The COVID-19 pandemic is the most challenging medical situation I have faced in 25 years as a nursing home physician and medical director.
In any setting, this novel coronavirus is a serious contagious illness with a wide variety of symptoms. It is infectious before the individual shows obvious symptoms. It spreads readily during ordinary human interactions, and it does not yet have treatments that slow or prevent this infection.
However, when coronavirus enters the nursing home setting of declining health, impaired immunity and physical proximity, it quickly overwhelms the body defenses of frail and elderly patients, often leading to end of life. It requires a completely different level of response from facility, staff and community.
The best approach to nursing home care values openness, collaboration and physical presence. Now, personal protective equipment such as masks, face shields, gowns and gloves physically intervene with personal interaction.
Nursing home care cannot happen at a 6-foot distance. Nursing home residents require extra care because of declining health and function. They have multiple diseases that limit walking, breathing and eating. They need assistance in the intimate details of daily living such as bathing, toileting and dressing.
Nursing home staff graciously provide this physical and emotional care. These nurses, aides and therapists learn to know their residents like family and develop deep emotional bonds.
Nursing home staff do not boast about what they do, but rather quietly deliver compassionate care day after day. They are your neighbors, fellow religious worshippers, shoppers at the store and parents of your children’s friends. They are integral parts of our community.
With the local spread of COVID-19 in early March, Lancaster County long-term care facilities promptly started unprecedented interventions. Visitation from family and friends stopped. Group meals and activities ceased. Residents were placed 6 feet apart, and then restricted to their rooms. Staff are screened for symptoms at the start and end of work, and wear masks for an entire shift. Gowns and gloves are everywhere. Multiple educational sessions guide staff on proper hygiene. Deliveries are left at an outside entrance. Numerous communications and phone calls update loved ones.
Despite these drastic steps, COVID-19 has come with vengeance to the five-star facility where I work. We have seen 39% of residents become infected with COVID-19, and 29 have died. The social and emotional toll mirrors the health consequences.
Most nursing home residents enjoy life and are at peace with death when it comes. Now they cannot eat with friends, socialize with others, visit with family or receive hugs. Multiple friends have become ill and died. Residents cannot have needed hours of family bedside presence and nurture near the end of life.
Staff members professionally continue care despite fears for their residents, their families and themselves. While many of us worry about physical distancing at the grocery store, in contrast, nursing home staff knowingly enter the room of someone with COVID-19 to provide extended intimate care. Then, after appropriate hand hygiene and equipment changes, they go on to the next room to provide care to the next person.
They do not start each day hoping to be heroes. Rather, they want to be valued members of our society, contributing with love, care, compassion and gentleness.
What have I learned during the past months? This is a drastically different type of infection with limited known interventions. I have renewed respect for nursing home staff who provide exceptional care. We must prepare for a prolonged COVID-19 pandemic and a future return.
In the discussion about community social distancing, my nursing home experience emphatically pushes for extended precautions. Since this coronavirus comes from outside of the facility, residents will be safer only when the community infection rate is minimal.
Nursing home lives are not just expendable numbers to be added or subtracted from daily tallies. They are individuals with life stories. They are our parents, our friends and eventually us.
We are fortunate to have wonderful staff members caring for our nursing home residents. Honor these heroes for the care they provide, often unseen and unrecognized, while carrying our community through this crisis.
Leon Kraybill, M.D., certified medical director, is the chief of Penn Medicine Lancaster General Health’s geriatric division and post-acute care.