Nursing home operator National Church Residences braces for virus-fueled storm
The new coronavirus attacks young and old alike, but it’s landed its most crushing blows to the elderly. As chief medical officer for National Church Residences, Dr. John Weigand feels a pressing need to protect the lives of the 25,000 seniors and 2,800 employees who live and work in the 25 states where the organization operates.
“There’s a wave coming in, and there’s a little bit of anxiety over that,” Weigand says. “We’ve seen what’s happened in China, we’ve seen what’s happened in Italy, we’ve seen what’s happened in Seattle. It feels like it’s approaching, and maybe too fast.” With an especially vulnerable population, “we feel like every minute we don’t organize things is a minute lost.”
As of two weeks ago, the pandemic had struck about 150 nursing homes across 27 states, according to data released by the U.S. Centers for Medicare and Medicaid, and that number surely has increased since then. At a long-term residential care facility in Washington, 81 residents, 34 staff members and 14 visitors contracted the coronavirus; 23 people died, the Centers for Disease Control and Prevention (CDC) reported. Similar outbreaks have occurred at facilities in other states.
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National Church Residences communities, of which there are about 50 in Central Ohio, encompass many levels of care, including assisted living, independent living (such as First Community Village), adult day care, hospice and home care. Affordable senior housing is its largest segment and the area where Weigand feels particularly concerned. With a primarily low-income population, it’s those residences where the organization has the least influence on safety precautions for those entering people’s homes to provide services. The majority don’t have clinical experience, nor do many of those coordinating their care, he says.
National Church Residences, like other operators, has barred visitors from its care communities except for end-of-life or other humanitarian situations. Not only has that been difficult for families, he says, “it’s created a new set of unintended but probably not unexpected consequences,” chiefly social isolation. “Now you’re piling on a little in that regard.”
Weigand is a geriatrician with a private practice in Columbus and has heard of cases where some patients in memory care units have essentially stopped eating because they are used to family members being present to feed them.
The organization is trying to mitigate that isolation where possible. At single-story facilities, families come to windows to visit. Some senior living communities are experimenting with technologies like Skype or FaceTime to keep families in contact. National Church Residences uses voluntary buddy systems where two residents phone each other daily.
Of equal importance is staff health and safety, Weigand says. Staff levels and turnover at assisted living and long-term care facilities is high industrywide and could be especially challenging now. “We do ask if there is the potential for burnout. Fortunately, we really haven’t seen it get to the level we’ve seen in other places,” he says. “The personality of the organization has a huge impact. Every organization has its own temperature in terms of how it responds. I found in those that portray a level of clarity and calm, employees will follow that lead.”
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As more caregivers get the virus, “they’re going to be out of the game for a while. I do see some cross-training where you maybe pass food trays instead of doing custodial tasks.” In some communities, retired physicians and those in practice are volunteering to help in COVID-positive facilities, as are nurses. “Situations like this can bring out the best and worst in people,” Weigand says.
National Church Residences must heed many voices, including gubernatorial and health department orders being issued one after another in the 25 states where it operates. Guidelines from the CDC, the Trump administration and medical and senior-living associations also are in the equation.
“The challenge is how to operationalize that” when dealing with precaution levels rapidly shifting among its multi-layered communities, where responses are needed at different care levels and at individual sites. A resident at one community needed to be hospitalized but didn’t speak English, relying on visiting family to interpret. “You can’t map that out in a tabletop exercise,” Weigand says. “You can’t always use an algorithm.” Potential cases are coming in so quickly that it’s increasingly challenging to respond on a case-by-case basis. In drafting policies, he said, “everything is written in pencil.”
Weigand, who was in the military medical corps, uses that experience now. “When you’re in a crisis, you have to establish a chain of command.” But with directives coming from so many entities, that model is harder to use. He used input from physicians who have experienced the crisis elsewhere and found that response at the state level was “quite honestly .. maybe a bit more robust. From my standpoint, I ended up looking to the state to be that command center.”
His biggest worry is, “have we done all we can without widespread test kits? In a crisis, you never know how prepared you are until it hits. I feel like there’s this clock that’s ticking.”
Throughout this unprecedented epidemic, Weigand has found strength from those working with him. He also uses his favorite hour at 5:15 a.m. for quiet time and reflection.
He reads The Peace of Wild Things by poet and author Wendell Berry. When the writer wakes at night despairing of the future, he lies down by the water and comes into “the peace of wild things … for a time I rest in the grace of the world, and am free.”
Laurie Allen is a freelance writer.