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Pandemic isolation

Care facilities work to keep residents safe and slowly begin to allow family visits

— Daily Freeman-Journal photo by Anne Blankenship Crestview Nursing and Rehabilitation is offering outside, socially-distanced visits for residents with family members. The facility is working towards an indoor visiting area.

When the COVID-19 pandemic hit back in March, area nursing and care centers locked down their doors to prevent a spread of the novel coronavirus through the facilities.

For the past six months, for most residents of care facilities, visits with family have been via telephone, through video chat, and sometimes with a window between the resident and their loved ones.

The Daily Freeman-Journal reached out to the three Webster City care centers and assisted living facilities. We wanted to see how the facility’s staff and residents had handled challenges of the pandemic. Crestview Nursing and Rehabilitation and Southfield Wellness Community took part in a Q & A session. We also contacted Windsor Manor but officials there did not return our phone calls.

Mindy Thumma, clinical nurse manager and infection preventionist, said Crestview Nursing and Rehabilitation has never had a a resident test positive.

“We’re so proud of our staff for that accomplishment,” she said.

— Daily Freeman-Journal photo by Anne Blankenship Southfield Wellness Community hopes to open a socially-distanced indoor visiting area next week for families and friends to visit residents.

Can you describe some of the virus mitigation practices you put in place when the pandemic first hit back in the spring?  

“There have been many changes in our facility since the start of this pandemic. At the start, new guidelines were coming out daily. This process to protect our residents has been ever changing.”

“We immediately put our plan into action.We first started by communicating with all staff, residents and their families about COVID-19 and what our plan was to ensure everyone’s safety. We continue to update everyone at least weekly.

We assessed our personal protection equipment supplies and started ordering more to prepare for the unknown. We initiated screening and hand hygiene of all employees and outside contractors prior to entering our building and would be sent home immediately if meeting criteria. We also screen everyone at the end of their shift. We use consistent staffing to try to limit spread of germs. We followed indoor visitor restrictions which were limited in the first week of this pandemic and then stopped all indoor visits the next week per guidelines. All non-emergent appointments were rescheduled and we started utilizing telehealth more to limit outside exposure.

We prepared a separate area of resident rooms to use for isolation of new admits, symptomatic or COVID positive residents. We monitor all residents by assessing for symptoms and checking their vital signs every shift and they are moved to an isolation room for observation if they meet any of the criteria.

We modified communal dining and limited our group activities to follow guidelines. We encourage our residents wear a mask when attending activities. We have also adjusted our kitchen and housekeeping to accommodate our changing infection control.

With fall and the possibility of influenza and other seasonal bugs, are you adding any further precautions?

With flu season approaching, we have already administered flu shots and are happy to report that 100% of our residents and 92% of our staff have received one.

What are your policies about visitors? How is Crestview working with families to make sure residents maintain contact during the pandemic?

We continue to follow the visitor restriction guidelines that are provided by CMS and IDPH. We allow indoor visits for end of life/compassionate care situations and are very structured.

At this time, we allow structured outdoor visits with strict guidelines and are currently working on preparing an indoor area for visits with the upcoming changing weather that will be ready next week. Our residents have been connecting with their families through phone calls, mail, Facetime, our Facebook page, closed-window visits, our current outdoor visits and our upcoming indoor visits.

Are staff members tested regularly? 

We have been following CMS guidelines for routinely testing staff and resident as they come out. Our county is currently in the monthly testing phase, unless we get a positive case.We have done two rounds of surveillance testing since the start of this pandemic and both rounds have both have resulted in all negative tests. We also test staff and residents if they develop symptoms.

Could you share any unusual or unique things you’ve done activity-wise to keep the residents engaged and active while still social distancing?

Despite all the restrictions, our residents stay pretty busy with activities.  We have an amazing activity dept that is always coming up with new fun activities for our residents.  One of the recent favorites was an outside activity where the residents were able to soak our staff with water balloons. 

