Nursing home/LTAC/SNF...dilema.

2,182 Views | 14 Replies | Last: 5 yr ago by canadianAg
OKC~Ag
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Seems to me, one of the keys to solving this pandemic is knowing what to do with the nursing home/LTAC/SNF population.

A Nursing home generates lots of COVID 19 patients since they are a vulnerable population and they are concentrated in poorly ventilated facilities. This is a perfect scenario for continued disaster.

We can't change Nursing home patient risk profile but we can decrease density...maybe they should be encouraged to go home to their family...( i know, a majority may not have a proper home that can safely take care of them)

Or improve ventilation of Nursing home facility.

I think there is a major flaw in the current HVAC system in use today be it in Nursing home or meat packing plant. Maybe the whole facility needs to be high flow, high exchange rate negative pressure room for not just the individual rooms but the whole facility. Current HVAC recycles air indoor to indoor and thus spreading virus particles. New HVAC needs to suck air from outside and exhaust spent air from inside away from intake vent...

We need a smart A&M engineer to come up with nuts and bolts for implementing this high flow HVAC to Nursing homes and Meat plants. This will not only solve the obvious COVID infection rate but solve the low oil/gas demand problem. This new super HVAC will air need to be treated. AC has to be running 24/7. The electrical power requirement will likely triple or more solving low energy demand. Lastly, the ensuing construction boom will partially mitigate low unemployment. Multiple problems solved except the cost of the upgrade.
aggiebrad94
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AG
So, something to quietly and constantly recirculate clean air. And, make it cost effective with government rebates to retrofit assisted living facilities.

I'm on board.
Sq 17
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the next generation of facilities will need to be designed differently of course the next generation of facilities is contingent on medicare & medicaid reimbursement rates. Optimistically the treatments get better over the next 60 days. Better treatment does not help anybody who got sick in the first wave.

A facility in the NE took the extraordinary step of the entire staff sleeping on site to prevent the Covid from being brought in. With enough incentive that could work but that is an extraordinary sacriface by the staff
Enrico Pallazzo
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When I'm in bad enough shape to need a nursing home, I'm going to be hoping for something that will come along and finish me off quick
TxAG#2011
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A lot of the older SNFs have window units in each room. Would love to see the data on those
Law Hall 69-72
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AG
Bingo Bango Bongo said:

When I'm in bad enough shape to need a nursing home, I'm going to be hoping for something that will come along and finish me off quick
I'm just the opposite. I don't care what shape I'm in, just keep me alive because I'll know that the next year will be Ags year.
88planoAg
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AG
it is my understanding that AC systems don't spread this virus.

The people who work in nursing homes do. Many work at more than one facility. Many circulate among all patients.

I've read strategies including isolating residents into smaller units that do not share workers, that way if virus is detected it is isolated more quickly. It requires quite a bit of restructuring and then the problem is dining facilities and other group locations.
Marcus Aurelius
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AG
The current epicenter of the virus IMO.
Not a Bot
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AG
Bathing the air in UV light at a few places along the system should be a fairly cheap / effective way to reduce HVAC spread (if this can even be spread that way).

We are assuming it is workers going from room to room who are cross-contaminating. But I would be curious to see architecturally how some of these HVAC systems work and how airflow design might be contributing to these outbreaks.
AggieBiker
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AG
My 83 year old mother has dementia and is in a nursing home. I'd love for her to be able to live at home with my dad but she requires too much assistance and care. Early on they had a worker that was Covid positive. Six weeks or more later and no other resident or worker has become ill. Yea!!! Thank the Lord, our prayer were answered.

But now after nine weeks there are other tolls. The toll of isolation on the residents and separation extended on their spouses and families is causing depression and decline in health. Obviously they are at less risk of infection but also at an increased risk of premature death due to the isolation and lack of socialization.

At the same time, they are not completely protected from the risk. Many of them regularly have to leave the home for doctor appointments. My mother leaves for dialysis at least three days each week and sits in a room with 20 other patients and workers for four hours each time who are coming from the same environments as the rest of us. Each worker lives their lives outside of their jobs just as the rest of us. They shop at grocery stores, live with family that work in public spaces, factories, and civil service jobs, they eat take out, get car repairs, have home improvements made and are regularly around people besides the residents and coworkers.

And what do they do to protect the residents from the workers and residents who commute to other places? When anyone enters they must wear a common surgical mask and they take their temperature at the door. That's it. I'm sure most of them also wash their hands and apply antiseptic product but that's all they do.

