A Summary: CALTCM White Paper April 2020

The World Health Organization has recognized what experts in geriatrics and long term care medicine have known for over two months.  Unfettered COVID-19 infections are devastating to nursing homes and assisted living facilities.  Reports are finally coming out that more than half of the reported deaths have occurred in senior congregate living settings.  It is quite likely that the number of deaths is still far underreported.  Only when the epidemiologists review all of the deaths across the U.S. and the world during this pandemic will we have the true answer.  The sad truth is that the experts in our field already know the answer.  We’re just waiting for corroboration.

This White Paper was borne out of this recognition and the reality that traditionally run nursing homes, no matter how well run and no matter whether they are for-profit or non-profit, struggle to combat COVID-19.  In order to have an impact on this deadly virus in congregate living settings, there must be a paradigm shift.  The simple way of looking at this shift is to imagine the normal workflow of a nursing facility, which starts with a daily “stand-up” meeting with department heads, focused primarily on facility admissions and discharges.  During this pandemic, if the person who wears the Infection Preventionist hat, typically the Director of Staff Development (DSD), spends their time in this meeting, they are being distracted from time that could be spent being the “Infection Control General” in the facility.  

CALTCM’s Long Term Care Quadruple Aim for COVID-19 Response requires stellar infection control.  There is no question amongst the experts that this is a necessary, but not sufficient, requirement to battling the virus.  The battle also requires an abundance of Personal Protective Equipment (PPE), without which, the virus will still spread.  If we are to effectively utilize limited supplies and resources, we also need readily available testing, so that facilities can respond to outbreaks with isolation and full PPE before staff and residents become symptomatic.  If we wait for symptoms the battle will already be lost.  

The final part of the Quadruple aim is acting with good crisis management methods, utilizing ones emergency preparedness plan.  This brings us back to the White Paper.  During a crisis, staff need to be focused on the most important tasks at hand.  The infection Preventionist must be completely focused on everyone’s hand hygiene and proper use of PPE.  Housekeeping must be completely focused on cleaning highly used surfaces every four hours.  Nurses need to know that atypical is the typical presentation of COVID-19 in a nursing home resident.

There are very few nursing home administrators and director’s of nursing in the country who have the experience and knowledge to effectively manage a facility during the COVID-19 pandemic.  That’s why a paradigm shift is needed. We can not bombard department heads and staff with a ton of information every day.  We need to find a way to tailor the information to fit their specific needs and focus on a daily basis.  

There are some nursing facilities that have the requisite leadership to deal with this pandemic.  They are the exceptions and not the rule.  Nearly every nursing home in the country can use support and guidance on how to function during this pandemic.  That is the essence of our White Paper.  In terms of setting up facilities that focus solely on COVID-19 patients, this need is greatly enhanced.  Such facilities require a complete paradigm shift if they are to have good outcomes.  We strongly believe that if they don’t change the underlying way they operate during this pandemic, it will be very difficult to limit the devastation that this virus brings with it.

Referenced Papers:

CALTCM White Paper April 2020

CALTCM Quadruple Aim April 2020

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