in time, if we have a second wave of the virus in the fall.


1) Not send an infected patient back to the nursing home to recover: The problem with this, is that the patient is still contagious and can spread the virus to the nursing home staff and other residents. Some states have recently doing this, but it's still being done in my state. 40% of our deaths were nursing home patients.

2) Make sure nursing homes have an adequate stockpile of PPE: The state and federal governments provided from their stockpiles, or procured PPE for hospitals and critical care facilities. They didn't do this for private nursing homes. In most cases, nursing homes had to do the best they could in a competitive PPE market. This only exacerbated the problem. If we have another wave of this virus in the fall, the government should help with this to make sure they have the needed PPE.

3) Test all patients and staff regularly: We kind of botched the testing effort when this thing first started. Hopefully, that's behind us and we'll soon have the capacity to do more testing. The most effective method of stopping the spread of the virus is detecting positive cases, then tracing and isolating their contacts. The only way to effectively do that is testing. In the case of nursing homes, if we're able to test all patients and staff on a regular basis, we can prevent the spread from running rampant throughout the facility.

4) Target resources toward nursing homes to decrease the death rate: To me, this is just common sense. 30% of the deaths are from a demographic representing a fraction of our population (nursing home residents). Seems like we'd make considerable progress toward reducing the death rate if we targeted more of our resources to make sure these facilities had the items I listed above.

5) Require nursing homes to report all Covid-19 cases and deaths: I was surprised that they weren't doing this but apparently it wasn't required. There have been outbreaks in some of these homes and the state and county health department didn't even know about it. I think this may be changing, if not, it needs to.
 

b2bailey

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Yes, this is what I had in mind. Was also thinking about bed management. But that's a tough request. My friend that I mentioned prior -- she was in a room with three beds -- that clearly looked to be designed for two. Since she was there on Medi-Cal, I guess that's how they handled the lesser payment.
 

Monykalyn

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Here are a few items that come to mind. I believe all are feasible, and can be implemented in time, if we have a second wave of the virus in the fall.


1) Not send an infected patient back to the nursing home to recover: The problem with this, is that the patient is still contagious and can spread the virus to the nursing home staff and other residents. Some states have recently doing this, but it's still being done in my state. 40% of our deaths were nursing home patients.

2) Make sure nursing homes have an adequate stockpile of PPE: The state and federal governments provided from their stockpiles, or procured PPE for hospitals and critical care facilities. They didn't do this for private nursing homes. In most cases, nursing homes had to do the best they could in a competitive PPE market. This only exacerbated the problem. If we have another wave of this virus in the fall, the government should help with this to make sure they have the needed PPE.

3) Test all patients and staff regularly: We kind of botched the testing effort when this thing first started. Hopefully, that's behind us and we'll soon have the capacity to do more testing. The most effective method of stopping the spread of the virus is detecting positive cases, then tracing and isolating their contacts. The only way to effectively do that is testing. In the case of nursing homes, if we're able to test all patients and staff on a regular basis, we can prevent the spread from running rampant throughout the facility.

4) Target resources toward nursing homes to decrease the death rate: To me, this is just common sense. 30% of the deaths are from a demographic representing a fraction of our population (nursing home residents). Seems like we'd make considerable progress toward reducing the death rate if we targeted more of our resources to make sure these facilities had the items I listed above.

5) Require nursing homes to report all Covid-19 cases and deaths: I was surprised that they weren't doing this but apparently it wasn't required. There have been outbreaks in some of these homes and the state and county health department didn't even know about it. I think this may be changing, if not, it needs to.
THis follows pretty closely on what CMS (centers for Medicare and Medicade services) have stated need to happen before the NH can open up and it’s a terrific start!
The only thing is with #1- where do you send a recovering CV19 resident? No way no how are there going to be independent “infectious disease” freestanding facilities and no way no how are hospitals going to keep a patient who no longer requires hospital level acute care. It’s why NH are to have separate units for these patients but...same issue with space (NH don’t run routinely with lots of empty beds- they can’t financially).
#3 also require testing of vendors (who have multiple places in multiple regions), visitors as well,
Frankly the only way we are going to get real significant change is to take profit out of healthcare completely. It’s sick that Americans are so poisoned against “socialism” without actually understanding how a FOR PROFIT healthcare system is BAD as well.
and that leads to this point: Actual LIVING WAGES for NH workers so they will be ADEQUATELY staffed and a NON PUNITIVE sick leave policy. If that means we buy 15 less machines of war to take care of actual living people to subsidize this then so be it. But I guess because you don’t need a high school degree to be a nurses aide they don’t deserve to be treated well (I’m not saying that but it’s been the argument against living wage) But look who controls the purse strings and who profits off war and death and who we elect to represent us...

sorry for the rant:p
 

SueDonJ

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Today is my son's birthday.

