Imagine having a hip fracture. You’re admitted to the hospital and later transferred to a rehabilitation facility where you’ll have an approximate three-week stay before being able to go home. You’ll receive any needed medical care, work with a physical therapist, and have the opportunity to participate in an array of engaging activities that will help you feel at home while you recover. During your stay, family and friends are welcome to visit.
Enter COVID-19. Your circumstances haven’t changed, but now those engaging activities happen from the doorway of your room, the friendships you had started to build with other residents are put on hold because it’s not safe to be in a common area and, most shockingly, none of your loved ones are permitted to see you for what appears to be the remainder of your stay. The changes are sudden and unexpected.
For many across the nation, the above scenario is all too familiar. Early in the fight against COVID-19, older individuals were identified as being at high risk for complications caused by the virus. In an effort to protect an already vulnerable population, the Centers for Medicare & Medicaid Services (CMS) issued a “no visitors” restriction to nursing homes on March 13, 2020. North Carolina Governor Roy Cooper and Department of Health and Human Services Secretary Dr. Mandy Cohen backed that guidance, essentially mandating that nursing homes throughout North Carolina stop all visitation immediately.
Now, though, thanks to updated guidelines from both CMS and the state, there appears to be a light at the end of the tunnel. After months of strict visitation restrictions forced upon skilled nursing facilities by regulating agencies, Iredell Health System’s Hospital-Based Skilled Nursing Facility (HBSNF) opened its doors in early September to welcome visitors of residents back.
“We are thrilled to be able to once again allow our residents the opportunity to visit with their loved ones while in our care,” said Lindsay Smith, Administrator of Iredell’s HBSNF.
The new guidelines on visitation put into place strict requirements for visitors, Smith said, all intended to continue to help protect residents and staff. Any facility allowing visitors must not have any positive COVID-19 cases – both among staff, providers and residents – for a minimum of 14 days. Every visitor must receive COVID-19 education prior to their visit and, upon their arrival, be asked to complete a health screening assessment, sanitize their hands, have their temperature taken and wear an approved mask over their mouth and nose.
Those new requirements are a happy inconvenience for families, like Hazel Hanlin, who had the chance to visit with her mother Frances Hilling recently for the first time in more than two weeks. She and her husband are the only family Hilling has locally and Hanlin visited her mother every day in the hospital before her admission to the HBSNF.
“It’s been a little difficult not having visitors, but all of the CNA’s and nurses do really good,” Hilling said. “I’m excited to be able to see Hazel now.”
“It was somewhat stressful not being able to see her, but I understand why the restrictions were in place,” Hanlin said.
The updated guidance is a welcome change for Iredell’s HBSNF, especially given the rigidity of the mandated restrictions over the last six months.
“When COVID-19 started to become problematic in the United States, CMS was very clear that all nursing homes needed to stop visitation and implement critical interventions immediately. They felt that the pandemic could carry negative outcomes for our high risk population,” Smith said. “While these restrictions have been difficult, we are grateful for the guidance from the state and CMS because it has helped ensure our residents and staff are safe.”
Those restrictions did not just prevent those working outside the nursing facilities from coming inside, though. It also included non-essential workers that were a part of the facility, like volunteers, beauticians, consultants, and others.
“We were also required to stop all group activities and communal dining. Plus, all staff and residents have to be screened daily for signs and symptoms of COVID-19 and have their temperatures taken prior to entering the facility each day,” Smith said.
Expanded state guidelines later required that every employee, provider and resident within skilled facilities be tested on a regular basis for COVID-19 as well. All staff who work in the facility in any capacity are tested – including employees of therapy, environmental services, dietary, maintenance, lab, radiology, the rapid response team, dialysis, and more. That process, along with daily temperature checks, symptom screening and wearing a mask, continues still.
The precautions and restrictions worked. As of Oct. 4, no resident at Iredell’s HBSNF has contracted COVID-19.
