The not-often talked about areas of healthcare affected by this pandemic are individuals receiving medical care in the home, and those who reside in small group-home type Assisted Living Facilities (ALFs).
Ongelia Moore is the Administrator for two of these facilities in Spring Hill. Rainbow Gardens and The Palms are two large homes that look just like any residence. Currently, there are ten residents between the two, which are cared for by nine staff members over three shifts.
Although smaller than most facilities, Moore’s homes are licensed and regulated by the state, and follow the same rules. Changes in the daily routine for Moore and her staff include daily communication with the Agency for Healthcare Administration (AHCA) and Florida Department of Health (DOH) three times per week.
During each check-in, the agencies ask about supplies and the health status of residents and staff. ACHA has asked about testing for the novel coronavirus, however has been informed each time that tests have not been made available to these facilities.
Staff members have been supplied N95 masks to wear when shopping and running errands. In the home, they wear cloth masks with filters, or general purpose surgical masks. All have their temperatures checked twice per shift, and practice established infection control procedures while not working.
Residents requiring followup visits with their doctors or nurse practitioners have been able to do so via telemedicine -- a video chat set up with the residents and medical staff. Of all the changes, this seems to be the most welcome by residents and staff.
Still, things happen. One of the residents suffered a fall that resulted in an injury to his hand. Unable to make his own medical decisions, the appropriate family member was consulted, and did not wish to send the resident to a hospital emergency room, which is the usual protocol. Bypassing hours in the ER, the resident was assessed by a home health nurse, who consulted a physician for pain management, and referred the resident to a local specialist to treat the injury.
Family and friends are keeping in touch using mobile devices, or by visiting through a screened enclosure in the backyard, keeping appropriate distances.
One of the ladies at Rainbow recently celebrated her 92nd birthday with her family, six feet apart from each other, separated by the patio screen. “It was awkward,” Moore said, describing the scene where the family couldn’t exchange their usual embraces. However, residents and visitors alike have been understanding and cooperative.
Some of the residents have family in New York, and have been concerned about the news reports of the high incidence of cases in that state. Through family and friends, these residents have found comfort by phone and video communications. “It’s the new normal,” Moore said, conveying the relief of her affected residents.
The overall mood was captured when Easter was approaching, and the residents of the homes weren’t able to see their hairstylist. When Moore explained this to the residents, she offered a compromise: one of the staff with prior experience could provide basic trims before Easter. “Why?” asked the lady who recently turned 92. “Are we going to be in a parade?”
In another larger facility on Florida’s east coast, the nurse manager wishes to remain anonymous. Her youngest patients are in their 40s, and they’re the ones struggling the most with the inability to visit their loved ones. These residents deal primarily with physical challenges.
“The human contact is missing, and that’s the hardest part.” Their families cannot visit, and the staff is limited to the contact required to provide necessary care. The manager’s voice falters, and she wishes there is more she can do. “Nothing can replace that.”
When asked about the mood of the population overall, she said, “Most of the residents are doing well.” They’re able to communicate with their personal devices or call upon staff to assist.
Recreational activities have been a challenge. The majority of residents are accustomed to bingo, poker, and outdoor activities that just aren’t possible right now. “They get it. They’re in decent spirits, but I can tell they’re anxious to get out.”
For now, they’re modifying indoor activities to keep everyone engaged, entertained and in good spirits.
Back in Spring Hill, Moore describes her efforts in trying to shop for basics. Some weeks ago, limits were set on milk and eggs, with the average household in mind. There were no exceptions for a “household” of ten. She employed family and staff to coordinate shopping at multiple locations, which worked.
However, when Moore attempted to purchase a large capacity “deep freezer,” she found the sale of such an appliance was banned. “Because of hoarding.”
The Hernando County Health Department checks in with Rainbow and Palms and 40 other long term care facilities in the county. Health Department Director of Nursing Ginni Randall and her staff now wear masks at all times, while maintaining social distancing. They’re the ones making sure the facilities have proper personal protective equipment (PPE) available for staff members.
“Life has changed because it's taking a whole lot more staff to do all the things that we need to do,” said Randall.
While addressing the specific needs of facilities and patients specifically with respect to SARS-CoV-2 (the virus that causes COVID-19), the Health Department still offers it’s usual essential services such as family planning, infection checks, taking care of people with tuberculosis or hepatitis C or HIV, and routine immunizations.
Before the pandemic awareness, the Health Department had one full-time person attending to epidemics, and now there are close to nine. “So everybody's duties are shifted a little bit. We've learned a whole lot,” Randall said, “I think we've been very successful.”