Walking the tightrope
Thompson House in Brattleboro.

Walking the tightrope

County’s long-term care facilities are — so far — free of COVID-19 infections, but staff are taking no chances

During pandemic times, we hear the words “fragile” and “vulnerable” most often when talking about our elders. Can you imagine if keeping a group of them safe from the coronavirus was your own responsibility?

That kind of burden is almost unimaginable to me. But I don't have to try. While reporting on a story about Windham County's response to the virus for a state-wide publication, I had the opportunity to talk to the heads of several elder care institutions here.

Their voices, even over the phone, echoed with concern, fear, determination, and the awareness of the precariousness of their situation. They sounded like people holding their breaths while walking on eggshells.

It took my breath away. It broke my heart.

The numbers are sobering. Statistically, when the coronavirus gets into a nursing home, one-third of the residents die. And according to The Guardian, as many as 1.5 million seniors across the United States live in such facilities.

“More than 28,000 of those seniors and their caregivers have died from coronavirus,” The Guardian said in a story published May 14. “Combined with nursing home workers, they make up 35 percent of all COVID-19 deaths in the U.S. Beyond other determinants - region, age, frailty, underlying conditions - one factor could have the greatest impact on elders' mortality: their caretakers' ability to effectively do their jobs.”

Vermont has done remarkably well in protecting its citizens, but when we look at the states around us, it is clear how close to disaster we have skated.

“We've dealt with hurricanes and fires, and that's what our disaster planning has been for,” said Mark Malloy R.N., the director of nursing services at Brattleboro's Thompson House Rehabilitation and Nursing Center. “This is all new territory, with a disaster that affects everyone in the state.”

For its size, Windham County has had a proportionally high infection rate - the third-highest in the state, with 76 people testing positive for COVID-19 as of this writing. We have suffered three deaths. But not one elder in an independent or assisted-living facility has tested positive.

This fact is a testament to the love, care, and concern of the people involved in caring for this most precious population.

* * *

“We know more than anybody how vulnerable we would be if we got this virus in the door,” said Susanne Shapiro, the executive director of Valley Cares in Townshend. “Our oldest resident is 108. We, as staff of long-term-care facilities, need to be more mindful than everyone else.”

Valley Cares, a small, independent nonprofit, has 42 residents in assisted living and another group living independently in 25 apartments. It is closely aligned with nearby Grace Cottage Hospital. “We feel we are sort of an extension, in that if we have an outbreak here it would adversely affect the hospital,” Shapiro said. “So we are glad to have good working relationships.”

“I don't think I can afford to feel very secure,” she continues. “It is a real threat, and it is a current threat. And, as society opens up more, we will be even more at risk.”

As of this writing, Valley Cares has tested a number of staff and residents and found no positive results for the virus.

Being around the residents is not the risk, Shapiro emphasized. The risk comes from the residents being around the staff.

“It is us, who come every day from our life, who in general pose a risk,” Shapiro said. “On March 11, we went into lockdown. Just a few days later, we were directed by the Health Department that no one could come visit, except for family with members receiving end-of-life care.”

“A lot of our success hinges on how we as individual staff members conduct ourselves, wear masks, wash our hands, and distance ourselves,” she said. “A lot of my time is spent helping staff understand how important this is.”

Most nursing home administrators are in constant contact with the Vermont Department of Health, the federal Centers for Disease Control and Prevention, and the Federal Emergency Management Agency.

“Our policies and procedures have to reflect the latest data, and things change from day to day,” Shapiro said. “We're very fortunate that, as a small state, we are in close contact with the people who help guide us.”

In Vermont, “It's personal,” she said. “I can get answers to my questions within a business day and, sometimes, within a moment, which is extremely helpful.”

The most meticulous precautions have to be taken.

“Staff must screen themselves with a questionnaire that the Health Department and the CDC have developed,” Shapiro said. The questionnaire confronts risks for COVID-19 by asking questions like: Have you traveled? Have you been exposed to anyone who might have the disease? Have you had symptoms? Have you checked your temperature at the door?

Resident temperatures are checked twice daily. Railings, doorknobs, and light switches are sanitized three times a day. There is no communal dining, and Shapiro described the dining room as “a gaping hole.”

“Residents can visit each other in a common area,” she said. “We discourage visiting in apartments, even with distancing and masks.”

With some patients, this new reality can be tricky to explain.

