Updated: Apr 19, 2020
There I stood, watching a mother and daughter divided by a thick piece of plexiglass and a brick wall covered in paper. The daughter, standing next to me wearing a surgical mask and rubber gloves and her mother, on the other side of this barrier, also wearing a mask, accompanied by a staff member wearing a disposable gown, a face shield, and gloves, left me contemplating the current health and economic conditions in America.
I kept thinking about the paradoxical passage from one of literature's greatest masterpieces: “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
This is the opening paragraph from the great Charles Dicken’s novel, A Tale of Two Cities. In this work, he was providing his thoughts on the disruptive state of affairs in 18th Century England and the country across the Channel, France, where economic and political unrest led to the American and French revolutions. And in many ways, this is the worst of times (at least for modern America) but may also prove to be one of the best of times. More on that later, now back to the current situation.
We were there to conduct business, to get a signature on a document. We placed the document on a piece of paper and it was slid in behind the large plastic shield. The mother and daughter who had not seen each other in weeks stared through the glass with pained expressions on their faces and tears welling up in their eyes as the signature was obtained. The document was then placed on a clean piece of paper and slid back to us under the plexiglass. And then it was over.
It was all very businesslike, very pleasant and very, very antiseptic. As we turned to leave, I could see the mother in the window, looking at the daughter and waving goodbye, fighting back tears. Her daughter stopped, mouthed the words, “I Love You” to her, and motioned that she would call her when she returned home. Until that time, I didn’t realize just how this brief interaction was so meaningful to this family and would be to millions of others who are in similar situations as a result of this current pandemic.
As we walked away, her daughter turned to me and said, “How do I know if they are treating her right? Being away from her and the way they are acting is making me very angry. I have a right to see my mother! I hope that place is clean!” Her anger was palpable and, she is not alone with those feelings.
We get the calls on a regular basis, from families with parents or relatives who are in nursing homes and hospitals. They hear the news reports about deaths in these facilities around the country and specifically in Rhode Island, Connecticut, and Massachusetts. The numbers have been reported matter-of-factly, almost replacing the scores of sporting events that have been canceled. As the toll adds up, the talking heads on TV continue counting, not considering the feelings of those at home who sit and wonder if their loved one is next or the work of the healthcare heroes who are working tirelessly to keep anyone else from becoming a statistic.
We hear the heartbreak of the families – “my mom was already sick, what if something happens and I can’t be there with her for her last moments?” “My father is in hospice because of cancer, I can’t see him, he can’t see his grandchildren, how do we know he is being cared for with all this?” "Are they keeping these places clean?"
Understandably, the families are concerned. As the Centers for Disease Control states consistently, those living in nursing homes are there because they are sick, frail from aging, suffering from dementia, cancer, and other illnesses, making them especially vulnerable to the coronavirus. They are in close quarters, sharing rooms and bathrooms, and come in contact with many caregivers on a daily basis. They need to be protected and the measures being taken are designed to do just that, as painful as it may be to those with loved ones living there.
This virus has changed our lives. It is almost the opposite of what we feel we need to do. At a time when we should be even more connected, we are forced to isolate. From family members to friends, we are told to social distance. All healthcare facilities have visitor restrictions, and we are not only worried about the virus but other effects of the restrictions.
We know that social isolation can lead to depression and anxiety, not only in the elderly but in their family member as well. Yet, we need to put our faith in those caring for them. And from everything we see, they are in very, very good hands.
“People go to nursing homes for a reason,” said Attorney RJ Connelly. “As much as we want to keep them home with us for their final days, there are medical needs that most of us just can’t handle. When the decision is made to place their care in the hands of another, we do so with the expectation that they will provide the same amount of love and compassion that we do. And being an elder law attorney who frequents these facilities on a regular basis, I can assure you that the overwhelming number of those working in these homes provide as much or even more care than perhaps many of us could in our own homes. I think this is evidenced by those who continue to go to work every day during one of the most stressful and emotional periods in my memory. ”
And what about cleanliness? Staff may very well be dedicated but are the necessary precautions being taken to address infection control? Once again, the answer is a resounding yes!
A director we spoke with told us of the checklist in place that is provided by the Centers for Disease Control and, as the checklist changes, they immediately put them into practice. “We follow the COVID-19 preparedness checklist for nursing homes that has been released by the CDC,” said the director of the home. “In addition, we have developed a comprehensive response plan if this virus somehow makes it in to our location.” The checklist he spoke of requires the facility to assess and develop:
Rapid identification and management of ill residents.
Protocols for visitors and other people coming into the facility.
Supplies and resources.
Occupational health considerations including sick leave.
Training and education for staff.
Surge capacity for staffing, supplies, and equipment.
