COVID19: The Nursing Home Staff Experience

We have all heard the harrowing accounts of hospital workers and their experiences with Covid19. I have read them even when it was easier to block out what’s been going on, because it is our country’s reality and we cannot afford to ignore it. Reinforcing the importance of taking precautions such as mask-wearing and avoiding large social gatherings is vital to enduring the restrictions. Personally, I don’t like following rules unless I understand the WHY behind them. And with this, I cannot deny the need for precautions. I don’t subscribe to blind fear surrounding the virus, and I don’t think we should have to be inside our homes 24 hours a day unless we are in an isolation period from exposure or have received a positive test result. I think there is a balance to be reached, and each individual scenario needs to have careful judgment applied.

This is all to say that I haven’t heard much about the Skilled Nursing Facility (SNF) experience from the healthcare perspective. These facilities are also known as nursing homes or subacute rehab facilities (which often house long-term residents as well). This is me. I work full-time as a Speech-Language Pathologist in a subacute rehab center that has 177 beds, about 60 of which are devoted to long-term care residents.

In March 2020, when the Covid19 pandemic triggered nationwide lockdowns, we braced ourselves. We had limited PPE (personal protective equipment) and what we had was locked up to prevent stealing and hoarding. Surgical masks, disposable gowns and gloves were rationed out to us, and we were expected to save our masks and wear them until they were “either wet or soiled” in some way (N95 masks came later). I abided by the rules and would wear a single mask for 2 weeks or so before the fuzzies (from it rubbing against my face) itched my nose so bad I couldn’t take it, and it smelled like bad breath. We didn’t have eye protection at first, but we were wearing gowns, gloves, hair coverings and feet coverings with any patient that had the slightest symptom. We were able to stave off Covid infections in our building for about 5 weeks into quarantine, but in late April, $#!% hit the fan.

I won’t say our precautions were perfect. CDC guidelines as well as my own company’s precautions were changing nearly daily, and it was hard to keep up. Even what were considered Covid19 symptoms were changing, as well as what temperature constituted a “fever.” PPE and testing were both in short supply. We had begun filling out symptom logs daily upon arriving to work, as well as checking our temperatures before starting our shifts.

Once we had positive cases, things got real. I think that nursing homes were painted in a very negative light once they started acquiring these positive cases, and in turn were blamed for driving up the numbers and “killing” their residents negligently. In reality, nursing homes were overwhelmed, inadequately prepared and insufficiently supported by the government to manage such a crisis. We had the most vulnerable population and were left to our own devices to manage the virus. When we first got tests, we were given SIX. Six tests. The administrator had to guard them and assign them only to those who “truly needed them.”

We initially admitted no known Covid19 cases. At first, we were just trying to keep Covid out of the building, of course, to protect our residents. The local hospitals were testing patients for the virus before they discharged them to subacute facilities, and Covid positive patients were recommended to discharge home if they were able to. What happened in our case was that patients were testing negative in the hospital, but then developing symptoms after their arrival to our facility, and then testing positive after their admission to us (and thus after unknowingly exposing us). If we had known they were actually positive, we could have kept them isolated much more securely. Either the in-hospital testing was unreliable, or they were being tested too soon to detect the virus. There is no way to know if the patients were exposed before, during or after their transport to our facility, but it was during this unknown window that they were cleared to come to us. Since they had tested negative (and I’m talking about dozens of patients), we felt safe admitting them, and though we continued with our use of PPE, our guard was down with those who had no symptoms and a negative test.

Patients started developing symptoms, and we finally received rapid tests to administer. The initial wave struck us like a tsunami. Within a span of 2 weeks or so, we had around 60 positive patients and 50 positive staff (so I heard). We weren’t being tested as staff in the facility yet, so when I developed a low-grade fever and lost my senses of taste and smell, I had to call out of work and get an order from my PCP for a test, which required her to lay eyes on me in a virtual appointment before she could write the order. My results took 4 days, which was less than some people’s had been taking, but it was still agony to wait. Once I tested positive, I was informed that at least 5 of the patients I had been seeing daily for speech therapy were also positive (and with severe cases). My viral load must have been extremely high, so I am lucky to not have required hospitalization myself.

