It's literally been 20 days since I first read about the nursing home resident in Washington state who had the Covid-19 virus. The Geriatrician and former nursing home chain CEO in me immediately reacted. I knew two things. This virus is lethal to frail older adults, and nursing homes are a particular setting where they would be at heightened risk. Falling back on the side of me that wrote a letter to President Johnson in the 60's asking him to end the war in Vietnam (yes, I was nine), President Carter and Menachem Begin in the 70's and 80's with ideas for bringing peace to the Middle East, and countless other Don Quixote-like adventures, I sprung into action. Why? I took an oath. I take that oath seriously, it's why I became a physician to begin with. And, I just can't help myself. It's in my DNA to try to make a difference in the world. I'm not looking for fame or fortune, I just want to help older adults. Might be hard for some to believe, but if you know me, it's the obvious truth.
The first week and a half was focused on writing op-ed's and trying to get them published. No luck. I finally went to my fall back position and reached out to one of the Long Term Care News Outlets, McKnight's. They agreed to publish my article. It took a few days, but it was published one week ago. https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/
I've actually been able to use this article to message people on social media. It will always be a reminder of why I'm so passionate about what I'm trying to do. In the meantime, I managed to get interviewed by NBC News, and actually provided the tag line for a story. https://www.nbcnews.com/health/health-news/coronavirus-nursing-homes-greatest-threat-years-here-s-what-they-n1153181 This article was actually published the day prior to my McKnight's article. I've subsequently been interviewed by a couple of other reporters.
About two weeks ago, I also began to realize the full scope of what was in front of us. As I followed the news and tracked the data, my concerns grew. I tried to reach out to people I knew at the CDC. I reached out to the people I knew at the nursing home trade association in California. I emailed the head of the California Department of Health. At first, I had the idea of offering to have my organization (a non-profit clinically oriented organization) provide leadership training that I felt was needed during this crisis. That didn't go anywhere. So, I sat back, took a deep breath, and asked myself, what is the most important message to get across right now. I immediately knew the answer. It was based on my experience and those of other experts in long term care.
Every nursing home has a person designated as an Infection Preventionist (IP). When I was at Rockport, as CEO, I convened a leadership retreat with all of the leaders in our organization, about three months into my tenure. One of the things we brainstormed on was how to help the IP have time to do their job! Looking back, it appears quite prescient. IP's are typically overburdened with multiple tasks outside the scope of their infection prevention and control duties. Knowing the full impact of what was about to confront us, I sat back and tried to think of one thing. The one thing that nursing homes could do in order to make a difference. In a crisis, focus is key. You can't try to implement 12 things. You can't even implement five. You need to focus on one or two. I immediately knew that the issue that I had found important over two years ago, was still the greatest priority. If every nursing home in the state of California (and the rest of the country for that matter) gave their IP full-time status, and empowered them to do their jobs, we might be able to impact change in facilities.
Having run a large nursing home chain, I am intimately aware of the operational challenges that most nursing homes face. Under a crisis like this, unless there is one person tasked and dedicated, infection control and prevention will ultimately succumb under the weight of all of the other fires that are needed to be put out on a daily basis. I reached out to the heads of the California nursing home facility organization and the State health department and made my suggestion. It went over like a lead balloon. I've since tried to message this to anyone or everyone who might listen.
CALTCM (the California Association of Long Term Care Medicine), of which I'm President, put on a webinar 9 days ago that spelled out the importance of the IP and the need to empower them. I've reached out to nursing home chains that I have a good relationship with, and made my pitch. I'm not sure what traction, if any, we've gained, but it's not for lack of trying. The forces that are aligned against this are great, as I found out today, even at the highest levels of our government.
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