By Alec Pruchnicki, MD
I’ve already described how the facility where I work functions during normal times (WestView News, February, 2020, “Assisted Living: Not Just for the Wealthy”). Now that times are far from normal, let me describe what we have done in the middle of the pandemic crisis.
One of our residents went into an ER for a non-COVID problem, but was coughing a little. This led to a COVID test which turned out positive. We received word of this on March 20th and our facility immediately went into lockdown. All group activities were cancelled including meals in the dining room, exercise classes, evening movies, library hours, etc. All residents were requested to stay in their rooms until further notice. Since all the apartments are studios for individuals, this isolated everyone from other residents. Although a few of those with dementia didn’t understand what was happening and had to have constant redirecting, most people complied. Residents with anxiety, depression, and dementia often had their symptoms worsen, but this was a small minority of the population.
Medications and meals were brought to each apartment by staff members who were wearing whatever personal protective equipment (PPE) was available. This always included masks and gloves, purchased under emergency conditions at exorbitant prices, and sometimes full body surgical gowns. Eventually full face shield-type masks were obtained. Our local assemblyman, Robert Rodriguez, helped acquire some of these items, but even for an elected official it wasn’t easy.
All visitors, both family and friends, were banned from coming into the facility. Although this made many visitors and residents unhappy, just about everyone understood the need for it and complied. Outside medical appointments were cancelled except for the most urgent. As word spread about the presence of COVID in emergency rooms, visits there were also kept down to the absolute minimum. Having a physician on site helped with this, as did the presence of our CEO, Nicole Atanasio, a nurse with extensive homecare experience. The patients and families understood this need to avoid the ER.
Some of these policies were made internally at the facility, but we also received many notices from the New York State Department of Health. In general, our policies were similar to those adapted by many nursing homes, although our patients are not as sick or debilitated as the typical nursing home resident.
Monitoring of staff also increased. Every staff member, including myself, had their temperature taken at the front door, and anyone with a temperature of 100 degrees or higher, or signs of a respiratory infection (cough, sputum, sneezing, etc.), was sent home. To keep staff from going in and out too often, lunch was provided free by the facility and also occasionally by generous family members.
As of this writing on April 19th, the results appear good, tentatively. Various unavoidable ER visits for non-COVID related matters resulted in five residents testing positive. Three survived their initial infections and are now in rehabilitation facilities, which often happens routinely. One resident is back at the facility in isolation, and one died in the ER, almost definitely from a non-COVID cause. One staff member became infected and is in isolation at home until recovery.
Of course, this could all change instantly. There may be infections of residents or staff that are asymptomatic and slowly spreading through the facility. Normal coming and going of staff could reintroduce the virus. A few unavoidable appointments to outside doctors could infect a handful of our residents. Thus, in spite of all our infection control, there could be internal spread of the virus by staff or patients. Let’s hope the recent data showing New York may have peaked in its infection rate is real, and that little by little we can get back to normal. But carefully, very carefully.