From our dharma sister, Alisa Tu, about COVID-19 and her facility, Gordon Manor
Part I
AMI arrived at our doorstep when the
infection was taking us over. I had been communicating with Public Health and
our licensing agency about our situation. Employees were leaving, more
residents were getting ill. Both Public Health and Licensing could only provide
guidance and read what the rules were. Gordon Manor thought that it was doing
its best to follow the guidelines, but we didn't know what we didn't know, and
we didn't know enough. In our setting, a non-medical home for 68 people with
memory loss, the only way to really control the infection was to implement
drastic containment measures which Dr. Plotkin and AMI effectively led and
successfully completed.
We knew that we were an
inappropriate setting, both in terms of staff type and training, resident
physical and cognitive issues, and facility layout to adequately and medically
deal with a COVID resident at Gordon Manor. We were at high risk for infection
if we had a COVID resident at Gordon. I had nightmares after hearing about
Kirkland, and when we heard that one of our residents that we had sent to the
hospital was positive for COVID, I advocated on our behalf to Public Health
to not take him back. The hospital called and they were ready to discharge
him back to Gordon Manor. I really tried to prevent the discharge stating that
we were not an appropriate facility for a COVID patient. This situation is not
without precedent, as there are other conditions that make a former resident
not appropriate to be readmitted to Gordon. This was a Sunday. The message we
received from the agencies is that if we didn't take him back it would be a
"wrongful eviction." We are in the habit of following the guidance of
our licensing agency and other overseeing agencies like Public Health. I tried
to convince them, but got to them a half hour too late, and I was faced with an
ambulance circling our parking lot with our first COVID resident already
inside. So, we had to accept him back with our Public Health cheerleading us
over the phone. If they thought that we could do it, maybe we could? A
communicable disease consultant came in the next morning to show us how to don
and doff, checked out our facility, and coached our staff. We felt pretty
good about the training. We were prepared with a stash of PPE and had done our
own training in house. We followed the consultant's recommendations, but it
became obvious very quickly that things were decompensating. Our staff started
to flee, only 3 staff would agree to care our one positive resident. Other
residents were developing fevers. I called our licensing agency and told them,
"You have to help us, we are drowning, I need a life preserver!" I
called our mayor who very familiar with our facility and is a friend. I reached
out to one of our other acquaintances who knows the county health officer.... I
told them that we needed help.
By this time it was the next
Saturday. We were all at work, trying desperately to make up for the staffing
shortages when the head of EMS called Gordon Manor to let me know that some
helpers were coming--a retired Colonel and someone who worked on Ebola and
COVID in Kirkland. I had no idea what was about to happen, but I felt hopeful
that help was on the way. Maybe something good was going to happen. In about an
hour, Dr. Ryan, Dr. Fred, RN Cooper, EMT Tony, etc. met with me outside Gordon
Manor to discuss the problem. One of our resident's daughter, Dr. Sarah Beekley
had been helping us by monitoring temperatures was also there to explain our
situation. After assessing the building and our situation, the AMI team deemed
the whole building COVID infected or "hot". The whole building was a
hot zone. They saw how the layout of the building, the types of residents that
we have, and the care program influenced the infection. The AMI staff checked
out the grounds, and determined that the backyard garden area was the best
place to set up shop.
The next day was Easter Sunday. The
"strike" team was there before 7 am setting up the necessary
stations. Things moved fast: handwashing stations moved, porta potties rented,
tents, tables, computers, printers, power strips, signs, extension cords,
lights, boxes of PPE, temporary fencing, sinks, garbage cans, hand sanitizer,
thermometers, refrigerator, microwave, tables, chairs.... The RNs, NPs, EMTs,
MDs, CNAs, LVNs, all mobilized to come up with the plan to protect the workers
with PPE, isolate residents in their rooms, set up testing.
By this time, even more Gordon Manor
workers fled. We were down to only a handful of workers. The residents needed
care. We had 68 residents when the outbreak began. All of our rooms were full.
Several rooms were double occupancy. Most of our residents have dementia,
several were bedbound on hospice, many are in wheelchairs, and about
a dozen are wanderers. I was scrambling to beg for more workers, looking
online, asking staff for more people. The workers that were still there were
were working round the clock trying to care for everyone. Our entire care
infrastructure was crippled, and we were all of a sudden struggling to provide
the basic services that are our core competencies... assistance with bathing,
grooming, dressing, feeding, incontinence care, housekeeping, laundry, etc.
