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The look and feel of the entrances to many senior living communities has changed drastically since February 2020.

In addition to a huge reduction in the number of people going in and out—visitation restrictions and quarantines, those who do come in may face a number of safety measures including screening questions and remote temperature sensing.

At the beginning of the pandemic, it was in some places difficult to get even mail delivery. Essential service providers such as physical therapists quickly got down to researching, planning, and implementing the ground rules to ensure the greatest safety. They had to work out how to prevent risks of illness while guarding against residents losing ground in their recoveries or losing flexibility and muscle—which can lead to injuries.

“When the pandemic first emerged in February of 2020 it was a chaotic time for the nation,” wrote Travis King, PT, DPT, GCS, chief quality officer at FOX Rehabilitation, in an email response. “We knew that we needed to create organization and systems to manage the moving parts of the pandemic. We first established an internal task force made up of executive leadership from each functional department of the practice.”

FOX then brought in consultant Phenelle Segal, from Infection Control Consulting Services, to help make informed decisions about what was needed in personal protective equipment (PPE), infection prevention and control (IPC), and employee and patient safety.

“The structure of a dedicated task force and the experience of a seasoned infection control expert facilitated systematic and precise decision making that could be deployed to the practice using our existing communication strategies,” King writes.

Consistent care matters

While keeping residents from having to visit the emergency room or the hospital whenever possible is a well-established goal in senior living. With COVID-19, clinics, physicians’ offices, and urgent care centers also became places to strenuously avoid.

The paradox is that regular preventive services, therapy, and mobile acute care services are some of the best ways to avoid ER visits and other health risks. Yet this means staff from these services must enter communities—which can carry COVID-19 infection risk. The solution from service providers was to triple up on safety practices, to get that risk as low as possible.

“Adopting very strong infection prevention strategies has obviously been top of mind for us,” says Dr. Stefen Ammon, MD, emergency physician, medical director, and contributing member of the COVID-19 task force at DispatchHealth, a mobile acute medical service that brings same-day complex health care to residences to help avoid unnecessary emergency room visits or ambulance transports.

“One of the challenges with this illness is that even when you’re seeing somebody for a laceration, given the rate of pre-symptomatic and asymptomatic shedding, you have to treat everyone as if theyʼre potentially a carrier. Thatʼs something weʼve really worked on with our providers—and itʼs something to keep in mind at each community.”

Special practices required

As with FOX, establishing a task force was also the first step for DispatchHealth. The issue is two-fold, Ammon points out: Preventing COVID-19 from entering the community, and identifying individuals—residents, staff, and service providers alike—who may have the virus as quickly as possible.

“It’s really incumbent on all of those who run communities as well as those of us who provide care and services in communities that we get it right,” says Ammon.

“With that in mind, best practices for controlling access can be an effective way to mitigate risks,” Ammon says.

DispatchHealth shares the following recommended practices:

Appoint an IPC champion. Identifying someone in your community who can “wear that hat,” train, and keep up with the changing recommendations gives staff someone to go to with questions who either knows the answers or knows where to find them. Some communities name a COVID monitor who can circulate the community and check that processes and practices are being implemented correctly—instead of or in addition to the champion. Ammon notes that this person should be a good communicator, to get good buy-in from staff and let families know what’s being done and why.
Control your points of entry. Clearly mark entrances. Establish entry checks as close to the doors as possible, so that no one needs to walk into the building to be screened. Track who is coming in and out so you can track any issues that may arise later. Some providers are establishing entries outside or at entry to grounds. Make sure your entry points are clear of other risks than that of infection—vehicle and human traffic, equipment, or furnishings can present fall hazards in temporarily assembled spaces.
Align protocols when possible. Check that the service provider has both been trained in processes and knows your community practices. For instance, have they been trained in gown donning and doffing, and do they also know the hows, whens, and wheres for donning and doffing particular to your community?
Review what residents want in terms of care. Review care plans, advance directives, what measures residents and their families do or do not want taken at different points in their health trajectory. What they want may have changed with the pandemic.
Reminders work. Signs on handwashing, social distancing, mask wearing, reminders about PPE policies, short training videos, encouraging messages on email or text, occasional announcements—these reinforce expectations and the understanding that all who enter or live in the community are looking out for each other.
Encourage vaccination. “Vaccination is part of a larger strategy, combined with behavioral infection prevention measures, that will help to end this pandemic,” Ammon says. “These are highly effective vaccines.”

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