My dad goes to the facility on my mom''s dialysis days, sits in his car and waits for her to arrive back. When she gets there he gets out and walks over to give her some fruit, cut up veggies or other snacks along with any clothes he has cleaned. He wears a mask and isn't allowed to get closer than arms distance. They speak for a couple of minutes, tell each other they love one another and say their goodbyes. Sometimes he will go to her room window and talk to her over the phone with the blinds raised.

That is all the interaction they are allowed. Before this he was there nearly every day for several hours. All the other patients and workers know him. He helped take care of mom, restricting her fluid intake, keeping her from removing bandages or picking at her wounds, communicating with the nurses, encouraging mom to do what the staff asked, keeping her room straight and clothes put away and providing companionship. Now he can't do any of that.

Dad is 83 and high risk like all the other elderly people are. He isolates pretty well only visiting my house or with my sister when she is able to come up from Round Rock. He buys his groceries and does his necessary shopping only. So is he any more of a risk to be allowed in the nursing home than any of the workers or even my mother after she goes to dialysis? Isn't it reasonable to take his temperature, have him wear a mask, scrub up and possibly even wear a disposable surgical gown over his clothes and still visit in an isolation area with mom?

I understand the base logic of the health officials and the rules they have developed. But I don't understand the limited scope of their view of what is best and what can reasonably be done to accommodate needs beyond the reduction of virus spread. I don't understand that they can't see the existing risk of the health care workers spreading the virus is no less and maybe greater than you or I visiting and following the same protocols in a health care facility. And this applies to other things such as the birth of my first grandchild coming up in September. And I don't know why they ignore the tremendous benefits to my mother and other patients that would occur if they were allowed a reasonably designed set of protocols that would allow them to spend some time with their loved ones and the benefits to people like my dad.

And to be honest, we can apply this same logic to bridging the Grand Canyon of change from the old normal to the strict social distancing instituted two months ago when we knew so much less than we know today.
KlinkerAg11
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AG
It's seems like it's affecting older people at a much higher clip.

Do you have any idea why it seems to randomly knock some young healthy people out or kills them? It seems statistically rare but I wonder why it happens.

Just thought you might have an educated guess.
OKC~Ag
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AggieBiker said:

My 83 year old mother has dementia and is in a nursing home. I'd love for her to be able to live at home with my dad but she requires too much assistance and care. Early on they had a worker that was Covid positive. Six weeks or more later and no other resident or worker has become ill. Yea!!! Thank the Lord, our prayer were answered.

But now after nine weeks there are other tolls. The toll of isolation on the residents and separation extended on their spouses and families is causing depression and decline in health. Obviously they are at less risk of infection but also at an increased risk of premature death due to the isolation and lack of socialization.

At the same time, they are not completely protected from the risk. Many of them regularly have to leave the home for doctor appointments. My mother leaves for dialysis at least three days each week and sits in a room with 20 other patients and workers for four hours each time who are coming from the same environments as the rest of us. Each worker lives their lives outside of their jobs just as the rest of us. They shop at grocery stores, live with family that work in public spaces, factories, and civil service jobs, they eat take out, get car repairs, have home improvements made and are regularly around people besides the residents and coworkers.

And what do they do to protect the residents from the workers and residents who commute to other places? When anyone enters they must wear a common surgical mask and they take their temperature at the door. That's it. I'm sure most of them also wash their hands and apply antiseptic product but that's all they do.

My dad goes to the facility on my mom''s dialysis days, sits in his car and waits for her to arrive back. When she gets there he gets out and walks over to give her some fruit, cut up veggies or other snacks along with any clothes he has cleaned. He wears a mask and isn't allowed to get closer than arms distance. They speak for a couple of minutes, tell each other they love one another and say their goodbyes. Sometimes he will go to her room window and talk to her over the phone with the blinds raised.

That is all the interaction they are allowed. Before this he was there nearly every day for several hours. All the other patients and workers know him. He helped take care of mom, restricting her fluid intake, keeping her from removing bandages or picking at her wounds, communicating with the nurses, encouraging mom to do what the staff asked, keeping her room straight and clothes put away and providing companionship. Now he can't do any of that.

