Rebuilding America: Pandemic presents 'an invitation' to evaluate caring for vulnerable populations
Dr. Gregory Poland of the Mayo Clinic and immunogenetic expert suggests nursing homes need better training and practices. USA TODAY
AZTEC — Rebecca Morgan, the owner of Namaste House Assisted Living in Farmington, said she hopes the coronavirus pandemic changes how people care for senior citizens and other people who may need a little more assistance.
“We, as a culture have an invitation right now in this really troubling time to really look at how we care for our elders and frail and vulnerable,” Morgan said. “Whether we will take the invitation and implement anything that is lifegiving is yet to be revealed. We don’t know that.”
Morgan said there are various factors that must be considered as the changes occur.
“It’s one thing to get everybody to saddle up and take care of the emergency,” she said. “It’s quite another thing to figure out how to do this in the long haul. And I don’t have all the answers for that yet.”
Congregate living facilities like Namaste House have faced unique challenges as the pandemic sweeps through society. Namaste House has been fortunate so far. While a staff member tested positive for COVID-19 and went into quarantine for several weeks, that staff member never developed any symptoms. Morgan said no one at Namaste House — staff or resident — has become sick because of the virus.
"Right now we are just going to try to keep the virus out of our house," Morgan said. "And I am not looking to the future too far until we have a sense that we are able to beat back the virus and not have it sweep through our house."
Two residents are currently quarantined out of precaution. Neither of them have tested positive for the virus. One is in quarantine because they just arrived and the other is in quarantine because they had a recent visit to the hospital that was not coronavirus-related.
But other congregate living facilities have not been so fortunate.
People who live in nursing homes and assisted living facilities or other congregate living communities tend to be older and more likely to develop severe COVID-19 symptoms. On top of this, residents tend to live in close contact with each other. This can make social distancing more challenging.
Thousands of congregate living facilities residents nationwide have died of coronavirus since the pandemic began. More than 50% of the San Juan County fatalities have been residents of congregate living facilities.
"I'm haunted when I think about the facilities that are losing half of their residents," Morgan said. "And they're dead. They're not just sick, they're dead."
She said that is a very sobering thing. Morgan said even though some of the residents are nearing the end of their lives, it is important to take steps to prevent them from dying a horrible COVID death.
And some of the people who are dying could have lived for several more years if they had not caught the virus.
The average number of life years lost for people who pass away from the virus is 10 years, said Dr. David Scrase, the secretary of the New Mexico Human Services Department, during a press conference on May 20.
'The end of this nightmare may be at hand'
Life Care Center of Farmington has had the highest number of residents die of coronavirus of any San Juan County congregate living facility — more than half of its residents.
For Philip Nickse, the executive director of Life Care Center of Farmington, reopening means hope and “the realization that the end of this nightmare may be at hand.
"It is impossible to convey the level of stress, anxiety, determination, compassion, fortitude and heartbreak experienced by our staff members, individually and collectively, who returned day after day to care for our residents through this crisis," Nickse said in an email to The Daily Times. "They feel the losses much like the families have, yet continue to fight the battle. As the world pursues a vaccine, and we collectively learn and adapt to this pandemic as a society along the way, the thought of reopening symbolizes a milestone of strength and resilience."
Nickse said he does not thinks society yet knows what the new normal will be.
Nursing facilities like Life Care Center of Farmington are subject to guidelines and regulations put in place by an array of federal and state agencies, he said, and the guidance from those entities has changed over the course of the pandemic.
"I believe the important social aspects of group activities and communal dining, which have been absent for quite some time, will return with modifications at some point," Nickse said. "But given the impact the pandemic has had on congregate facilities across the country, I do not anticipate a complete return to 'the way it was.' In many respects, the healthcare field will be better prepared collectively having learned and adapted from this experience."
Like Morgan, Nickse said the pandemic should prompt evaluation of how society cares for senior citizens.
"My hope is that this experience will force this discussion beyond regulatory aspects," he said. "We need to clarify what priority our society places on our senior population and follow through as a nation."
Nickse said families may be less likely to place older relatives in assisted living or independent living facilities. However, nursing homes tend to care for people who need a bit more assistance and advanced care.
"It typically is not an easy or guilt-free decision to place a parent or grandparent in a nursing facility, and the memory of this pandemic will be present for years to come," Nickse said. "But nursing care has and will continue to evolve in a positive manner as a result of this event and what we learn from it."