“We have also taken a pro-active approach to this virus above and beyond the initial CDC recommendations,” he continued. “We’re not waiting for a resident or a staff member to present with symptoms of the coronavirus, we began instituting an active screening process for all concerned weeks ago. Because of this, we think we are staying ahead of the curve.”
For Attorney Connelly, he has seen the operations of senior care facilities throughout Rhode Island, Connecticut, and Massachusetts and is impressed with what is in place. “The people who work there and those in administration are amazing people,” said Connelly. “Because of this virus, we are becoming aware of the sanitation issues needed to control these bugs, but I can tell you that every facility that I deal with, their infection control procedures are up and running 24/7 to deal with the seasonal flu, a norovirus or any other communicable disease, something that we would struggle to do in our own homes. And their staff are always trained in the latest disease control protocols.”
A director at a low-income senior housing program that has several locations throughout Rhode Island echoed similar thoughts, “Although most of our residents may not be in need of supportive medical care, the majority of them have underlying health conditions like heart disease, diabetes or may even be cancer survivors. Weeks ago, even before the Governor instituted her policies, we were adamant about our staff self-checking before coming into our locations. If they felt ill, they were told to stay at home. We took a hard line with that."
A supervisor at an assisted living residence in Connecticut stated that she began taking steps in late February to increase the awareness of protection against the virus when she began to see the guidance in other countries regarding COVID-19. “There were two things I was concerned with, first, we did have a small outbreak of residents with the seasonal flu, and secondly, what COVID-19 was doing on the west coast. To account for both, we began limiting crowds by staggering mealtimes and being much more conscious of how we served our meals, such as keeping utensils covered and tables wiped cleaned with a bleach solution. I believe this helped us tremendously.”
“I spoke with a friend of mine who is an administrator for several healthcare facilities for seniors and was astonished at the health logistics behind the operations of these buildings,” said Connelly. “Even before this pandemic, he and his staff needed to have a keen knowledge of disinfectants that control multiple viral and bacterial infections, as well as always maintaining an available and adequate supply of alcohol-based hand sanitizer, mild but effective soaps for handwashing, and paper towels. These are things we don’t always think about when it comes to the daily operations of senior care facilities.”
And when it comes to routine caregiving in a nursing home, this involves more than just throwing on a mask or pulling up some gloves. At a facility located on the south coast of Massachusetts, the staff are routinely trained on the use of protective equipment. One of the nursing directors told us, “We train our staff from the minute they walk into the door how to use the equipment correctly. This includes proper use of facemasks, gowns, eye protection such as face shields or goggles, and disposable gloves.”
“And,” she said, “We tell our residents not to take it personal when we suit up with this equipment. In reality, we are doing this to protect them from what we walk in with and not because we are afraid of them. Seniors in our care don't have the same robust immune system that our younger staff does. Our procedures are designed to protect all concerned.”
But, what about COVID-19, isn't this a "new virus"?
“Again, we added a bit more to the protocol, like respirator masks, which include a filter to prevent wearers from breathing in small air particles, that fitted correctly over the mouth and nose, provide more protection for staff and residents who may be presenting with symptoms of this novel coronavirus, but other than that, our infection control processes remain the same. The safety of our residents and the staff are always paramount.”
So as frustrated as we are with not being able to see loved ones, remember, those working in and running nursing homes are under the same orders as we are. Further, they are responsible for scores of lives, both patients and employees.
“Nursing home employees are the unsung heroes of this COVID crisis,” said Connelly. “The work is more difficult than it’s ever been and yet, they are doing it with compassion and great spirit.”
Finally, although we tend to focus on front-line medical personnel, there is an entire team at work in healthcare facilities. This includes CNAs, housekeepers, cleaning staff, unit clerks, security personnel, medical office assistants, office/switchboard operators, clinic managers, laundry workers, plant service/maintenance workers, food service workers, physiotherapists, social workers, respiratory techs, lab techs, occupational therapists, dieticians, drivers, ambulance staff, divisions and shared care staff, medical imaging techs, pharmacists, pharmacy techs, auxiliary volunteers, payroll clerks, medical record keepers, administration staff, and transcriptionist. We apologize if we missed anyone - but you get the point.
When this pandemic ends, and it will, let’s always remember the sacrifice our healthcare workers have made to keep our loved ones as safe as possible during the worst of times. And it is this group who will also be responsible for making it one of the best of times.
We would like to remind everyone that Connelly Law Offices, Ltd. remains open to provide all of our services during this difficult time. We practice all required sanitization of our offices as directed by the CDC including social distancing and face protection. All appointments are conducted by phone but face to face transactions can occur in emergency situations.
Call us today at 401-724-9400