Nursing homes - Wrong plan

denverpilot

denverpilot

Tied Down
Joined
Nov 8, 2009
Messages
55,483
Location
Denver, CO
Display Name
Display name:
DenverPilot
An opinion and warning for those of you in States that haven’t already seen this. Posted this elsewhere after looking at our numbers (currently 40% of deaths) and hearing the story of a friend who was in a facility and literally across the hall from a Covid patient in another State.

I was greatly relieved when her facility said she wasn’t in great shape due to her knee issue, but GTFO and go home and we’ll get you back in somewhere for rehab if you really can’t figure something out to handle daily stuff away from here.

Friends and neighbors are helping her out and it’s a hell of a lot safer than those who had to stay inside the facility.

But we see the rest of the medical community splitting buildings, and we see other essential businesses kicking everybody out temporarily to disinfect and re-open. It’s much harder with nursing facilities but we have to adapt these procedures to work, or you’re just killing the vulnerable.

At least try. The numbers are a flashing red warning sign way clearer than any of the other larger picture tea leaves. Washington State saw it first. Now we see it.

Get on it and get further out in front of it than we did here. Evacuate. Demand it.

——

Severe policy change needed for nursing homes NOW.

If we are evacuating grocery stores and food processing to clean them before people are reintroduced, after any reported cases inside, we need to do the EXACT same thing with our most vulnerable.

BIG undertaking. But States that are behind Colorado, you’d better take warning and DO this. Demand it. Roughly half our deaths are in facilities.

Hospitals spilt buildings into wards with and without. Same deal. Do what the rest of the medical community is doing. No interaction between sides. NONE.

Or get them OUT and clean.

No more “there’s a Covid patient across the hall” BS. No!
 
Sometimes it’s easier said than done. The facility I’m at will isolate on suspicion and if tested positive, will be moved to a wing solely designated for COVID patients and will be treated by staff who only stay on that unit. For those who are still relatively independent, it’s a lot easier to send them elsewhere to receive care, but those who are in a vegetative state on a vent or need constant care pretty much have to stay in house.
 
Ryanb said:
Sometimes it’s easier said than done. The facility I’m at will isolate on suspicion and if tested positive, will be moved to a wing solely designated for COVID patients and will be treated by staff who only stay on that unit. For those who are still relatively independent, it’s a lot easier to send them elsewhere to receive care, but those who are in a vegetative state on a vent or need constant care pretty much have to stay in house.
Click to expand...

Totally understand. But once confirmed... we are clearly doing the wrong thing.

The numbers aren’t lying on this one.

If it takes a massive outside help effort, for each facility, so be it. Those emergency hospital tents, staff from elsewhere, etc.

It needs serious consideration and planning and it’s going to get worse.

Warehousing the elderly inside an infected building where there isn’t room to split the building, and staff, like hospitals have done... is clearly not working.
 
denverpilot said:
Totally understand. But once confirmed... we are clearly doing the wrong thing.

The numbers aren’t lying on this one.

If it takes a massive outside help effort, for each facility, so be it. Those emergency hospital tents, staff from elsewhere, etc.

It needs serious consideration and planning and it’s going to get worse.

Warehousing the elderly inside an infected building where there isn’t room to split the building, and staff, like hospitals have done... is clearly not working.
Click to expand...
I agree and it’s up to each facility to have their own plan of action as to what measures to take if someone internal becomes infected. At the facility I work at, there’s a wing that’s totally vacant and will hold any COVID positive patient and will use employees who only staff that unit. It’s totally isolated (if need be) from anyone else in the building. I’d say we’re better prepared than anyone else on this matter, but hope we don’t have to use it.
 
There just aren't any other places to put grandma. Families "can't" (won't).
And there is inertia. That would be a huge task, to find places and relocate them all.

Also I think these homes are going to have a difficult time soon if not already, finding staff who are not carriers (possibly visitors brought the virus in initially but I think now the staff is the biggest source). We can't do daily rapid testing of staff yet, and no one wants to - once you send all the caregivers home, there will be not enough left to look after the elderly.

Running on an hour sleep so may delete all the above once I wake up later.
 
Ryanb said:
I agree and it’s up to each facility to have their own plan of action as to what measures to take if someone internal becomes infected. At the facility I work at, there’s a wing that’s totally vacant and will hold any COVID positive patient and will use employees who only staff that unit. It’s totally isolated (if need be) from anyone else in the building. I’d say we’re better prepared than anyone else on this matter, but hope we don’t have to use it.
Click to expand...

