Some Nursing Homes Escaped Covid-19—Here’s What They Did Right

In mid-March, as San Francisco mayor London Breed issued a citywide stay-at-home order, Peggy Cmiel started getting prepared. Cmiel is the director of clinical operations at the San Francisco Center for Jewish Living, or SFCJL, a 9-acre senior housing complex in the Excelsior neighborhood that includes long-term care facilities, short-term rehab housing, and a memory care wing. The campus houses over 300 elderly residents, members of one of the populations most vulnerable to the deadly and highly infectious coronavirus that has spread across the globe.

Cmiel’s staff stocked up on personal protective equipment and masks for workers and residents; screened everyone who walked in the door for symptoms; hired more staff to clean bathrooms and common areas; and started educating everyone on best practices for containing the virus, like washing hands, avoiding close contact, and keeping an eye out for symptoms like fevers or coughs. And while nursing homes account for nearly half of California’s coronavirus fatalities, at the SFCJL not a single resident has tested positive for the virus. “Getting an early start was really the most helpful thing we did,” says Cmiel. “The doorknobs in this facility have never been more clean before.”

Not every home was so lucky and so well prepared. Nursing homes across the US have been devastated by Covid-19. In many states including Colorado, Massachusetts, and Virginia, nursing home resident deaths account for 50 percent or more of coronavirus deaths. But the success of a handful of homes, like SFCJL, might offer their colleagues some clues about how to keep residents safe as the nation braces for a potential second wave of infections.

Geriatricians and nursing home operators understand why these spaces are so vulnerable. Long-term care facilities are, in many ways, perfect virus incubators. Residents, who are older, frail, and often have comorbidities like heart disease or diabetes, are more susceptible to severe Covid-19 infections. Many need help performing basic tasks like eating, dressing, or bathing—care that can’t be delivered through a video appointment, making it more likely they could get an infection from the aides who help them, or pass the virus along to their caretakers. Those aides may work at several different facilities, and unknowingly carry it from one home to another.

The layout of these facilities also furthers contact in various areas. Most residents share bedrooms, bathrooms, activity rooms, and dining rooms—and staffers share a break room. Those group spaces are designed partly to cut costs, and also to encourage socializing. But shared spaces have also helped spread the virus. Senior facilities do have protocols to handle outbreaks like the flu, but the pandemic arrived so quickly and the SARS-CoV-2 virus is so contagious that many facilities were caught unprepared. “There’s an extent to which this virus just had the upper hand,” says Anna Chodos, a geriatrician at the UCSF. Unlike hospitals, most nursing homes aren’t ordinarily well stocked with gear like masks and gowns, which aren’t necessary when containing the flu.

Now, as states slowly start to reopen, senior care facilities are facing a more complicated endeavor: figuring out how to keep residents safe and maintain their quality of life as the Covid-19 pandemic stretches on. Even for facilities like SFCJL, the path forward is far from clear. “How do we safely and slowly introduce visitation and group activities? It’s going to be very careful and very cautious,” says Cmiel. “It will just be very scary to start bringing people back into the community again.”

Unlike hospitals, most nursing home residents live in these facilities permanently, so staff have to create environments that are comfortable for people’s long-term emotional, social, and physical well-being. But the novel coronavirus has put those important psychological services on hold. “The way of life inside nursing homes is so disrupted,” says Kathleen Unroe, an assistant professor of geriatrics at the University of Indiana. “This is where people live. These are social places.”

Or at least they used to be. Many facilities currently are restricting movement as much as possible, keeping people in their rooms and out of shared spaces. Unroe consults for several nursing facilities, and says that at one of them, family members haven’t been allowed to visit for two months. “I have these family members who say to me, ‘I have never been away from my 95-year-old mother for this long in my life,’” she adds. “It’s profound.”

Unroe also points out that at some facilities, even people who have recovered from Covid-19 can’t always go back to their own rooms. If they continue to shed virus and test positive for weeks after their symptoms have resolved, they have to stay in isolation, which can be scary and upsetting. Some don’t understand why they can’t go back to their usual rooms; “others just feel abandoned and are just confused or mad.”

“Our seniors are in crisis and no one really cares about them or seems to care. We as a nation must take care of our aging population right now because the scale of death is only going to get worse” Or is what’s happening now a sign of how we resolve our aging population problem. “LET THEM DIE!!!”

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