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Nursing homes still struggling with COVID-19 threat

Examiner-Enterprise - 1/16/2021

Jan. 17—Kerri Hampton kept her promise.

Sitting on the floor, crying, she told the man on the phone she would be at his mother's side as the woman took her final struggling breaths.

She had always planned to, of course. The nature of facilities like Bartlesville Assisted Living weaves staff intimately with patients' lives — as the lead nurse, Hampton assesses every patient upon their arrival, manages their daily care and communicates with families regularly for years.

Nurses, physical therapists, managers and owners at nursing homes across Bartlesville describe it the same way: They become family. It is hard on them when a patient dies.

The difference now is that Hampton's presence with the woman was not in addition to her family — the pandemic precluded visitors, as it had for the final months of her life, from its final moments, too.

"The aftermath of what this virus is leaving behind is devastating. It's hard. It's so, so hard. It's heartbreaking," Hampton said.

"All the little things you have to do, they just break your heart. All the phone calls you have to make to family."

Between COVID-19 reaching Washington County in March and Friday, there were 3,762 total cases — 7.3% of the county's population.

Long-term care facilities have been hit particularly hard throughout the pandemic, with some gaining attention for being early outbreak sites. As of Jan. 8, the most recent availability of facility-level data, 7.2% of Washington County COVID-19 cases and 52% of associated deaths were patients or employees of local facilities.

While these facilities were included in the first phase of COVID-19 vaccine distribution in late December, it does little to mitigate their concern for the foreseeable future, said Steven Buck, president of Care Providers Oklahoma, an industry group for long-term care facilities.

The age and co-morbidities of patients make facilities uniquely vulnerable to community spread, so the risk will remain as long as the virus is transmitting locally. While availability of the vaccine marks a milestone, it will take time for enough of the vaccine to be produced to reach the general public in the final phase of distribution, he said.

The second of the four distribution phases began in Washington County on Jan. 4, although the length of each phase remains elusive as county officials await vaccine doses and information from the state.

"(The vaccine) is not a panacea. There will still be a lot of work, there will still be community threat as long as there is spread of the virus within the community. This will be a point in time where we can perhaps have some optimism that we can put this behind us in the not-too-distant future," Buck said.

Spread of the virus remains high. This week, weekly case growth in Washington County dropped below 200 for the first time since mid-November, although it still remains higher than in September and October.

Meanwhile, life has moved forward as normal in parts of Bartlesville. Masks are required in city and some county facilities. Some stores, such as Ross, TJ Maxx and Walmart hand them out at the door, but do not enforce their use.

Many gas stations and stores, such as the ASAP General store at 3901 Nowata Road, do not have signs displayed encouraging social distancing or masks, nor staff wearing masks inside.

"If I had a different job, I'd probably have the same feelings as most people — 'It's no worse than the flu. (But) I could change (people's) minds real quick. Just come here and watch," said Alex Dout, owner of Bartlesville Health and Rehab.

"If you're in this industry, COVID-19 never goes out of your brain. You wake up with it, you deal with it all day, you dream about it, you get up the next day and you deal with it again. It's hard to get through your other responsibilities throughout the day, due to COVID-19 precautions.

"This thing is real. It'll kill you. It tried to kill me, it tried to kill my employees."

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Dout was studying to be a teacher and coach when his father-in-law invited him to help run a long-term care facility in western Oklahoma. He knew little about the industry, and on his first day a resident punched him in the mouth.

"I could have turned around and walked away, but I knew that was where I was supposed to be," he said.

Twenty-nine years later, Dout understands the unique requirements and challenges that set long-term care facilities, like Bartlesville Health and Rehab, apart from hospitals and other medical settings.

The patient base comes with a specific set of medical needs, including difficulty with daily physical tasks and memory, and patients stay for months to years, instead of days to weeks. The extended-stay nature makes the transition to living in a facility difficult, leaving patients feeling a loss of independence and families feeling guilty.

However, Dout said the industry has changed since the start of his career. What was once overly regimented now caters to patients' needs in a "more person-centered" way, helping with the transition and providing social engagement.

"Our industry is not on anybody's bucket list. I get it ... but what happens is, you have a grandma or grandpa show up on your doorstep and you're responsible for them. You want the best for them," he said.

In Bartlesville Health and Rehab, Dout translated that industry-wide shift to making individualized, flexible daily schedules for residents and increasing social engagement.

Staff host games and activities in the common areas. There is a resident welcoming committee, monthly cookouts, carnivals and an annual memorial balloon release. Residents and staff eat in the communal dining hall together, celebrate holidays together.

That is, they did before COVID-19.

"It's totally flipped our business upside down," Dout said. "It's had a very negative effect on the residents because of quarantine days when they have to stay in their rooms. I can't do the things I want to do, the staff can't. It bothers us, because it's so quiet.

"It goes against everything I believe in."

Staff wear personal protective equipment, including masks, gloves and gowns, and are tested regularly, with a positive case triggering facility-wide resident testing. The HVAC system has been updated with better air purification, and staff members use white boards when residents have trouble understanding them through masks.

While some pandemic precautions are rigid — use of personal protective equipment, elimination of large gatherings, regular COVID-19 testing — some are on a spectrum of strictness determined by the countywide positivity rate.

When active cases are low in Washington County, residents are able to eat in the dining hall, albeit one person per table. They can visit family on the patio, separated by plexiglass at all times.

Even when there are no cases within a long-term care facility, however, it is required to take extra precautions when there is a spike in countywide cases. At Bartlesville Health and Rehab, Dout said, that means residents eat in their rooms and family interactions are limited to phone calls, video calls and waves through closed windows.

