How Extended Care Clinical Worked to Halt a Nursing Home COVID-19 Outbreak

Less than 10 days ago, the Chateau Nursing & Rehabilitation facility in the suburbs of Chicago was in an incredibly difficult position: One day after 22 residents were initially confirmed to have contracted the novel coronavirus, the number of cases climbed to 46, according to local news reports.

With long-term and post-acute care providers well aware of the danger that COVID-19 poses to frail elders, the situation was critical. But as of Friday, the facility had stabilized, Ron Nunziato — CEO of Extended Care Clinical, an Evanston, Ill.-based firm that provides consulting services to Chateau — said.

“It’s rebounding, and every day, I think it’s getting a little bit closer to normal operations,” Nunziato said of the state of play at Chateau, a skilled nursing facility in Willowbrook, Ill.


The facility was associated with the first coronavirus death in DuPage County, Ill., according to news reports, when a resident in her 90s succumbed to the disease. But the property has not reported new cases since the initial wave, and Nunziato praised his team for working through the crisis to protect residents from further spread of the disease.

As nursing homes across the country face similar outbreaks amid steadily rising COVID-19 infection rates, SNN called Nunziato to learn how Chateau and Extended Care Clinical were able to turn the tide — as well as the top lessons that operators should take away from the team that managed the crisis firsthand.

Walk me through the situation at the Chateau facility.

What I’d like to talk about is just the preparedness of a situation like this. The country’s cases were starting to grow, and just the ability at that time — earlier in March, there wasn’t testing readily available. Still, testing is a little spotty and not as readily available. So you’re really managing someone based on symptoms, and symptomology and signs and things like that — which is difficult for facilities, because the symptoms are so concurrent with other types of illnesses that we see.


Everyone knew that COVID-19, the coronavirus, would eventually hit the nursing home population — because the residents that we serve in these facilities are often very compromised, often have significant amounts of comorbidities. So you’re treating someone as though you think they might have pneumonia, or they might have the flu, which all the symptoms are very similar to the coronavirus. It becomes difficult to really prepare, in a concerted effort, when you don’t have results to back up those findings.

So you end up putting people in isolation as a precautionary measure, and then working from there out. We have been extremely fortunate to have not only the leadership of Chateau Nursing and Rehab, but also Extended Care, which is a consulting company that provides consulting services to our facilities. We have a number of nurses and a number of support staff, social services, and even business development people that we were able to deploy to the facility to help manage not only just patient care — obviously for the nurses — but also things like returning calls to family members.

In the beginning of it, we were doing restricted visiting, and then toward the middle of it, there was no visiting. That became very difficult for residents, very difficult for family members. Anxiety’s high: “What’s going on? I can’t come in and see my loved one.” People were visiting through the windows of the facility. So having the staff that Extended Care has, to be able to supplement the facility staff, was critical.

I’ve been extremely fortunate to have the professionals and the staff at Chateau that have really dug in, and really have been there to provide care and services — and do whatever is necessary to be able to make the residents of this facility as comfortable and as cared for as possible. And then the Extended Care staff on top of that — it’s been heartwarming to see the amount of hours that people have picked up and worked to make this all work.

What’s the biggest lesson you’ve learned from the experience?

The biggest lesson that I took away from this is the preparation piece for things that you wouldn’t have thought about or expected.

We can all prepare for emergency supplies and PPE and things like that — that we knew were going to come. We started ordering a little bit more each order that we placed, and the counties that we’ve worked with have been very supportive in getting supplies to us if we weren’t getting a shipment in on time. So the front-end stuff has been, I don’t want to say easy, but has been workable.

The back-end stuff that you don’t really think about — like the laboratory can’t send someone in to draw blood samples. The delivery company who delivers our payroll won’t come to the building, because they believe it’s a quarantine operation.

Those types of things you don’t really think about; you think about supplies, you think about staffing, you think about food, you think about all those things. But the back-end stuff that you don’t really think about are what have been the lessons learned for me — to start thinking about: What if I can’t get the delivery company to come to the building? How do I get payroll checks? What if I have staff that don’t want to come into the building because they’re fearful themselves, or they have children, or they live with their parents and their parents are compromised, so they don’t want to come to the building? Those are the things that were really the lessons learned for me, operationally, as we roll this out.

