Following the tough lessons learned during the early days of the COVID-19 pandemic, nursing home operators are finding ways to ensure they are never caught off guard again.
Improving nursing home preparedness has not only been on the mind of operators but government officials and industry experts as well when it comes to discussing reform for the sector — most recently through the Biden administration and a 600-page report released by the National Academies of Sciences, Engineering and Medicine.
“We have to be ready for whatever the next Covid is,” ArchCare President and CEO Scott LaRue told Skilled Nursing News. “You can only do that through auditing, supporting the staff and reinforcing infection control practices and procedures. Your disaster plan is not a paper document that can sit on a shelf and collect dust. It’s a living document that people have to be familiar with and ready to respond to at any moment.”
One of the researchers of the NASEM report, Jasmine Travers, assistant professor of nursing at NYU Rory Meyers College of Nursing, said the pandemic reemphasized the importance of these plans and putting procedures into place to ensure they are understood by staff and reviewed on an annual basis — if not more frequently.
“It’s not something we only do once or twice a year,” LaRue said. “We’re constantly scanning the external environment for how we should be modifying our plans because there’s always the possibility that something you never anticipated will happen.”
There were times over the course of the pandemic where nursing homes in every state were reporting personal protective equipment (PPE) shortages as ongoing supply chain challenges is something that operators are looking to learn from.
The state of New York, for example, implemented new laws to safeguard nursing home emergency response, one of which requires operators to have a plan in place to secure two months worth of PPE in case of an emergency. Nursing homes operating in New York also have to develop a pandemic preparation plan, which must be updated on an annual basis.
“We have 60 days worth of key medical supplies on hand,” LaRue said. “We rent a warehouse in the community for backup supplies which was not something that we did before.”
ArchCare is the continuing care community of the Archdiocese of New York that includes nursing homes in Staten Island, the Bronx, the Upper East Side, East Harlem and Rhinebeck.
He expects disaster planning training and education to be much more of an ongoing discussion for operators going forward.
Communication will also be key.
“Your plan has got to include communications and multiple vehicles like text messages, webinars, social media and flyers,” LaRue said. “Every one of your constituents might have a different way that they communicate.”
Ramping up emergency prep
Amy LaCroix, senior vice president of community operations for Covenant Living Communities and Services, sees the heightened focus on emergency preparedness and infection control as one of the few bright spots of the pandemic.
“We’ve learned just by looking at systems and processes about how we can better work together to be better able to respond to emergency situations,” she said.
An organization with 18 communities in 10 states, Covenant Living offers housing and care across the care continuum including 900 skilled nursing beds systemwide with a mix of both private and semi-private beds.
While emergency preparedness planning has “always been there,” Covenant has really “ramped up” the way it looks at it post-Covid, LaCroix said.
“From a budget standpoint, we’ve increased budgets because naturally our PAR [periodic automatic replacement] levels are higher and we want to be able to be sure we’re responding,” LaCroix said.
Covenant Living has also revamped how it trains and educates employees and staff about emergency planning as well.
“We have increased our tabletop [emergency] drills and exercises and we’re really looking at health care coalitions and aligning ourselves more with those locally and nationally,” she said.
To be better positioned to respond to all emergency types, nursing homes need to be more closely involved in planning conversations on the local and state levels of government, according to Travers.
“For example, in Florida, academic centers were providing leftover PPE – gloves and gowns they weren’t using because things were shut down – and sharing with other institutions so being able to have that relationship already fostered, would be a tremendous support,” she told Skilled Nursing News.
Travers added that collaborating with hospitals, academic centers and state health departments is one way nursing homes can avoid working in isolation.
“Nursing homes are typically left out of the whole stream of things,” she said.
Learning to be more nimble
Reinforcing emergency preparedness planning for nursing homes first came into focus during Hurricane Katrina for LaRue.
“We didn’t need Covid to teach us, Katrina taught us and the education is constant, it’s ongoing and we embed it within our regular operations,” LaRue said.
Travers admitted it wasn’t “anything new” to see nursing homes unable to respond to the pandemic.
“This is not the first time we’ve seen this with regards to nursing homes’ response to such emergencies,” she admitted.
Public officials have taken notice as well.
The Centers for Medicare & Medicaid will be examining and considering changes to emergency preparedness, as directed by the White House, after both the pandemic and the increase in natural disasters have demonstrated how critical it is.
One way Covenant Living is looking to prepare itself for the next disaster is by establishing a command center at its central office, allowing the organization to easily “pivot” and be more “agile” when an emergency situation occurs.
“We’ve worked through some drills there as far as how we are responding and how we are being supported between the community and central office and focusing on bolstering how that communication works,” LaCroix said.
ArchCare has also revised its approach to disaster planning and preparation and, like most operators, changed how it looked at infection control.
“We hired an infectious disease medical director. We put an infection preventionist in every one of our homes and we have a kind of infection preventionist SWAT teams that are responsible for caring for and addressing an outbreak of any type of infectious disease,” LaRue said.
LaRue felt that operators can no longer wait to be told what to do and must be prepared for the worst case scenario.
“The pandemic brought to the forefront how quickly you’re completely on your own,” he said.
Companies featured in this article:
ArchCare, Covenant Living Communities and Services, National Academies of Sciences