When I went out with Covid, so did so many of my coworkers. This meant that we left behind a skeleton crew of staff members who, though you might deem the “lucky” ones, were left to pick up the pieces.  For these people I will be forever grateful. The nurses and CNAs worked on the Covid unit, doing temperature and breathing checks on the patients multiple times per shift, making sure the medications were administered, and trying to keep the patients comfortable and alive. If they needed to, they sent them out to the hospital, but for some there was no time and they died in the building. We lost a lot of patients who were otherwise not that medically compromised prior to contracting the virus. Physical, Occupational and Speech therapists were still providing skilled therapies to positive Covid patients, as it not only helped maintain their strength and mobility during their illness, but also provided assistance to the overwhelmed nursing staff. Family members were calling nonstop to check on their loved ones, and were often met with endless ringing on the other end and no answers. The nurses tried to keep up, but there weren’t phones behind the Covid unit barriers (aka plastic curtains with zippers) so they had to somehow find the time in their day to come out and return messages (which didn’t always happen). Those on the Covid units were wearing all the PPE, sweating and uncomfortable all day, often unable to take breaks to eat or use the bathroom. They grew weary physically and mentally, as the constant fear of contracting the virus themselves couldn’t keep them from doing their jobs and serving their residents. I am sure this is no comparison to what ER and ICU staff have endured- people for whom I am also very grateful. I am simply shedding light on the experience in my setting, which typically does not experience this level of acuity with our patients.

Housekeeping staff got hit hard with the virus as well, as they are tasked with a lot of the infection control in the building. They were expected to keep surfaces sanitized, empty trash and collect linens from positive patients, which resulted in many of them getting infected themselves. In order to keep the building running, therapy staff (physical, occupational and speech therapists) stepped into housekeeping and CNA-type roles to pass out meal trays, provide patient care within and outside of the Covid units, keep linens stocked, do laundry, collect and empty trash, answer phones, facilitate Facetime and window visits for patients, call back family members and help nurses with tedious tasks that didn’t require a nursing or CNA license. Kitchen staff were also chipping in with extra jobs. It was all hands on deck. Nurses were crying during shifts. Family members were yelling at staff over the phone (understandably). People were furloughed or had hours severely reduced due to lower resident census, which meant not as many staff were financially justifiable (despite the building seeming like it needed all the help it could get).

When I returned from my isolation (about 17 days), I only had a few therapy patients to see, so I filled in as a unit clerk answering phones, scheduling dialysis transportation for residents, updating families and completing tasks for nurses so they could focus on patient care. There was a real sense of teamwork and camaraderie among the staff that was there, like those left behind had an unspoken bond that only trauma can bring. I was happy to be back and happy to help, but I will never know the worst of it like many of my colleagues do.

With the warm weather and general adherence to lockdown protocols, things improved and we were Covid-free as of around the Fourth of July, 2020- and we remained that way for several weeks. We had some positive cases here and there, but were generally safe until just before Thanksgiving when we had another small outbreak which required me to miss seeing my family for the holiday due to an exposure (which was for the best, since numbers spiked from there). As of this writing in January 2021, we have one Covid isolation unit with dedicated staff who have to leave from a separate entrance so as to not expose the building (a precaution we did not have until this fall). We have had some small outbreaks with staff and residents which were able to be contained, and we as staff are now being tested twice weekly (once with a mouth swab test sent to a lab, and once with a rapid test).

We continue to struggle with PPE at times, but have developed better standardization regarding precautions and protocols for infection control. Every new patient is quarantined in their room for 14 days upon arrival, regardless of diagnosis and test results, and of course any known Covid cases go straight to the designated unit, through its own entrance. This protocol is isolating for the patients and frustrating for therapists, who are limited to treating in the rooms, but administration feels this is the best policy for infection control (and they are probably right). Window and Facetime visits continue with family members, but patients’ mental health still suffers from the isolation. This is no fun for anyone, but we try to make the best of it to give our patients what they need, so they may thrive again and be able to return home after their stay.

From the therapy department’s perspective, we are doing our best. The building did not do everything “right” (I say that in quotes because it’s hard to know until hindsight what “right” is), and there were decisions made with good intent that probably led to more cases than there needed to be. We have learned from mistakes and made corrections, but we still struggle. Census is low again, and staff are losing hours and pay. Morale isn’t great. But we keep showing up every day, for each other and for the patients. Some have gained work hours at other facilities that need coverage, and some are probably considering unemployment applications if things continue to worsen. I am working on blog posts, recipes and other content to bring value to my followers in my free time, as I am planning to scoot away from speech therapy and dive further in to nutrition and wellness coaching in the coming years.

Thankfully, nursing homes were included in the first phase of the vaccine rollout. I have gotten my first dose of the Covid vaccine and am anxiously awaiting my second one next month.

Please don’t hesitate to reach out with questions regarding my experience, and feel free to share your own stories and perspective from your profession’s experience with Covid19. I’d be happy to share your story on the blog as well!

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