When the COVID-19 pandemic struck last spring, health authorities in Riverside County, California, tried to keep nursing homes and similar facilities up to speed on how to deal with the crisis through weekly phone calls. Three weeks into the crisis, it was clear that more help was needed.
On April 8, one skilled nursing facility in the region had to evacuate about 80 residents when dozens of employees didn’t show up for work. A handful of staffers had fallen ill with COVID-19; others were awaiting test results for the novel coronavirus; some were too afraid to come in, out of fear of becoming sick and infecting their families. The staff shortage threatened to jeopardize patient care, prompting the evacuation. Anxiety was spreading.
Health authorities decided they needed to act quickly to educate and support workers not only at that facility but at many others. Their aim was to keep the alarm from escalating and possibly compromising care for more patients.
“We realized we had to go beyond the weekly phone calls to help,” says Dr. Frank Flowers, the senior physician adviser for Riverside University Health System, where he consults with more than 50 skilled nursing facilities. He and his team provide education and support to nursing homes and other communal living facilities, such as memory care units.
Two days after the evacuation, Flowers, 65, joined more than 20 colleagues – county health officials, emergency medical services leaders and his health system – to brainstorm ways to offer even more assistance. And fast.
Skilled nursing facilities typically serve patients who don’t require long-term care but need rehabilitation for specific medical needs, such as recovery from joint replacement surgery. Some patients who are released from a hospital stay go to a skilled nursing facility until they can move safely in their homes, get in and out of bed without much assistance and use their cane, crutches, wheelchair or walker without danger.
Nursing homes provide provide permanent residence and supervised care. Most of the skilled nursing care facilities in Riverside County, about 50 miles southeast of Los Angeles, include both types of residents.
Dr. Frank Flowers is the senior physician advisor for skilled nursing facilities in Riverside County, California, for the Riverside University Health System. Flowers, other health system representatives and Riverside County health officials have developed the SOS project, in which teams of experts go to skilled nursing facilities to distribute playbooks on how to avoid being infected by the novel coronavirus, discuss best practices and when necessary provide protective gear. (Courtesy of Riverside University Health System)
In response to the mass evacuation, Flowers and his multi-agency colleagues devised a two-pronged approach: They would create and distribute a “playbook” to help guide these homes through the COVID-19 crisis, and they’d hit the road to offer in-person support. They called their roving squads “Skilled Nursing Facility Outreach Support Teams,” or SOS units.
Within days, the four SOS teams started fanning out to every corner of the sprawling, 7,300-square-mile county. They were charged with advising staffers about how to keep their residents, their families and themselves safe from the new virus. They answered questions and delivered PPE: gowns, gloves and N-95 masks. Each SOS team was comprised of a physician assistant, an emergency medical services worker and a behavioral health nurse or therapist to offer strategies and resources on how to manage stress during the pandemic.
They also distributed their playbooks. The softcover version is about 30 pages long, with charts and illustrations. A digital version is available for staffers who prefer to read the material online. Both versions are offered in English and Spanish; many nursing home and skilled nursing facility staffers are Latino, and some are more comfortable reading in Spanish.
By mid-October, SOS teams had conducted more than 1,200 site visits, going to each location multiple times. The teams also visited dozens of group homes and homeless shelters.
“We started creating these relationships with (skilled nursing facility staffers), making it clear that we were there to help them,” says Rodney Koenig, a physician assistant with Riverside University Health System and one of the SOS lead team members.
At the outset, the SOS teams made it clear that they were not visiting in a regulatory role, but rather to partner with the workers on the front lines of the pandemic, Koenig says. After several weeks, the four teams scaled back to two, and by July there was one SOS unit, which remains active.
During initial meetings, it became clear that many of the employees believed that working in a nursing home or other such facility all but guaranteed they would become infected.
To help allay those fears, Koenig and fellow SOS team members often demonstrate how to don and doff personal protective equipment safely. They explain to workers that they could not “zero out the risk (of infection), but if they used the PPE properly, your risk was much lower.”
The SOS team also emphasizes the importance of identifying residents and workers who become infected and quarantining them quickly to prevent the spread of the virus.
With time and repeat visits, “you saw the fear leave (the workers),” Koenig says. “They were no longer afraid to work, because they understood how the virus spreads and what they can do to protect themselves, not only at work but at home as well.”
Within a few weeks, word of the SOS teams spread. By mid-summer, officials at the facilities began reaching out, asking for an SOS team visit, Koenig says.
“Administrators started requesting us to talk to their night shift or their weekend crew. They asked for us when they had new hires, or when they’d developed new protocols and wanted us to look at them,” Koenig says. “They bought into us very quickly.”