“This is a huge accomplishment, especially when you look at the number of nursing homes across the country where staff and residents are testing positive,” Smith said. “All of these individuals truly deserve a standing ovation for taking this pandemic as serious as they have not just at work, but also in their own personal lives. They have taken our infection control policies extremely serious here and have also implemented these practices at home. To all of them, thank you for a job well done.”
Most residents average a stay of about 21 days at Iredell’s Skilled Nursing Facility, which is designed as a short-term rehabilitation facility.
“Our goal during this pandemic has not changed,” Smith said. “We remain focused on getting our resident’s back to their previous level of function by issuing the best care and therapy possible during their short term stay.”
Despite the rigid visitation restrictions, the guidelines have allowed for an exception with what it termed a “compassionate visit.” That exception allowed limited visits for residents who were nearing the end of life, or whose health was determined to be significantly declining due to the absence of family.
Most residents – like Hilling – didn’t meet either of those exceptions, which challenged Iredell’s Skilled Nursing Facility to come up with new, innovative ways for residents and their loved ones to communicate.
“We were forced to think outside of the box,” Smith said. “Almost immediately upon learning of the restrictions, Iredell Health System purchased two iPads for our facility so that our residents could utilize FaceTime and Zoom meetings. We wanted to ensure that our residents and families could continue visual communication to alleviate any fears or anxieties either party may have had. We offered Netflix to our residents and even purchased Echo Dots so residents could listen to music and ask general questions to Alexa about weather, news, and more. We have learned how to hold activities from the resident’s doorway, like Bingo, and we even created our own version of an ice cream truck (with music) that comes around every Friday to deliver ice cream treats to the residents. It has been a challenge, but the staff embraced that challenge which has allowed us to be successful.”
While the restrictions haven’t been easy on residents, their loved ones, or the staff, all understand the necessity and are grateful for the extra precautions that have ultimately prevented the local facility from becoming part of the nation’s list of skilled nursing facilities with extremely serious COVID-19 outbreaks. Residents entering the HBSNF typically have several comorbidities, Smith said.
“Visitor restrictions were crucial to our residents’ safety,” Smith said. “As hard as these restrictions have been, we are grateful for them. We have received overwhelming support from so many different people throughout this pandemic. Family members of our residents have been so encouraging and understanding, despite their own difficulties, even taking time to deliver special treats to our staff. Other employees within the Health System and department managers have sent cards, flowers, emails and special recognition that remind us to keep up the great work. And, we have had tremendous support from our medical director, Dr. Carla Pence, and her nurse practitioner, Alicia Bolton. It truly has taken everyone to help us be successful during this pandemic and I am eternally thankful for all these blessings that Iredell’s HBSNF has received each and every day.”
As the pandemic now stretches into its seventh month with no foreseeable end in sight, Smith applauds her staff, the facility’s residents, and family members who have coped with such unprecedented changes and challenges and is confident that, together, they will continue to do what’s best for all despite what the future holds.
“In the 26 years I have worked in long term care, this pandemic has been the most difficult situation that I have ever witnessed. The impact that it has had on our residents has been heart wrenching, each and every day. To suddenly have to stop visitation without much warning has been very hard on our residents, who miss their families very much. The heartache and pain that our residents have been forced to accept has been very difficult,” she said. “I commend Iredell’s HBSNF staff for the compassionate care they have delivered to each resident who has come through our doors. The smiles that our staff continue to wear every day, even though they are hidden behind a mask, are still visible with their positive and bubbly personalities. This type of staff does make a difference in a resident’s life, especially during a pandemic like this. They spend quality time with our residents and know what will brighten their day, and I am so thankful that Iredell has been blessed with these special caretakers. I am very proud of all of them.”
Photo: Frances Hilling, front, a resident at Iredell’s Skilled Nursing Facility, recently had the opportunity to visit with her daughter, Hazel Hanlin, after visitor restrictions were relaxed at the facility. She had not seen her daughter in 17 days.