We’ve been very clear that COVID-19 is probably already in several buildings, and it’s just undiagnosed. There are many people, anecdotally that you talk to, that say: “Yeah, you know, I had all these symptoms in early January. But I wasn’t thinking it was COVID-19 because it hadn’t hit Illinois yet.”


People chalked it up as: “Oh, I have a cold. Oh, I have a flu.” And now, looking back at it in retrospect, you’re wondering: “Hmm, did that person really have COVID-19 and not the flu?”

The numbers are going to increase, and that’s the other piece to this: The numbers are increasing as we go forward. In my opinion, the state is not being overtaken by COVID-19. It’s more about: Testing was so slow, you didn’t know how many you had, whether it’s in the nursing home industry or the hospitals or the community at large.

We started out at zero, and the more tests we do, the higher the number is going to go. Gov. [J.B.] Pritzker in Illinois, and the governor of Indiana [Eric Holcomb], in their press briefings have been very upfront with: These numbers are going to increase significantly until we get a baseline of some testing methodologies. The virus isn’t increasing per se, but it’s just based on the amount of tests that are being done.

Staffing is obviously a major concern right now — how are you handling those situations where, for instance, someone doesn’t want to come in because of worries about contracting and spreading the virus to others?

There’s an initial pushback and initial concern, but I think as you move through it, and people start critically thinking [about] the process, they start to become a little bit more understanding, and a little bit more open to the possibility.

Did we have staff that said, “No, I’m not coming”? Yes, absolutely, we did. But it was in small numbers. As I said, most of the employees at Chateau and Extended Care have been there, and worked a significant amount of hours to make sure our residents were taken care of.

Some of it’s just about education, where you’re teaching people and reminding people. I equate this all the time to the AIDS crisis in the early ’80s, where we learned infection control was to treat everyone as potentially infectious. So if you’re in a skilled building, and you’re using that prism to do your work, just because this person doesn’t have signs and symptoms of COVID-19, they potentially still could be COVID-19 [positive]. And I need to make sure that I am protecting myself with personal protective equipment, and the way in which I’m doing my job.

There’s a variety of things. When people go in to deliver a food tray, do they need to get within six feet of every resident? No, they don’t. Some residents can get up and get their food tray. Some residents do need more assistance.

So knowing those things, and preparing for those things — knowing and training that this resident may need assistance, and you may need to get closer to them because you need to open their milk, or you need to help them with the straw, and you’re going to be closer. So wear the mask and wear the eye shields and the protective equipment that you need to wear.

[Whereas if] you’re going in and just dropping a tray off at the nightstand, and you’re not getting within six feet of the resident, do you really need to do that? [That’s] some of the training we do.

Now, very different at Chateau, where we’ve had a number of cases. We are wearing personal protective equipment throughout the building and in all the rooms. But in other facilities, they can assess where that infection control barrier might be.

We’ve talked about that all over — even at the consulting office here in Evanston, where we’re not dealing with patients and we’re not dealing with sick people. But people are fearful: “If I come in and I pick up the phone, am I going to get it?”

[We’re] talking to people about understanding how the infection barrier is created: If someone had COVID-19 and touched the phone or coughed on the phone, and then you use the phone, how does that enter your body? Are you washing your hands? Are you being protective before you’re introducing this virus into yourself? Not: Someone is introducing it.

So looking at those types of things, too — making sure that we have hand sanitizing gel, making sure we have antibacterial soap in the bathrooms, and that people are washing hands and people are saying safe distances away from each other.

It’s all been, I think, an incredible learning experience for the general public on infection control. But I also think it’s been a learning experience for facilities to continue that process of understanding how viruses or bacterias are introduced into our own bodies.

As we wrap up here, just wanted to confirm — as of Friday morning, is the situation mostly contained, or are there new cases spreading?

No. It is mostly contained. We did an update to the facility’s website for families … and what I wrote is the facility is beginning to rebound back to normal — or what I believe is the new normal. Where we may have been plugging significant holes two, three weeks ago for staffing, we’re now plugging a few holes — “holes” meaning open shifts that we have to either augment or supplement the Extended Care staff into, or [use] temporary agency people.

It’s rebounding, and every day, I think it’s getting a little bit closer to normal operations.

This interview has been condensed and edited for clarity.

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