He's right now on his way to the facility where he serves as Director, to greet the National Guard team that the DPH is sending in as much-needed staff relief. It truly is amazing what our National Guard does in times of crisis, marshaling all their professional strengths when answering every call. The teams being sent to this facility are comprised of nurses, EMT's, firefighters trained as paramedics, and ancillary housekeeping and food service workers. Heroes, all.

He's also waiting on the results of the latest batch of tests that have finally been performed on all residents and staff, hoping that he doesn't continue to lose valuable staff to positive-but-asymptomatic results.

His test result should be in this batch.

Late this afternoon we'll do a drive-by birthday celebration depending on how late he gets home.

I am beginning to hate drive-by birthday celebrations, and I am sincerely worried about the mental health of every single person who is charged with caring for COVID-19 patients. We better not EVER let them forget that not everyone in this country was content to sit back and let them bear this burden alone.
 

Monykalyn

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I am beginning to hate drive-by birthday celebrations, and I am sincerely worried about the mental health of every single person who is charged with caring for COVID-19 patients. We better not EVER let them forget that not everyone in this country was content to sit back and let them bear this burden alone.
I have to :love::love::love::love::love::love::love::love::love::love::love::love::love: so many more times than a single click!!!!
And i hope the tests are negative! When you are able-please give your son an extra hug from an internet stranger in thanks for all he is doing. Happy Birthday to him as well!
 

Monykalyn

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SueDonJ

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I give him credit for being willing to think outside the box, but chances are very good that the vast majority of longterm-care facility owners/directors/administrators could not afford to do what this one has done. He mentions that the personal debt he's incurred has been worth it, for him, but we have to consider that some people are not financially well-off enough to do it - incurring debt, that kind of debt, comes with a requirement that you fit into a lender's risk pool and not all owners/directors/admin make the kind of money that puts them in such a pool.

Kudos too to the staff who elected to take him up on his offer, especially those who have children at home. Again, that requires a situation where daycare does not have to be a consideration. Maybe those who could do it have partners who aren't themselves considered to be "essential," thus were live-in caregivers for the duration? So while this novel approach worked in this one situation, for a number of reasons not limited to just the two I mention it's unrealistic to expect that it would work in all. The major obstacle being that there's no way that monies would ever be appropriated by the powers-that-be to cover the kind of costs this owner and his staff incurred. But why would any of us want it to be?!

Ask any longterm-care facility owner/director/admin to imagine a do-over and no doubt all of them would start with, the plans and safety net that should have come from the top and didn't must be reinstated. And then they'll add a whole list of specifics that would have fallen into place naturally had the responsibility at the top been correctly managed.
 

Brett

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This topic is specifically related to Seniors who were housed in care homes of any type.

Knowing what we do, what could/should have been done to better control the loss of life? And I'm talking about things that could actually have been implemented, not just wishful thinking.

What role did existing Advance Directives play?

Personally, one of my best friends has been confined in long term care for 2+ years due to mental issues. Physically, at 67 she was one of the strongest there. On March 11 she died suddenly of a heart attack. I have to be honest and say I was happy to hear the news. (We shared the same faith, so that is a large piece of my joy.)
For my mother's nursing home, probably nothing. They quarantined early and limited visitors so no loss of life or sickness.
I'm hoping this pandemic ends at some point so we can have real person visits.
 
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LMD

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I am in SW FL. I do some work in area ALF's from time to time. Several of the SNF and ALF's in my area have cases and just under half the deaths in my county are residents at long term care facilities. One facility in particular that has NO reported cases (among residents or staff) closed its doors to visitors and to non-essential staff (including outside care providers such as myself) very early on. I have to give them kudos for implementing early and strict policies as no doubt it has saved lives.
 

Monykalyn

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I am in SW FL. I do some work in area ALF's from time to time. Several of the SNF and ALF's in my area have cases and just under half the deaths in my county are residents at long term care facilities. One facility in particular that has NO reported cases (among residents or staff) closed its doors to visitors and to non-essential staff (including outside care providers such as myself) very early on. I have to give them kudos for implementing early and strict policies as no doubt it has saved lives.
Sounds like what mine did here in SW missouri-all the homes I go to have had no cases among staff or residents, and have been very proactive on restrictions even before state mandates. I think it did make a difference. Now here's hoping we can slowly/sensibly start loosening up-even if I can't get in for a while I do hope they can find a way to for families to start in person visits-even if masks/distance outside on a patio needed!
 

SueDonJ

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Thank you to everyone who's asked - my son's test came back negative. We're very relieved, of course, but he's too busy dealing with the reality of add'l staff members' and residents' tests coming back positive. On the plus side, the Nat'l Guard will be assisting the facility for as long as it takes for affected staff to quarantine at home - and my son tells me they are wonderful people who truly care about what they're doing.

Some day we will have to honor all of these heroes - medical personnel and those who are spelling them - properly. I'm looking forward to that day.
 
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