A New York Member’s Playbook to Manage a COVID 19 Surge

Members | May 06, 2020 | by Dee Pekruhn

On April 8 2020, LeadingAge members had the unique opportunity to hear important lessons learned from Liz Weingast, VP of Clinical Excellence for the New Jewish Home in New York. With tips and stories straight from the ‘front lines’ of handling a surge of confirmed COVID 19 cases, Liz offered her wisdom, her pragmatism, and her compassionate realism. Liz’s inspired leadership example lights the way for other members around the country who may soon experience the challenges – and hopefully successes – that battling COVID 19 brings to member communities.

Top Four Considerations: Liz’s COVID 19 Surge “Checklist”

 

  1. On Staffing Concerns:
    1. Communicating with Staff.
      • Be truthful
      • Be up to date
      • Be deliberate
      • Establish a reliable routine of communication
      • Educate, educate, educate
    2. Incentivizing Staff to Work:
      • Use consistent staffing, and deploy teams that are “close knit.”
      • Use a post-acute team, that is “already used to dynamic, clinically challenging resident needs.”
      • Enhanced education and more frequent visits by leadership help reassure and motivate staff.
    3. When Staff Get Sick:
      • “When staff are out sick, expect them to be fully out.”
      • The virus hits even well, active staff members hard; a leave period of 10-14 days should be expected.
      • Check in calls with staff after they have been out 5 days.
      • Staff call outs were roughly four times the usual call-out rate.
    4. Alternative Staffing:
      • “Repurpose” other healthcare workers, home health workers, and support staff.
      • Support and housekeeping staff are essential; items must be packed and rooms disinfected swiftly.
      • Rotate staff members who are assigned to communicate with families.
      • Had therapeutic recreation staff help in set up virtual calls when they can’t visit in person.
    5. Medical Staffing:
      • Have medical professionals (doctors, NPs, PAs) vary their work schedules for support seven days a week.
      • Hire extra NPs; recruited fellows in a geriatrician training program from a local medical school to augment existing medical staff.
    6. Returning Staff to Work:
      • Hire a part-time nurse practitioner just to handle occupational health. This NP would help coach and clear staff who were recovering from COVID19 to return to work.
    7. Onboarding New Staff:
      • Offer an expedited, tightly organized training program.
      • Offer both new and existing staff extra support and education.

 

  1. On Setting up a Cluster Unit:
    1. The First Unit: Our Own Residents
      • Reduced the risk of exposure to others (residents, staff).
      • Helped preserve hard-to-find PPE.
      • Utilize an established team from a post-acute setting, already well-versed in dynamic, clinically challenging resident needs.
    2. Recovery Cluster Units: Serving Our Mission
      • On a suburban campus.
      • For people discharged from the hospital with confirmed COVID19.
      • Ensured lots of support and education for staff to assuage fears.
      • Ensured we had needed O2, PPE to manage the units.
    3. Cluster “Roommates:”
      • Residents with the same COVID 19 diagnosis can share rooms.

 

  1. On COVID Testing:
    • Tap into existing lab service.
    • Establish “presumed diagnoses” using symptomology (fever, coughing, malaise) that can be later confirmed by testing.
    • Work with state or local health department, or office of emergency management.

 

  1. On Observations of the Virus:
    1. Symptomology:
      • The virus is manifested in surprisingly diverse ways.
      • Expect a wide range of symptoms – or none at all – from residents with confirmed COVID19.
    2. Hospitalization and Mortality:
      • Add Advance Directive Planning to emergency planning efforts.
      • Address funeral home shortages by renting refrigeration trucks to safely hold resident remains.