That’s great. We’ve seen facilities here that were too small or simply didn’t care enough to have such plans, and that’s an oversight problem.

Multiple lawsuits already started to see when the overseers knew and what they did about it, too. They’ve been stonewalling the press.

My sentiments in the warming aren’t to flame broil any place ready for it.

It’s more of a “hey folks, get ahead of this in your local area and get pressure on your regulators to make sure they know the facilities have a real plan, or just get ready to move people...”

We still don’t seem to have a real plan here. Real logistics plans take time. So I’m just saying, use the time your State is behind ours, as wisely as possible.

Somebody had to go first. We botched it. Don’t be us.
 
We need all kinds of things. We can stockpile supplies, tents, even build emergency facilities to be used in a crisis like this but....who the hell is gonna staff it? Without trained doctors its gonna be a freak-show of med techs killing people with fancy equipment and supplies that we stockpiled.

Thank god there is probably no way to track how many of these people end up dead due to medical errors because I am certain it would not look good.
 
Let'sgoflying! said:
There just aren't any other places to put grandma. Families "can't" (won't).
And there is inertia. That would be a huge task, to find places and relocate them all.

.
Click to expand...

Remember it’s only long enough to clean and re-enter. It may happen multiple times at multiple facilities but the lockdown measures have slowed the overall occurrences.

If us younger jackasses can do it for a grocery store...
 
denverpilot said:
Remember it’s only long enough to clean and re-enter. It may happen multiple times at multiple facilities but the lockdown measures have slowed the overall occurrences.

If us younger jackasses can do it for a grocery store...
Click to expand...

Or does moving everyone around just spread it more?
 
Let'sgoflying! said:
Also I think these homes are going to have a difficult time soon if not already, finding staff who are not carriers (possibly visitors brought the virus in initially but I think now the staff is the biggest source). We can't do daily rapid testing of staff yet, and no one wants to - once you send all the caregivers home, there will be not enough left to look after the elderly.
Click to expand...
It’s already difficult. There’s been a handful of employees, kitchen staff and caregivers, who have reported symptoms and were sent home promptly, but they all tested negative for COVID. There’s been a few employees quit as well.

As with every other facility in the nation, we are locked down to employees only. The ONLY exception is for family members to enter if their loved one is on hospice and about to expire.

As for preventing the staff from bringing the virus in - nearly impossible imho. The CDC has set some strict guidelines but they don’t cut the mustard in all reality. We no longer allow employees to leave campus during their shift (unless they’re a social worker). Temps are taken upon entry to the property and masks are to be worn at all times. Now, the question I raised was, how does this change anything at all? Employees leave campus at the end of their shift and go out in public (to the grocery store and back home to their families who have been no telling where) so in the grand scheme of things, you’re not really safeguarding against anything. The biggest measure is training employees on proper glove usage, hand washing etc. It’s a problem that really doesn’t have any viable solution since the virus would most likely be employee-patient transferred before it would become patient-patient, because none of the patients can leave the property right now.
 
denverpilot said:
That’s great. We’ve seen facilities here that were too small or simply didn’t care enough to have such plans, and that’s an oversight problem.

Multiple lawsuits already started to see when the overseers knew and what they did about it, too. They’ve been stonewalling the press.

My sentiments in the warming aren’t to flame broil any place ready for it.

It’s more of a “hey folks, get ahead of this in your local area and get pressure on your regulators to make sure they know the facilities have a real plan, or just get ready to move people...”

We still don’t seem to have a real plan here. Real logistics plans take time. So I’m just saying, use the time your State is behind ours, as wisely as possible.

Somebody had to go first. We botched it. Don’t be us.
Click to expand...
Yeah, and those places without a proper plan are recipes for disaster, but the real problem is corporate oversight rather than an individual facility driven issue. Life Care for example. The biggest thing with the place I’m at, is that we’re independent, there’s only one of us, so we have ZERO corporate oversight. All decisions are made in house by competent management. Let’s keep our fingers crossed that things continue going COVID-free. :)
 
bnt83 said:
We need all kinds of things. We can stockpile supplies, tents, even build emergency facilities to be used in a crisis like this but....who the hell is gonna staff it? Without trained doctors its gonna be a freak-show of med techs killing people with fancy equipment and supplies that we stockpiled.

Thank god there is probably no way to track how many of these people end up dead due to medical errors because I am certain it would not look good.
Click to expand...

Again, a reason to get ahead of it and get proper mutual aid set up. You have hospitals with plenty of qualified staff with low patient loads... etc.

