Pandemic Sanctuary

Is It Safe?

So the question that needs to be answered is, even in the face of a pandemic, “can a well-run LTCF, with rigorous COVID-19 practices, continue to serve not only as a tailor-made oasis but as a sanctuary of safety, isolating them from the pandemic going on outside and around the world?”

To answer that, let’s looks at what those practices of safety and isolation might look like. The United States Center for Disease Control (CDC) has put forth a guideline that we can hope all LTCFs are following rigorously. These guidelines were developed as a result of studying what happened in New York and Washington and how it could have been prevented. Here are those guidelines:

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Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs)

COVID-19 cases have been reported in all 50 states, the District of Columbia, and multiple U.S. territories, many having widespread community transmission. Given the high risk of spread, once COVID-19 enters an LTCF, facilities must act immediately to protect residents, families, and staff from a serious illness, complications, and death.

Keep COVID-19 from entering your facility:

• • Restrict all visitors except for compassionate care situations (e.g., end-of-life).
  • Restrict all volunteers and non-essential healthcare personnel (HCP), including consultant services (e.g., barber, hairdresser).
  • Implement universal use of source control for everyone in the facility.
  • Actively screen anyone entering the building (HCP, ancillary staff, vendors, consultants) for fever and symptoms of COVID-19 before starting each shift; send ill personnel home. Sick leave policies should be flexible and non-punitive.
  • Cancel all field trips outside of the facility.

Identify infections early:

• Actively screen all residents daily for fever and symptoms of COVID-19; if symptomatic, immediately isolate and implement appropriate Transmission-Based Precautions.
  • Older adults with COVID-19 may not show typical symptoms such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, or diarrhea. Identification of these symptoms should prompt isolation and further evaluation for COVID-19.
• Notify your state or local health department immediately (<24 hours) if these occur:
  • • Severe respiratory infection causing hospitalization or sudden death
    • Clusters (≥3 residents and/or HCP) of respiratory infection
  • Individuals with suspected or confirmed COVID-19

Prevent the spread of COVID-19:

• Actions to take now:
  • • Cancel all group activities and communal dining.
    • Enforce social distancing among residents.
    • Ensure all residents wear a cloth face covering for source control whenever they leave their room or are around others, including whenever they leave the facility for essential medical appointments.
  • Ensure all HCP wear a facemask or cloth face covering for source control while in the facility. Cloth face coverings are not considered personal protective equipment (PPE) because their capability to protect healthcare personnel (HCP) is unknown. Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required.
• If COVID-19 is identified in the facility, restrict all residents to their rooms and have HCP wear all recommended PPE for the care of all residents (regardless of symptoms) on the affected unit (or facility-wide depending on the situation). This includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and gown. HCP should be trained on PPE use, including putting it on and taking it off.
  • • This approach is recommended because of the high risk of unrecognized infection among residents. Recent experience suggests that a substantial proportion of residents could have COVID-19 without reporting symptoms or before symptoms develop.
  • When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit or in the facility.

Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply:

• • If you anticipate or are experiencing PPE shortages, reach out to your state/local health department, who can engage your local healthcare coalition.
  • Consider extended use of respirators, facemasks, and eye protection or prioritization of gowns for certain resident care activities.

Identify and manage severe illness:

• • Designate a location to care for residents with suspected or confirmed COVID-19, separate from other residents.
  • Monitor ill residents (including documentation of temperature and oxygen saturation) at least three times daily to quickly identify residents who require transfer to a higher level of care.

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What are LTCFs Doing?

Many facilities around the world are probably taking these or similarly issued guidelines very seriously. However, this is not generally regulated. In some cases, state or local governments are taking more action; California, Governor Newsome has taken further steps to ensure the safety of the residents in LTCFs. Sadly, left to their own management, some LTCFs may not be as rigorous, finding it too costly, or too tedious to sustain the necessary rigor.

At the same time, if we have older loved ones still living at home, we may be also be concerned. If they have caregivers and family coming in and out of the house, this presents a very significant risk. Even if they are taking some precautions, it is probably not to the level presented in the CDC guideline (included above.) A study in New York hospitals showed that even with their extreme sanitation practices, they found that the virus was being tracked all over the hospital on the bottom of their shoes.

So how do we protect our elder loved ones? Well, even if an LTCF has the potential for risk in some ways, a well-run facility that takes the guidelines very seriously and perhaps even goes above and beyond, could actually serve as a sanctuary from this pandemic.

Cielito Lindo is just such a place. They closed their doors to visitors before the CDC guideline even came out. And they are genuinely committed to the safety of their residents. So much so that they are going above and beyond what the guidelines specify. For example, they have some of their caregivers living full time in the facility to reduce traffic from the outside, and others are being assisted with their commute, so they don’t use higher risk public transportation. When entering from the outside, caregivers don’t just wash their hands; they take a shower and put on a complete change of clothing.

It is also worth noting that the facilities are designed to greatly limit the spread of any sort of contagion, such as COVID-19. This begins with spacious private rooms, each with their own private bathroom (many facilities are largely double occupancy and have dorm-style shared bathrooms). Much of the issue with US LTCFs is the close quarters with shared rooms, toilets, and showers. Additionally, instead of long and narrow indoor hallways, rooms are accessed with outdoor covered walkways.. All of this leads to easier and more natural social distancing and less communal air and surfaces. Furthermore, Cielito Lindo has a 1:3 caregiver to resident ratio with is far better than what you will find in the U.S., this means that the staff is rushing from one resident to the next without taking the proper hygiene precautions.

Cielito Lindo is concerned about this pandemic and the risk to elders so much so that they are offering a low cost easy to perform temporary inscription for those seeking sanctuary from the coronavirus pandemic.