May 18, 2021
Nursing Homes During COVID
"There are published checklists for how to determine the quality of care a facility can deliver. But most of that's gone out the window because COVID has changed everything."
-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN
As of February 2021, 35% of COVID-19 deaths in the United States have occurred among the nursing home population - and these deaths include residents and staff. For over a year now, family caregivers, volunteers, and/ or paid companions have not been allowed to enter nursing homes.
The pandemic highlighted many problems that already existed in our nation’s nursing homes, particularly related to staffing. Many facilities struggled with short-staffing prior to COVID - but COVID has amplified staffing shortages and residents are suffering; and some have died as a result.
Providing a paid Companion has always been one option for ensuring 1:1 care in a facility for your loved one. Although families do have to pay for this out-of-pocket, some facilities are still not allowing companions into the facility - over a year into the pandemic.
In this episode of This Is Getting Old: Moving Towards an Age-Friendly World, Kenya Beard, Associate Provost for Social Mission and Academic Excellence at Chamberlain University, will share her experience of losing her Mom due to COVID while in a nursing facility.
It's difficult to lose someone you love while still dealing with the horrors and uncertainties of the COVID-19 pandemic. Kenya and her family went through then when their mom was infected with COVID during what was supposed to be a short-stay rehabilitation experience. Instead, she ended up dehydrated and hospitalized from her stay; and ultimately, died.
COVID took the whole world by surprise. We were not prepared, and it exposed a lot of leaks in the healthcare system and exaggerated other leaks that were already there.
The nursing home facility that Kenya's mom was in did not allow companions that the family was willing to pay for in order to get 1:1 care for their mother - they essentially tied their hands behind their backs.
It all started when Kenya's mom fractured her ankle. She had this injury treated and was ok for several years. However, she woke up one morning in early 2021 with horrific pain, crying. Kenya and her sister hesitated to bring her to the hospital because of the pandemic. But the pain was so excruciating that they were left with no other options and she was taken to the emergency room.
Unfortunately, from being in bed for so many days, Kenya's mom declined and deconditioned. Since her sister wasn't comfortable having a physical therapist come into the home (because she had a bubble that she wanted to protect and keep everyone else safe, too), they decided to allow their mom to go into a nursing home.
While in the nursing home, January this year, Kenya's mom tested positive for COVID. Kenya was very upset - because they assured her in the beginning that they had guidelines in place to protect individuals from getting COVID.
Here comes the sad part of the story, Kenya knew her mother needed assistance, and she felt that if the facility put her into isolation because of COVID, that would not get the care that she needed. So she asked the nursing home Administrator if they (the family) could hire a companion. The nursing homes’s Director of Nursing said, “Oh, I don't think we can. If you can find a facility for me that's doing it, let me know."
"The nurse (in the hospital) held the phone for half an hour so we could see my mother. She never said, ‘I have to go. You guys have to wrap this up’ - she stayed with us on the phone all that time." —Kenya Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN
Kenya made phone calls over the weekend and asked several facilities about whether or not they allowed companions. She even reached out to the Department of Health (DOH) to verify the guidelines regarding companions for older adults in nursing homes. Although the DOH responded that they don't have some guidelines and it's up to the facility, they still refused to have a companion for Kenya's mom. Instead, they assured her that everything would be handled.
The next couple of days, Kenya received a call from the nursing home supervisor asking for permission to start an IV because her mother is dehydrated. When she got off the phone, Kenya called the Department of Health and filed a complaint. A few days later, they received a call that the facility was going to have to send her mom to the emergency room. Her sodium had come back at 167 and her mental status had declined.
Three days later, Kenya's mom died.
The pandemic has put further pressure on the primarily frail nursing home facilities, which have long struggled with staff turnover, persistent personnel shortages, and elevated burnout. To safeguard nursing home residents from the pandemic's long-term effects, we must first consider how COVID-19 has impacted employees' day-to-day jobs and the areas where they need help.
While the effect of COVID-19 on older adults has received a lot of coverage, there has been even less reflection on how the pandemic has affected long-term care workers' careers and responsibilities.
Short-staffed facilities resulted in poor resident outcomes, even death. COVID has put such stress on the staff. Even people that have worked on a long-term care corporation for 30 years are like, “I'm out of here. I can't do it anymore.”
Guidelines for allowing companions for older adults in nursing homes has not been required to be transparent for older adults and their families during the COVID outbreak. Who suffers the most with these decisions to prohibit companions? The older adults.
Nursing home administrators have spoken about the difficulties in handling variations in implementing COVID health safety protocols on top of adhering to the regulated rules and guidelines. Many administrators complained that policies from state authorities were ambiguous and inconsistent at times.
"If you are a skilled nursing facility, you are required to have one registered nurse on duty, 24/7."
—Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN
Corporations primarily own nursing homes, and while they have to follow federal and state guidelines, the important thing to know is how each individual facility is implementing policies and procedures related to companions and visitation.
Nursing home administrators and directors of nursing have been faced with incredibly trying times for the nursing home industry. They have had to be flexible and try to balance the priorities of families, residents, and all the layers of regulation (federal, state, corporate office). Some individual leadership decisions have resulted in adverse patient care outcomes.
COVID has taught us many lessons. The most important of which is to cherish the ones we loved more than anything else. COVID won't be the last pandemic or infectious disease that we're going to have to deal with in this country. So what lessons should we learn so the same situations won't happen again?
The number one thing people need to know before they put a loved one in a facility is you have the right to ask if you can have a companion. Put your loved one in a facility that allows for companions if you cannot be there.
The pandemic has been going on for 14 months - it’s time to create better road maps for taking care of our older, most vulnerable loved ones. Now; and in the future.
Kenya V. Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN, is the Associate Provost for Social Mission and Academic Excellence at Chamberlain University. As a 2012 Macy Faculty Scholar, she propagated research and best practices that advanced the needle on diversity, inclusion, and health equity. She supported schools in the development of a multicultural curriculum that empowers all learners. In her former role as Senior Fellow at the Center for Health Policy and Media Engagement at George Washington University School of Nursing, she wrote blogs and co-produced health care disparity segments for the Center's radio program, HealthCetera, on WBAI-FM for an audience of over 400,000 diverse listeners. Her webinars, blogs, workshops, research, and publications speak to the critical need for authentic race-related discourse.
I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.