Making a Difference

It's been a little over a week since it was reported that a nursing home resident in Washington state had died from COVID-19.  It moment I read this, I knew.  I knew that the COVID-19 virus was deadly for frail older adults.  How did I know?  Years of experience as a geriatrician, combined with the growing knowledge of the virus had suggested that this was not a virus that killed kids, but that older adults were more prone to bad outcomes.  The fact that the first U.S. death occurred in a nursing home scared the daylights out of me for many reasons.  First, I know the milieu that are nursing homes.  Second, I understand the staff and the challenges that they face every day.  Third, I know the nursing home environment and the pressures that facility leadership faces in making decisions.

I knew that I had to do something.  My alarms were ringing all over the place.  The first thing that I did was reach out to the administrator at the facility where I'm the medical director.  I told her my concerns.  Fortunately, the facility has great and caring leadership.  They were already on top of things.  I'm not sure that I added much, except for one thing.  Knowing the fact that nursing home front line staff rarely earn a living wage and often live paycheck to paycheck, my immediate concern was one that I felt that most clinicians, including medical directors, would not think about.  That was the fact that these wonderful people might go to work despite having symptoms of being sick, out of fear of losing wages.

I often talk about the need for healthcare leaders to have a better clinical understanding, and in the case where that care involves older adults, the need is even greater for leadership to have a full understanding of the geriatrics approach to care.  Somehow, the fact that the first death in the U.S. was in a nursing home set off all the bells and whistles in my head.  It was one thing making sure that my nursing facility was instituting the necessary policies and procedures, it was another to try to expand this knowledge to facilities throughout California.  I reached out to the state health department with a proposal for leadership and management training.  I probably should have known that such a proposal would be overwhelming to them. Too much, too big, too soon.  They suggested that we put together a webinar.  Why not?

Starting on Friday I reached out to the person I respect the most when it comes to infection control in nursing homes.  We brainstormed the key elements that we wanted to get across to nursing homes and were in complete agreement on what those were.  By Saturday we had a presentation prepared.  Now, we just needed to set up the webinar.  Fortunately, having a great project director to call upon in our organization paid dividends.  The webinar is set up for Monday afternoon.  We'll see how many people listen in, but at least the information will be available for anyone who is interested.  Instead of focusing on what and why, we're going to focus on the key things that MUST happen in every nursing home to prevent this from getting completely out of hand.  It's wonderful to be part of a team of caring people, let's hope that our message gets out and that we can truly make a difference.