Once AMI arrived, they set up the
donning and doffing tents, paths in, paths out, face washing, and clothes
changing. They ensured that every person was screened for temperature and
symptoms. Gordon Manor, AMI and all other essential visitors were fully PPE'd
with double gloves, gown, shoe covers, n95 masks and face shields. This seemed
like a huge undertaking, but totally essential to prevent transmission between
staff and residents, as well as between staff, and it was just one of the many
huge undertakings....
Next, AMI staff mobilized quickly to
care for the residents while implementing the strict isolation measures. They
also had to work with our remaining staff to understand the residents care
needs, communicate what work needs to be done and what had been done. Since
Gordon is not a medical facility, not a skilled nursing facility, but a
residence, a home. The residents are residents not patients. They do not have
ID tags on their wrists and don't have care plans in their rooms. The medical
model did not apply to Gordon Manor, yet, in this situation, we had to adapt
and use those tools that work in hospitals. We put care plans on the doors, put
care recording sheets on the doors, put tags on their wrists, so that the
helpers could help.
The isolation measures were
essential to contain the spread of the virus between residents. Social
distancing for people who have dementia is practically impossible without
drastic measures. Our residents will not be able to consistently wear a mask or
remember to stay away from people. This is why the virus spread in our
community despite our best efforts. This is where Dr. Plotkin in close
collaboration with the resident's health team (PCP, family, and/or Healthcare
Agency) devised a plan for each individual resident who could not comply with
the shelter-in-place or social distancing protocols. Without AMI or Dr. Plotkin's
help, this could not have been done. Gordon Manor could not have made the
decisions necessary to achieve isolation. Dr. Plotkin being on site making
decisions as the problems presented themselves was crucial to saving lives.
This containment stopped the infection from spreading to more people.
(To be continued tomorrow)__________________________________________________________________________
Our ZHS on-line schedule:
- Mondays: 7-8:30pm - zazen, short service, lecture/discussion
- Tuesdays-Fridays: 5:30-6:10pm - zazen, offering of merit/bows
- Saturdays: 8:00-10:15am - zazen, short service, tea, discussion/study
- For more information: www.zenheartsangha.org)
__________________________________________________________________________
Special bows for today:
- Please offer bows for Dottie Kelly, Misha's family member, who died of COVID-19 on May 20th
- Please offer bows for Annette Merrill, Misha's cousin, who died on May 13th from lung cancer
- Please offer bows for Donald Kennedy, former president of Stanford University, who died from COVID-19
- Please continue to offer bows for Nick Battaglia, Camille Spar's father, who died Aprill 13th
- Please continue to offer bows for the family of Alison Templeton, a PS parent, who died on April 1st
- Please continue to offer bows of well-being for:
- Claudio Pannunzio, dharma friend of Twining Vines Zendo, who is undergoing chemotherapy
- Rev. Les Kaye, Misha’s Zen teacher, who is recovering at home while undergoing chemotherapy
- Brendan, Kate Haimson’s son, who is recovering at home from surgery
- Michael Tieri Ricaud, Dainuri Rott’s brother, who is suffering from MS
____________________________________________________________________________________
Wonderful links shared by sangha members and friends:
- Zen Heart Sangha website: resources about COVID-19: www.zenheartsangha.org
- From our dharma sister, Misha: article from the New Yorker, Reinventing grief:
- https://www.newyorker.com/maga
zine/2020/05/11/reinventing- grief-in-an-era-of-enforced- isolation - From our friend, Candace Pierce: Song of The Longest Time - Quarantine Edition
- From our dharma sister, Camille: a modern fairy tale about the pandemic:
- From our friend, Candace Pierce: Bolero from Juillard: https://www.juilliard.edu/
school/news/media-gallery?utm_ source=pardot&utm_medium= email&utm_campaign=content& utm_content=bolerojuilliard_ 04.30.20#/node/146356 - From our dharma sister, Lucille, for a little humor on 'What You Should and Should Not Do: https://youtu.be/wVs5AyjzwRM
__________________________________________________________________________________
Many thanks to those of you who are sending me articles to share, links to helpful information, and for making comments…it is a gift beyond measure. Please know that you can either leave a comment on the blog itself, or send something directly to me and I will be happy to paste it in.
No comments:
Post a Comment