A properly managed, even slightly botched, response is not going to be worse than letting it get loose in a facility, which we are seeing happen with significant enough frequency that we KNOW it’s not working.

Deal with the emergency you know you have, not the imagined one... it’s a lot easier to pivot a bad tech to good behavior while working the non-fatal known patient problem, than to pivot the dying patient with no available treatment.

Honestly if the facilities can’t split wards and do what all other medical peers are doing, the answer might be to immediately ship out their infected patients to the hospitals. Nobody infected stays. That caused a different set of problems, but maybe more manageable for some facilities.

Probably in the end it’s a combo of many techniques. What we know for sure is the current techniques, and vulnerability of the patients, needs a change. Or an attempt.

I get it. The vulnerable are going to catch it and die.

I just think we have a glaring warning going unheeded in the numbers. Whether it’s truly fixable, hard to say.

Whether our deaths are happening in facilities that are half assing things, only the experts know. I won’t try to guess at that part.
 
If I even say anything meaningful or constructive here I'll just be accused of politics or spin, so I'll just quietly STFU.
 
bnt83 said:
We need all kinds of things. We can stockpile supplies, tents, even build emergency facilities to be used in a crisis like this but....who the hell is gonna staff it? Without trained doctors its gonna be a freak-show of med techs killing people with fancy equipment and supplies that we stockpiled.

Thank god there is probably no way to track how many of these people end up dead due to medical errors because I am certain it would not look good.
Click to expand...
The CDC figures that we kill about 150,000 to 200,000 per annum, due to preventable medical error, in an ordinary year. Yikes.
 
My mom was in a nursing home for a few weeks for her fall when this was all starting. Within a couple weeks after she left, 31 residents had died (not sure the total number in the facility, but that's a very large percentage). Mom is fine, but that's a lot. Personally I figured it was only a matter of time before the infection would spread, especially in NYC where everyone who works there is riding the subway or taking the bus.

That said, moving everyone out is much easier said than done, especially the most frail who have special requirements for care. And moving them in with families who might have high exposure themselves (like us) and worse disinfecting procedures may not help the case any.

I don't know what the answer is.
 
Ted DuPuis said:
Within a couple weeks after she left, 31 residents had died (not sure the total number in the facility, but that's a very large percentage).
Click to expand...
That would be under 10% (440 bed facility) of the total resident population where I’m at. Still, that’s a very large sum nonetheless.
Ted DuPuis said:
That said, moving everyone out is much easier said than done, especially the most frail who have special requirements for care.
Click to expand...
Echoed my point near verbatim. Thanks
 
This happens every year at nursing homes, generally a patient goes out, picks something up like the flu, pneumonia or a norovirus and it spreads through like wild fire. In the winter the "attrition" rate is greater than in the summer when these illnesses subside. It's pretty much the nature of these places. Some are **** holes, but most are pretty good. I think the criminal aspect of this pandemic is governors ordering infected patients admitted to these nursing homes to recover or die while elderly patients are still there, WTF. Also, we had a veterans home in Massachusetts where the guy in charge was accused of hiding the problem while veterans were dying. Now full story isn't out in this case, the guy said he notified his bosses about the problem and they didn't help him. It's just a mess.
 
I thought a few leaders have stated the elderly are of course willing to make a sacrifice for the future generations. This is a cost saving measure, so we can open everything up faster.... remove the vulnerable with plausible deniability!

Tim (could not resist)
 
Sac Arrow said:
If I even say anything meaningful or constructive here I'll just be accused of politics or spin, so I'll just quietly STFU.
Click to expand...

I’m being careful trying to get the word out to folks to get ON their politicians BEFORE they make it political and the lawsuits fly... like here.

The hiding that causes of the data because there’s now a “lawsuit pending” is freaking idiotic.

Math be math. Ain’t working, choose Plan B and try it or end up where we are in numbers. That’s all I’m really sayin’.
 
denverpilot said:
I’m being careful trying to get the word out to folks to get ON their politicians BEFORE they make it political and the lawsuits fly... like here.

The hiding that causes of the data because there’s now a “lawsuit pending” is freaking idiotic.

Math be math. Ain’t working, choose Plan B and try it or end up where we are in numbers. That’s all I’m really sayin’.
Click to expand...
The lawsuits are going to happen no matter what. In my state, the state health department claims that HIPAA prevents them from releasing data - the homes have nothing to do with that.

