Assisted living facilities are at a high risk for coronavirus infections and deaths according to the Centers for Disease Control and Prevention, with a New York Times database finding that even though only 11% of cases occur in long-term care facilities, they account for more than a third of fatalities. Luckily, Fergus Falls’ PioneerCare Center has not had a case yet, but the facility is working hard at minimizing risk and ensuring that, should a case arise, they are prepared. “We are working so hard at prevention, we’ve got many, many strategies aimed at our prevention control practices, but, if and when the day should come that we would have a positive case, we’re ready,” says PioneerCare CEO Nathan Johnson.
The facility has not been accepting visitors since mid-March when Gov. Tim Walz issued the stay-at-home order. “Really the only situation where we are allowing visitors is compassionate care, end of life situations,” Johnson said. “Even then, we limit the number of family members that are in the room at a time.”
Instead, family members sometimes come to sit with their loved ones at many of the large windows at PioneerCare, sharing a meal and talking to each other on the phone. The facility also recently purchased a number of computers and tablets that allow residents to speak to family and friends through Skype. “That’s just another way that we’ve been able to get creative and use virtual visits to keep people in contact with their families,” says Johnson.
Even regular bingo has been adapted to meet the needs of staff and residents, with residents coming to their doorways to play as staff call the numbers down the hallway.
Staff, too, must be careful when coming into work. They start by washing their hands with hand sanitizer and then get their temperatures taken. They also put on new surgical masks and glasses which must be worn throughout the facility.
For about two months there was no communal dining whatsoever, with residents taking meals in their rooms, but since some restrictions have been relaxed by the government, residents are now allowed in the dining area if they need help or want to get something. If residents leave their rooms, they must wear masks. Kristen Anderson, the infection preventionist, says residents might not like the changes, but they understand why they’re important. “Many residents have said, ‘I don’t like wearing the mask, but I’m so thankful that you guys are doing your best to keep us healthy,” and I’ve had residents say, ‘I’ll keep wearing my mask and you guys keep wearing yours, just keep it out of here,’” she says.
Before COVID-19, Anderson was tracking infections (like strep, the flu, etc.) at the facility a few hours a week, identifying and isolating individuals, trying to stop things from spreading. Now, her work is almost entirely focused on COVID-19. She visits each wing of the facility to check with staff to see if they’ve identified anyone showing symptoms, checks charting for sick residents, tracks and traces any sick employees or staff, goes on calls with Minnesota Department of Health and CDC and cooperates with other people on their emergency preparedness coalition for the county. “We’re learning what to do for COVID-19 and how to keep it out of here and keep these people healthy,” she says.
PioneerCare also has two new units to deal with COVID-19. The first is adapting their short stay unit, which hasn’t seen as much use as before since elective surgeries have been halted at hospitals, into a step-up unit. “We’ve been following very strict criteria from the Department of Health, from the CDC and from (the Centers for Medicare & Medicaid Services), but one thing that we were advised to do and that we’ve done is we’ve created a step up unit,” Johnson says. “When a new admission comes in, they come to (the step-up unit) right here and they’re isolated to their room, we isolate and monitor for 14 days. If they remain symptom-free for 14 days, then we can move them to their permanent room.” If a current resident has to be hospitalized and then returns, they will also stay in step up for 14 days.
Part of the short stay/step-up unit has been walled off with a temporary airtight wall behind which is the COVID-19 unit, which has not seen use yet. The wall can be moved in the event more rooms need to be added to the unit (there are currently four rooms). The rooms in the COVID-19 unit are the same but have an added HEPA filtration system to turn them into negative-pressure isolation rooms in the event that COVID-19 is proven to be transmitted through the sytem. It’s currently only known to be transmitted via respiratory droplets and contact routes. There are currently 6-7 staff members who have volunteered to work in the COVID-19 unit in the event of a positive case and, should they be placed in that unit, will not be working anywhere else in the facility.
The COVID-19 unit rooms are only meant for managing mild cases and are not equipped for intensive care. “If they have shortness of breath to the point they need respirator care or something like that, yes, they will end up in the hospital,” says Johnson. “We are not an ICU. … We are not a hospital. What nursing homes do, and what we’ve always done over the course of time, is we’re maintenance, we do maintenance care.” However, if Lake Region exceeds capacity then PioneerCare would work with them to pivot into more serious care.
Luckily, the facility has not had any positive cases yet. “We do test, and we have tested several residents and several staff over the last three months, and all of our tests so far have been negative,” Johnson says. “Employees of long-term care facilities and residents of long-term care facilities are priority for testing.”
That being said, he doesn’t foresee being able to open up PioneerCare to visitors again soon. On May 12, Otter Tail County only had 25 confirmed cases. In one week it’s increased to 52. “I believe it’ll still be months yet before we get to the point where we’re able to safely reopen nursing homes, because there has to be certain signs that the number of positive COVID tests are declining in the community in which the nursing home exists, so it’s not just based on what happens here in our building, a lot of it depends on what happens in the greater Fergus Falls area,” he says.