Dad is 83 and high risk like all the other elderly people are. He isolates pretty well only visiting my house or with my sister when she is able to come up from Round Rock. He buys his groceries and does his necessary shopping only. So is he any more of a risk to be allowed in the nursing home than any of the workers or even my mother after she goes to dialysis? Isn't it reasonable to take his temperature, have him wear a mask, scrub up and possibly even wear a disposable surgical gown over his clothes and still visit in an isolation area with mom?

I understand the base logic of the health officials and the rules they have developed. But I don't understand the limited scope of their view of what is best and what can reasonably be done to accommodate needs beyond the reduction of virus spread. I don't understand that they can't see the existing risk of the health care workers spreading the virus is no less and maybe greater than you or I visiting and following the same protocols in a health care facility. And this applies to other things such as the birth of my first grandchild coming up in September. And I don't know why they ignore the tremendous benefits to my mother and other patients that would occur if they were allowed a reasonably designed set of protocols that would allow them to spend some time with their loved ones and the benefits to people like my dad.

And to be honest, we can apply this same logic to bridging the Grand Canyon of change from the old normal to the strict social distancing instituted two months ago when we knew so much less than we know today.
I agree with 100%, these visitations policy lacks compassion and wisdom. It may also be meritless.

I just don't understand how these policies became implemented seemingly overnight in the hospitals and nursing homes...not just in our region but nationwide.
Marcus Aurelius
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AG
Yeah. When it hit I saw some younger folks, including fatal cases. Earliest 40s? But now man it's preying on the elderly in SNFs etc. Wicked. As to heterogeneity in presentation in the younger healthy patients. So many theories out there. I like the glutathione deficiency idea. Makes sense pathophysiologically. The ABO serotype story is yet untold. I expect ACE-2 receptor polymorphisms will prove to have an impact. Also- there is data looking at surfactant and surfactant protein differences impacting pulmonary injury patterns. Including using surfactant as a therapy in COVID19 lung injury. Surfactant proteins interest me particularly as I did basic science molecular biology research on SP-C and pulmonary fibrosis for several years in academics before I bailed to clinical practice.
ham98
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I think select members of the national guard should be given a crash course on elderly care and stationed to nursing homes in multi month on site only rotations until the end of the pandemic. Rotate them in 3-6 months at a time so they don't go crazy but protect our elderly population.
college of AG
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AG
SNF admin-

The isolation has been/will be incredibly difficult on staff, residents and families.

We have done everything possible to reduce risk, knowing we can't get to 0 risk. We are stepping in trays to disinfect the bottom of our shoes, spray disinfectant on on tops, masks, washing, trying to clean high touch every 2 hours, feeding staff on their shift to keep them from leaving, no group activities, no communal dining, residents wear masks outside their rooms. Residents, that can, are taken outside as much as we can to get fresh air. Staff work with specific residents only. Screen staff 2X's per shift and residents 3X's per day. AC fans running 24 hrs a day and pulling over 10% outside air. No marketing, no hospice staff,
no staff that works anywhere but here. Pulling our own labs. Anyhing we can think of. We realize how dangerous this is.

And you are right.. I've told our staff, we are the biggest risk!! If it comes in, it is because of us. I've asked them to refrain from many activities outside of work, but who knows if they are.

I want to have family visitation, first. Above all other concessions. It is the most vital. I can police the staff and make them follow policy or leave. The issue with families is that many won't follow the rules because they don't see themselves as a risk. It has been a real challenge to maintain the "distance". Families opening windows, calling and asking their mom or dad to meet them outside, etc. They do not understand how interconnected they all are. I've suggested they call their Congressmen and the policy makers to ask for changes. If visitation began on Monday, we would have people skipping screening, removing their masks, etc because the "rules are stupid". This isn't everyone but some.

I wish there were better answers.

canadianAg
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AG
My wife is a SNF therapist and we've found this whole thing fairly frustrating. She was on maternity while this all went down and now they won't let her back to work. They're not letting anyone in the facility that hasn't regularly been there and they also just disallowed PTO for employees.

We've found this a bit ridiculous because unless you take the drastic step of sequestering all employees in the building (was surprised to see someone actually did this), then you're not realistically reducing the risk profile. Employees still go about their regular lives interacting. And some employees still work other PRN jobs for different facilities.

And given everything I've heard about most of the CNAs/LVNs at my wife's location, I wouldn't trust them with a ten foot pole when it comes to following safety/health precautions. And this is what would be considered one of the best SNFs in the county (major city).
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