There also this: https://www.washingtonpost.com/loca...d329d4-7b85-11ea-a130-df573469f094_story.html
 
PaulS said:
This happens every year at nursing homes, generally a patient goes out, picks something up like the flu, pneumonia or a norovirus and it spreads through like wild fire. In the winter the "attrition" rate is greater than in the summer when these illnesses subside. It's pretty much the nature of these places. Some are **** holes, but most are pretty good. I think the criminal aspect of this pandemic is governors ordering infected patients admitted to these nursing homes to recover or die while elderly patients are still there, WTF. Also, we had a veterans home in Massachusetts where the guy in charge was accused of hiding the problem while veterans were dying. Now full story isn't out in this case, the guy said he notified his bosses about the problem and they didn't help him. It's just a mess.
Click to expand...

In New York City, it was especially criminal because both the temporary hospital at the Javits Center and the USNS Comfort had been converted over to treating COVID patients, but were underutilized. Comfort has 1,000 beds, but treated fewer than 200 total patients during her stay. The Javits Center had 2,500, beds but treated just over a thousand. Yet recovering COVID patients were sent to nursing homes full of elderly people to convalesce.

That's all. If I say any more about this, I'll be banned for sure.

Rich
 
A lot of nursing home residents are dementia patients who are in danger of wandering off to god knows where if not supervised. Their families may not be ready or able to handle that.
 
  • Like
Reactions: Ted
RJM62 said:
In New York City, it was especially criminal because both the temporary hospital at the Javits Center and the USNS Comfort had been converted over to treating COVID patients, but were underutilized. Comfort has 1,000 beds, but treated fewer than 200 total patients during her stay. The Javits Center had 2,500, beds but treated just over a thousand. Yet recovering COVID patients were sent to nursing homes full of elderly people to convalesce.

That's all. If I say any more about this, I'll be banned for sure.

Rich
Click to expand...

Comfort was explicitly not intended for covid patients. They didn’t want it on the boat. It was for hospital non-Covid overflow.

However they did accidentally transport something like 6 Covid patients there in the latter part of the first week or early second, so I don’t know if that forced them to swap it up and make it a Covid ward.

The hospital ships by default are not used for outbreak patients, if sent anywhere, though. They provide a safe hospital location for regular hospital duties, usually.

Kinda the same problem as nursing homes. Tighter quarters, more contact, etc.
 
cowman said:
A lot of nursing home residents are dementia patients who are in danger of wandering off to god knows where if not supervised. Their families may not be ready or able to handle that.
Click to expand...

Understand. Locked wards need special procedures. They are quite far from the majority.

Also should be noted that while also not a majority a fairly large population of nursing facilities aren’t elderly either.

My friend was simply convalescing from knee surgery with complications that needed IV drugs, etc. They managed to remove the drugs in question for her to return home. Alternatively home care nursing can do that, but it reintroduces a different risk more limited than a sick building.

Coin tosses every time the home care worker walks in. Same coin toss we all face at the grocery store.
 
denverpilot said:
Comfort was explicitly not intended for covid patients. They didn’t want it on the boat. It was for hospital non-Covid overflow.

However they did accidentally transport something like 6 Covid patients there in the latter part of the first week or early second, so I don’t know if that forced them to swap it up and make it a Covid ward.

The hospital ships by default are not used for outbreak patients, if sent anywhere, though. They provide a safe hospital location for regular hospital duties, usually.

Kinda the same problem as nursing homes. Tighter quarters, more contact, etc.
Click to expand...

That was the original plan, but they changed Comfort's mission early in her stay. I don't think it was forced so much as ordered by a certain Commander in Chief in response to a certain governor's request. They also expanded her mission to accept patients from the greater Metro area, not just New York City.

Same with the Javits Center. The original plan was to use it for non-COVID overflow, but there was none. Trauma cases were down because nothing was moving (hence fewer accidents); and the more pedestrian heart attacks and the like chose to take an aspirin, take their chances, and often die, rather than calling EMS.

Last time I talked to friend who's FDNY EMS, at-home DOA's were up 1,000 percent. Many of them were decedents sitting in chairs or laying on their beds next to a bottle of aspirin. And mind you, with no one checking on these people because of the lockdown, and no way to notice changes in people's routines, they're probably the tip of the iceberg. Once the bodies start to rot and stink, they expect many more at-home DOA calls.

Rich
 
RJM62 said:
That was the original plan, but they changed Comfort's mission early in her stay. I don't think it was forced so much as ordered by a certain Commander in Chief in response to a certain governor's request. They also expanded her mission to accept patients from the greater Metro area, not just New York City.

