As officials at the nation's nursing homes began to realize their facilities and elderly populations were deeply vulnerable targets for the spread of novel coronavirus, the medical director at one of the largest chains realized he needed a new playbook to take on an outbreak this dangerous.
"We were determined to do our best to contain it," said Dr. Mark Gloth, chief medical officer for HCR ManorCare. "I said, 'Why can't we MacGyver it and put something together that will actually provide an additional level of support for our patients and employees?'"
The resulting plan, now implemented in 15 of the chain's 168 nursing homes and planned for 25 by next week, involves walling off a section of each home with heavy-grade plastic to serve as make-shift isolation units. Staff has quickly set apart residents who have a temperature, cough, or other symptoms of the virus. ManorCare officials did confirm they have positive cases of coronavirus in their system, but declined to provide details.
The isolation pods are just one new approach in a patchwork of improvised efforts some nursing homes are instituting to protect one of the most vulnerable populations to the outbreak, as equipment shortages threaten to make finding solutions even more imperative.
"We're doing a lot of things, and we're being very creative in trying to meet regulations to keep the residents safe and also ensure that we prevent COVID-19 in our organization," said Keith Myers, President and CEO of MorseLife, one of the largest senior care facilities in Florida, with more than 800 residents. "It's very challenging."
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Already, seniors in institutional settings have proven to be tragically susceptible to the highly contagious illness. When the outbreak struck a nursing facility in Kirkland, Washington, in late February, it spread to 129 people, killing 35. Loss of life has followed at nursing homes in Georgia, Illinois and Florida.
Florida Gov. Ron DeSantis lashed out publicly at one facility in his state last week, after coronavirus infected 10 residents, killing three of them. DeSantis accused the Atria Willow Wood home of failing to screen staff, cooks and construction workers prior to letting them enter.
"It clearly fell below the standard of care, and whether it went into criminal ... I think that that's a possibility," DeSantis said during a press conference.
The company that runs the home, Atria Senior Living, called DeSantis's remarks "an inaccurate description of many steps we have taken to protect the health and safety of our residents. Beginning March 4, we have been actively screening all visitors and prohibiting anyone from working in the community if he or she is unable to pass our screening, well before any state guidance on this was provided."
This week, the entire population of a New Jersey nursing home had to be transferred to another facility when coronavirus swept through, infecting residents and caretakers and leaving the original location short-staffed, New Jersey Department of Health officials said Wednesday.
To date, 147 nursing homes across 27 states have reported at least one resident with COVID-19, according to data released by the Centers for Disease Control.
For many companies that run the nearly 16,000 nursing homes in the U.S., though, this has been a time to rally around each other in search of solutions, Gloth said.
"We're all in it together," Gloth said. "Everybody's intentions are really solid here."
The first step many nursing homes took, he said, was to shut down access to outsiders, including family members – a painful decision because it further isolated residents, but one he credited for slowing the assault of the virus.
Officials at MorseLife, a large not-for-profit senior care facility in West Palm Beach, took that step three weeks ago, shutting down the sprawling campus to visitors and volunteers, and canceling activities from the outside.
Carmen Shell, who oversees the skilled nursing home and long-term care center as the Senior Vice President of the MorseLife Health Center, says MorseLife now takes the temperature of all staff when they initially enter the building and twice throughout their shift. Additionally, they take a complete set of vital signs for all of the long-term care residents daily and document observations on any respiratory symptoms every shift. For short-term residents, their vitals are taken every shift. New patients are monitored every hour for the first three days. So far, MorseLife says it is not aware of a confirmed case of coronavirus in its facilities.
When Florida officials announced they were further tightening restrictions statewide, assisted care facilities like MorseLife had to get creative. They didn't have enough protective gear on hand to comply with new rules requiring that all staff needed facial masks, so they are buying ultraviolet lights to disinfect the supply they had on hand and have started to use what Shell called "alternate face masks."
She said some employees are using scarves, while others "are actually making, sewing cloth masks that can be reused until our inventory gets up because of the number of residents that we care for and the number of staff members, we have a very high burn rate. And right now we don't have sufficient masks to give everyone else."
These are measures that the Centers for Disease Control and Prevention called "a last resort," and says that the ability of scarves or bandannas to protect healthcare providers is "unknown."
Gloth said ManorCare has audited the supplies across the country and right now has enough masks and gowns. But as numbers of positive coronavirus tests have crept up in certain markets, he said he knows the supplies could start to thin.
"We've been very careful looking at our resources," he said. "We have a finite number of tools… [But] I never ever ever want to say no to a request for resources. I'm worried about that."