“Some of our residents have dementia,” Shapiro explained. “Their routines have been changed. Now there are no group activities [like exercising]. We have to make sure all of our residents take walks in the hallways, and, now that the weather is better, outside. We have to find other ways to mobilize people and keep them agile.”

Without visits from family and friends, the loneliness of the residents is palpable.

“For two months now, our residents have not been able to visit with their family members.” Shapiro said. “A lot of our work is now geared to the effects of isolation. There's depression for some, the anxiety from losing all your routines.”

Yet the residents inspire Shapiro.

“Our residents are in their 80s and 90s,” she said. “They have lived long lives and experienced several world crises: the Spanish flu, two world wars, polio. It makes them very resilient, which makes them amazing. They watch TV, and they know the risk they're in.”

“I find it really amazing to be able to work with people who have that kind of life wisdom,” Shapiro said.

* * *

In the Brattleboro area, Brattleboro Memorial Hospital, Thompson House, Pine Heights, Garden Path Elder Living (Bradley House and Holton Home), and Vernon Homes (Vernon Green Nursing Home and Vernon Hall) are all coordinating with one another and with the Department of Public Safety's Vermont Emergency Management team. Group calls happen twice a week.

Thompson House, for example, has 39 people in rehabilitation and nursing beds, and 12 people in residential care.

“We've gone further than the precautions,” said Dane A. Rank, Thompson House's administrator. “Our strategy has been to not just track employees who have symptoms of the virus. By that point, the virus would be in here and a third of our residents could be catastrophically ill.”

Instead, “We are asking employees to report on themselves and close family members,” Rank explained.

“If anyone has any of the symptoms - including headaches and nausea - we receive them in a clean room, keep them from entering the rest of the building, and send them home while we test them. In several cases, we have paid for the testing of a family member or friend.”

They are taking no chances. Three people were put on sick leave because either a family member had symptoms or because a child of a family member was in a day care with another child who had symptoms.

So far, only one member of the staff has tested positive. That person was sent home to quarantine for two weeks, and then retested. When the test came back positive again, that person was again sent home. It will take two more negative tests before that person will be allowed back to work.

In addition, Thompson House is rotating its staff, sending people home to isolate in two-week increments.

“So, if the virus does hit, we will have well employees for reinforcement,” Rank said.

Again, the loneliness of separation is profound for his staff as well as for the residents, Rank said.

“I have a nurse here who hasn't seen her grandchild in two months,” he said. “We're asking our staff to go from work to home to work again and to self-quarantine whenever possible.”

“The personal sacrifices all the staff are making on a daily basis is to be commended,” Rank observed.

“I can't express what an emotional toll this is taking on everyone,” he continued. “We used to have visits from community entertainers on almost a daily basis, and now they're not able to be in the facility. What entertainment we have comes from the staff. We're doing our best to keep people's spirits up.”

Residents now have to visit with the outside world via videoconferencing applications like Apple's FaceTime. The entertainment that's available now takes place outside.

Rank said the Retreat Farm was going to bring a few goats around for the residents to watch through the windows. Goats!

“Once, some neighborhood kids came out and did some dancing on the patio,” he said. “The residents were in hysterics. The community support has been overwhelming.”

* * *

In the beginning of the pandemic, hospitals were hot spots. Now, attention is turning to long-term-care facilities, and not a moment too soon.

“Now that it appears we are not experiencing a surge in the hospitals, this might be the time to focus our attention on the elderly, on the people who will comprise half of those who die from the virus,” said Rank, who is worried about the next chapters of COVID-19.

“As we start to reopen, when people start to relax, we're afraid the surge could happen,” he said, concerned that with their guard down, “people will feel that freedom and they might not carry through everything they've learned” about social distancing and hygiene.

“The surge is still possible and it will affect long-term care in a very negative way,” he said.

Both Shapiro and Rank said their staff were heroes doing heroic work.

Shapiro said she was proud of her staff.

“I feel very proud to say our team here at Valley Cares is superb,” Shapiro said. “We know each other well, we work well together, and we get the job done.”

Rank echoed that sentiment as he offered some contemplative words about where we go from here.

“If and when it gets worse, there's going to be a lot of soul searching about life choices and career choices,” he added.

“No one is going to escape without trauma. We're worried in Vermont about the number of caregivers available,” Rank said. “We need to support them, especially in times like these.”

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