What’s been the most challenging aspect of the pandemic?

The most challenging aspect of this pandemic, aside to the ever-changing guidance, would have to be seeing our residents not have that physical connection with their families. Visual and auditory connection is great, but nothing compares to touch.

Reid Giovanine, administrator at Southfield Wellness Community, agreed that the social isolation is challenging for residents, as well as family members and friends who long to visit their loved ones.

Can you describe some of the virus mitigation practices you put in place when the pandemic first hit back in the spring?  

We officially closed our doors to “social” visitation in mid-march. All staff wear a face mask and a face shield while in the building. We also started a screening procedure that every single person who enters the building goes through before entering. This includes a set of CDC-recommended questions, temperature check and hand washing. Our hand washing station was provided by TMI and has been a great asset.

Other mitigation practices include twice daily symptom checks of our residents to ensure timely reaction at the development of symptoms. We have also stockpiled a fair supply of Personal Protective Equipment (isolation gowns, surgical face masks, N95 respirator masks, gloves, face shields, sanitizer etc.) so that we are prepared to stop the virus if it does enter our building. Our whole company (ABCM Corporation) has adopted a rigorous testing plan to test all staff frequently to ensure any staff members who may have the virus but aren’t showing symptoms stay out of the building until they no longer are able to spread the virus. To date we have done 9 rounds of staff testing! 

How have those practices changed/evolved as time has gone on?

New recommendations and guidance from the Center for Disease Control, CMS, and Iowa Department of Public Health come out almost constantly.  Southfield has changed its practices in many ways as time has gone on in order to stay up to date with the latest recommendations on how to prevent COVID-19. We have also obtained great ideas for prevention from other homes that we have adopted as well. 

With fall and the possibility of influenza and other seasonal bugs, are you adding any further precautions?

With the exception of providing our residents and staff influenza vaccines, there is not many other precautions that we can add. Our staff and Corporation has put enormous amounts of time, effort, and resource into maintaining the safety of the vulnerable population that we serve.

What are your policies about visitors? How is Southfield working with families to make sure residents maintain contact during the pandemic?

We are currently open for visitors. Most of those visits are being held outside, but I expect to have an indoor visiting area set up as early as Oct,. 6. All visits maintain a 6-foot-distance at all times and require the use of a face mask by both parties. Visits are set up by appointment only and have a 30 minute time limit at this point to ensure all residents get to see their loved ones.

At this point we are following the Iowa Phased Easing of Restrictions for Long-Term Care Facilities from Iowa Department of Public Health and the Department of Inspections and Appeals.

Are staff members tested regularly?

Staff members are tested regularly, at least every 2 weeks, sometimes more often. We have not had any positive residents to date, and have had a total of 4 asymptomatic staff members thus far throughout the last 6 months. According to regulations, we technically are in a “outbreak” every time we have an asymptomatic positive case, but I do not consider Southfield to have had any sort of outbreak up to date. 

Could you share any unusual or unique things you’ve done activity-wise to keep the residents engaged and active while still social distancing?

Activities look a little different during this crazy time but we have still stayed active and have been having a great time. We’ve been doing in room activities, hallway and small group activities. Some of the activities we have done include having a Kentucky Derby, hallway karaoke and dance party, and neighborhood competitions.

All the residents shared their words of wisdom with each other on their doors and during a slideshow. We also had fun making a “We’re All in This Together quilt” where the residents wrote messages to their families on the quilt squares. All of these activities were completed while social distancing and a great effort has been put forth by our activity staff to continue to meet the needs of our residents.

What’s been the most challenging aspect of the pandemic?

The most challenging aspect of this pandemic, by far, is having to work with families of our residents who want to visit but due to restrictions in the past were not able to. The last thing I ever want to do is deny someone a visit with their wife, brother, or life-long friend, but in order to keep our residents safe we have had to do this on many occasions.

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