"Peoples' actions outside of the facility who don't have a loved one in a facility can be a positive or a negative. ... We're fighting an invisible enemy. We fight it every day. That thing's looking in our windows every day. It's a beast and I hate it. We're at war every day trying to keep it out," Dout said.

Employees of Bartlesville Health and Rehab, Bartlesville Assisted Living and Ignite Medical Resort Adams PARC said they have seen sadness, fear and depression in residents from months of isolation, decreased engagement with others and separation from loved ones.

"You've got to have that interaction with others. Touching, hugging. When all that stuff is taken away, you see people digress, start isolating. Fear, anxiety and depression take over," Bartlesville Assisted Living Administrator Roxanne Fanning said.

The hit to morale has impacted patients' medical conditions as well.

"Motivation is a big factor in getting them to partake in (physical) therapy," Adams PARC nurse Katrina Howry said. "A lot of people are here for falls, so if you can imagine the pain you'd be in after you've had a hip replaced, a knee replaced. It takes quite a bit of motivation to want to get up and partake in therapy, and COVID has been a hindrance on that."

Not to mention the impact of having COVID-19.

Staff at long-term care facilities throughout Bartlesville said the disease amplifies underlying conditions, leaving patients with more confusion and less energy even after they recover.

"It's constant. People are getting sick. It's real," said Jennifer Brewery, a physical therapist assistant at Adams PARC. "(Patients with COVID-19) are very, very sick, they're very, very weak. It's rough seeing them like that. It's rough seeing them get winded from sitting up on the edge of the bed."

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Hampton, the lead nurse, has not stepped foot in a grocery store since March.

She did eat in a restaurant once, although she "felt terribly guilty."

While she lives alone, not having to worry about transmitting it at home, she has limited in-person interaction with family and friends, has groceries delivered and wears a mask when she goes out in public.

"Everything has changed," Hampton said. "You worry about yourself, but these are seniors and they trust you with their life. I'm worried about my own life and how it affects my family, but I'm so concerned about protecting the people I'm charged to care for. You take every step imaginable to protect yourself so you don't bring something back in."

Long after statewide lockdowns were lifted in late April and early May, staff at long-term care facilities throughout Bartlesville have not let their routines bounce back to pre-pandemic times — knowing the risk posed by bringing the virus home or to work with them.

Howry and fellow Adams PARC Nurse Judi Armstrong both reported putting work clothes directly in the washer and showering at the end of each shift, thoroughly washing their cars and every surface they may have touched in their cars and homes.

It is impacting their families, too.

"It's like I have the black plague. People treat me like a leper. There's parents who won't let their kids hang out with my kids, because they know where I work," Howry said.

Their jobs, of course, have become exponentially more difficult. An already demanding job now includes exposure to high-risk patients, hazmat-esque layers of PPE worn constantly, extended hours to make up for staff members who do get sick and a higher emotional toll.

"We're all very tired," Armstrong said. "Day-in and day-out, everything changes because we're still learning about COVID itself. The struggle of figuring out what tomorrow brings, what changes are going to come, what extra layer of something we'll have to wear."

Even with all the precautions, long-term care facilities have been devastated by COVID-19.

Since March, there have been 104 cases and 20 deaths in Bartlesville Health and Rehab, 23 cases and three deaths in Bartlesville Assisted Living and 101 cases and 14 deaths in Adams PARC — although no cases originated in the latter.

Bartlesville Health and Rehab was hit particularly hard early in the pandemic, when information and PPE was scarce. Patients and staff were scared. Two staff members were put on ventilators with COVID-19 — both recovered and one returned to work. Dout himself caught COVID-19 and had a heart attack in April. The day after the heart attack, he was working from home.

Dout had trouble talking about the "really bad" days and was quick to defend the facility, pointing out it was not the only one with outbreaks.

Throughout the daily struggle that continues, the weight of the early loss weighs on him.

"We lost quite a few staff, because they were scared; burnout is huge right now. And I don't know what to do about that ... It's already a very demanding job, but now you're adding all this to it," Dout said.

Buck, the industry advocate, said facilities should not be judged too harshly on outbreaks, as reliable research has indicated they are highly impacted by community spread, despite the quality of infection control measures.

"This virus does not discriminate against a facility's past history of excellence in infection control in any area. It is a function of community spread," he said. "Even during this period of COVID, Oklahoma long-term care facilities and nursing homes are showing significant improvement relative to the national average in their ability to address these quality indicators."

Several Bartlesville facilities reported that while access to personal protective equipment is not a problem anymore, staffing is a constant concern. Dout said Bartlesville Health and Rehab is doing all right now, but it has increased pay and the need for additional staff means a "constantly running ad."

Some staff members left early in the pandemic to protect family from the risk of COVID-19, which Dout said he understands. But extra precautions and reporting requirements related to the virus, as well time off to quarantine after exposure or contracting COVID-19 means more work for remaining staff.

While in normal times unrelated facilities would be willing to "lend" staff when one was short, that is no longer an option, and staffing agencies are stretched thin.

"I pray every day that everyone's going to show up for work tomorrow. Those guys are working their tailends off. It was already a hard enough job, now we're asking them to put all of this (PPE) on and keep an invisible enemy out that's knocking on the door every day. The numbers keep skyrocketing (locally)," Dout said.

One thing the pandemic has done, however, is brought out the best in the staff who stayed, he said. They have rallied around their jobs and one another.

Hampton said staff members understand the struggle and take care of one another

"I've seen them cry together, I've seen them laugh together, I've seen them smile together, I've seen them so tired," she said.

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