Protecting residents of nursing homes from pandemics

Last week I listened to a webinar on protecting residents of nursing homes from pandemics, hosted by STAT News and sponsored by AARP. The three medical experts on the call offered a multitude of recommendations, some of which will no doubt be familiar to long-term care leaders, while others may provide new avenues for thought and direction.

The specialists discussed the importance of consistent access to personal protective equipment and the use of universal precautions, noting that the experiences of nursing homes around the country show that “we can’t worry about keeping the virus out, we have to figure out how to live with it” — a sobering comment that rings true to me.

The physicians emphasized the importance of hiring infection control specialists and of having clear, standardized infection control guidelines. Consistent guidelines increase the ability of staff members to learn and practice them and, from a psychological perspective, they reduce the anxiety that staff members feel when they discover that last week’s rules are no longer in effect. (“Did I inadvertently transmit or catch the virus by following last week’s recommendations?!”) In a relatively low-paying and now more dangerous field with ongoing staffing shortages, we should make every effort to reduce staff anxiety regarding infection control.

Frequent COVID-19 testing with rapid results for both visitors and staff was seen as essential, because test results that take days leave a large window of opportunity for the virus to enter facilities. They additionally recommended outdoor visits with family members and gradations of visiting policies depending on the level of community spread.

Based on the webinar recommendations, other information sources, and my observations of the emotional and practical impact of a highly restricted visitation policy, I don’t think we can wait until this is over in order to resume family visits. It may not be safe for a long time and things will probably never go back to the old normal, just as we never have boarded an airplane the same way after 9/11.

We, therefore, ought to develop reasonable Plan B options. Creative ideas include a “happiness bubble,” where friends and family members can see loved ones separated by a clear plastic wall, and a “hug tunnel,” which allows visitors to hug their loved ones through a plastic shield.

We need to develop alternatives when outdoor visits aren’t feasible. A section of that beautiful lobby or impressive entryway may have to be turned into a safe visiting area. It might not look as attractive, but this is a time to forego visual appeal for the sake of emotional necessity.

Another consideration emphasized in the webinar was that nursing homes should partner with local hospitals since they serve a shared population. It was further recommended that facilities become “learning organizations.” This concept includes not only the suggestion to collaborate with academic settings for increased access to well-informed and innovative professionals, but also a rethinking of the punitive culture of nursing homes.

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