Contradictory messages create challenges
Morgan said the contradictory messages people are receiving, often from media sources, have made it harder for the congregate living facilities.
Nickse said the experience at Life Care Center of Farmington shows that the virus is not a hoax and he encouraged people who are being presented with sometimes contradictory messages to carefully select information sources.
"There is an enormous amount of information disseminated every day, both locally and nationally, through a multitude of media sources," he said. "The wide variation in fact presentation and perspective in the media may be a reflection of the conflict we as a nation are grappling with. I strongly suggest through our own experience that this pandemic is not a hoax — it is very real and needs to be treated as such. Please choose your information sources wisely and stay informed. And social media should not be the sole source of anyone’s news."
Short-term living facility copes with virus, looks to the future
Not everyone who resides in a congregate living facility is nearing the end of their lives. Some residents just need a little extra care for a short time to help them get back on their feet after injury or illness. That's where facilities like Welbrook Transitional Rehabilitation Center come in. The short-term care facility is relatively new to Farmington and has been open for a little more than a year.
“We are different than traditional skilled nursing facilities in that we only offer short term services, not long term care,” said Mark Guth, the vice president of business development. “Our team is also different, in that we offer physical, occupational and speech therapies six days per week with a higher staff to guest ratio than traditional skilled nursing facilities. Our focus is on getting people well and back to their home setting as quickly and safely as possible.”
Welbrook has seen a client, or, as it prefers to call them, a guest, die of coronavirus since the pandemic began.
But the loss has not prevented Welbrook from safely admitting new residents. The way Welbrook is set up with three distinct sections has allowed the facility to continue admitting new patients, Guth said.
“We are arranging our protocols and procedures to cope with this situation for as long as it continues and we will continue to adapt to the situation in accordance with guidance that are provided to us from the CDC and other governmental agencies,” he said.
Providing contact with loved ones
The residents living in these facilities often crave contact with their loved ones. For example, Morgan said one of the Namaste House residents really benefits from having daily visits with his daughter. As facilities work to keep their residents safe, they must also balance those needs. That can mean visits through windows or virtual methods.
Life Care Center of Farmington closed to visitors on March 14.
"This has put emotional stress on our families and residents, and our staff as well, as I am sure it has in other facilities," Nickse said. "Almost immediately, we instituted FaceTime visits and “through the glass” visitation opportunities, both of which have been popular with our families and have helped our residents’ emotional well-being while adhering to visitation rules."
Welbrook offers video visitation, but Guth said some family members “are coming to the guest’s window and speaking via cell phone to get as close as possible.”
Large windows in the bedrooms at Namaste House also allow family members to visit through the glass.
At this point, family members seem grateful that the facilities are taking steps to protect residents, both Guth and Morgan said.
The coronavirus pandemic has forced nursing home across the country to restrict visitors. USA TODAY
Pandemic could cause future hesitancy
Guth anticipates that the virus may create some hesitancy for people to enter congregate living facilities, but he stressed the importance of getting care when needed.
"If the COVID emergency continues, it will be natural for people to be hesitant about going somewhere other than their own home," he said. "However, COVID deaths in the home appear to be increasing as people are fearful of seeking health care from hospitals and other care settings/ providers."
Morgan said she is anticipating conversations with the New Mexico Department of Health in upcoming weeks regarding the reopening process for the congregate living facilities.
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Messages for the community
In the meantime, both Morgan and Guth emphasized the importance of following public health directives.
“We will get through this together," Guth said. "Following the guidelines helps keep us all as safe as possible and Welbrook will continue to abide by the guidance and recommendations from the experts. We too look forward to getting to a place where we can allow better visitation and return to as normal a situation as possible.”
Nickse had three messages for the community.
"First, I would like to say to our family members, on behalf of our entire staff, how much each of us feels the loss of each and every resident that has passed due to this virus," he said. "Most of our staff have made Life Care their second home through the years and our residents became their family as well. Second, a number of staff members became ill themselves during the course of the past two months, but they have been returning as soon as they have been cleared. I have never experienced such heroism. To our community, thank you so much for the support and understanding you have given us, from the numerous offerings of help to the heartfelt words of encouragement found posted outside our building. You will never know how deeply appreciated and needed those gestures were."
Hannah Grover covers government for The Daily Times. She can be reached at 505-564-4652 or via email at firstname.lastname@example.org.
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