Explanation of the problem:
If you’re over 80 years old, the risk of dying from coronavirus is the highest of all age groups at 15 percent. The average age of residents in long term care is 80. Nursing home staff, particularly nurses and certified nursing assistants (CNAs) who come in direct physical contact with residents frequently during the shift and extended shifts should also be considered among the high-risk potential.
There is no data available on how safe care should be provided in the nursing home during the early stages of a coronavirus pandemic. In my discussion with the Marathon Health Department Tuesday, they informed me their guidelines included screening everyone coming through the door and limiting the number of visitors, without specifying a percentage.
In fact, due to the dearth of such vital information, responses by nursing homes around Wausau have been drastic in their response and, themselves, pose harmful situations to residents, visitors, staff and the community at large.
Visitors aren’t allowed. Disconnection from support will lead residents into further depression and malnutrition, stressing an already taxed immune system. Families become increasingly distraught from the separation and fret that their loved one will suffer from fear and abandonment.
Essential visitors (health care providers and technicians) do or don’t wear protective garments. The staff is not wearing protective garments in any facility (specific to coronavirus prevention), except, I did see all staff wearing masks for the first time this week in one facility.
Historically, in nursing homes, staffing is chronically low with turnover of CNAs and nurses at 100 percent and above. Their sick time benefits are wanting.
For-profit companies have been downsizing staff while spending millions to purchase more to dominate the market. Not-for-profits chronically scrape and scratch for more resources to meet their residents’ and staff needs.
The capability of our nursing homes to deal with a rampant event, as happened in Washington, is harrowingly inadequate due to care, nominal staffing, business motivations and lack of scientific knowledge.
Those affected must participate in the response. Investiture improves compliance, minimizes fear and assures the plan is comprehensive. Proposed Interventions: The bottom line must move to the front line. The federal government must vigorously fund and support this massive effort.
1. Create a community coronavirus board comprising representation of LTC residents, LTC facilities and the Marathon County Board of Health to develop common sense policy about preventive interventions, rapidly disseminate breaking developments, and educate the public. Relax detrimental visitation policies while we develop plans to address the need for stricter isolation measures, such as universal virtual visits.
2. Establish a national nursing staffing pool, aggressively recruiting and preparing nurses and CNAs to meet the anticipated surge of care as the virus peaks. Offer appealing wages. Allow student nurses to be hired with experience counted as credit toward their degrees. Start now.
3. Sick leave and medical bills paid for staff afflicted by the virus. No loses to their livelihood from this pandemic.
4. Increase state minimum staffing levels for long term care. This readies us to respond more effectively to crises while addressing the incessant incidents of preventable injuries and poor outcomes popularly attributed to traditional nursing home care.
5. Work toward developing a universal system of healthcare to minimize fragmentation while consolidating the wealth and knowledge of our country to address human need as a priority.
Bruce Grau of Wausau, gerontological nurse practitioner and palliative care provider
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