Same with the Javits Center. The original plan was to use it for non-COVID overflow, but there was none. Trauma cases were down because nothing was moving (hence fewer accidents); and the more pedestrian heart attacks and the like chose to take an aspirin, take their chances, and often die, rather than calling EMS.

Last time I talked to friend who's FDNY EMS, at-home DOA's were up 1,000 percent. Many of them were decedents sitting in chairs or laying on their beds next to a bottle of aspirin. And mind you, with no one checking on these people because of the lockdown, and no way to notice changes in people's routines, they're probably the tip of the iceberg. Once the bodies start to rot and stink, they expect many more at-home DOA calls.

Rich
Click to expand...

Weren't there new rules for reviving heart attack victims in NY? If the patient couldn't maintain a heartbeat on their own for 5 minutes they were allowed to die or something like that.
 
PaulS said:
Weren't there new rules for reviving heart attack victims in NY? If the patient couldn't maintain a heartbeat on their own for 5 minutes they were allowed to die or something like that.
Click to expand...

Yes, although I forget what the exact time limit was. FDNY, however, largely ignored the state directive.

Rich
 
PaulS said:
Weren't there new rules for reviving heart attack victims in NY? If the patient couldn't maintain a heartbeat on their own for 5 minutes they were allowed to die or something like that.
Click to expand...

From a paramedic there, that was just a re-issue of a long standing order to not attempt CPR on essentially dead patients. Medics love to try.

State re-released the guidance since sucky face and lots of pulmonary work, would eventually lose them medics.

But it wasn’t new.
 
denverpilot said:
Remember it’s only long enough to clean and re-enter. It may happen multiple times at multiple facilities but the lockdown measures have slowed the overall occurrences.

If us younger jackasses can do it for a grocery store...
Click to expand...

I’m with you on the spirit of this, but it isn’t that simple. In my wife’s Level 1, takes over an hour for a team to sanitize a single room (CV patient). Any entry by any person at any time...eg, just to check vitals or empty a catheter bag...requires scrub-in and our procedure, don/doff, and the available PPE to replace the coverings (all must be thrown away. every time). As for dedicated area...she has fewer than 5 pts on her Covid floor (we are talking Texas here, not NY). The other icu floors (non-covid) are bursting at the seams from elderly ending up there because of injuries found late due to isolation and lack of access to ongoing care due to primary care providers cutting back or temporarily eliminating services. (along the lines of what @RJM62 was saying)

It’s a mess.
 
RJM62 said:
I was more than that, Nate.

https://nypost.com/2020/04/21/ny-issues-do-not-resuscitate-guideline-for-cardiac-patients/

FDNY basically told the state to pound sand.

Rich
Click to expand...

That article was debunked. Notice the only guy they got to say anything was the union guy? The policy wasn’t new. NY post wanted manufactured outrage mostly.

That’s all I said. Wasn’t new.

Didn’t say everybody didn’t ignore it. My contact said nobody cared about it in his dept.

But the article was the usual media garbage. That’s why I asked him, wondering if it was.
 
denverpilot said:
That article was debunked. Notice the only guy they got to say anything was the union guy? The policy wasn’t new. NY post wanted manufactured outrage mostly.

That’s all I said. Wasn’t new.

Didn’t say everybody didn’t ignore it. My contact said nobody cared about it in his dept.

But the article was the usual media garbage. That’s why I asked him, wondering if it was.
Click to expand...

Well, it was widely reported in practically every newspaper in the state, as was the state's hastily rescinding the order the next day.

There are many EMS companies in New York, and they all have their own protocols. That's allowed as long as the local protocols don't contradict the state laws. I suspect that may be the reason for the different stories.

Rich
 
RJM62 said:
Well, it was widely reported in practically every newspaper in the state, as was the state's hastily rescinding the order the next day.

There are many EMS companies in New York, and they all have their own protocols. That's allowed as long as the local protocols don't contradict the state laws. I suspect that may be the reason for the different stories.

Rich
Click to expand...

Makes sense. You’re closer than I am. Lord only knows what the algorithms are showing me. LOL.
 
We removed my wife’s 93 year old mother from her rehab facility in Spokane, Washington shortly after The Governor locked down the state. In general these facilities have been hit hard in Washington State and one such facility on the West Side was fined over $600K for various violations of the health and safety regs and had I think 30 or so deaths. So now into week 8 with my MIL with no end in sight. She lives in an independent living facility that is pretty much locked down. Probably will open sometime in June but who really knows. And if just one resident gets Covid-19, it will fly through that place. Hmm.
 
You must log in or register to reply here.
Back
Top