This conversation originally aired on March 12, 2020. You can listen to it in its entirety here:
Lori Walsh: Welcome back to In The Moment. I'm Lori Walsh. Nursing homes and longterm care facilities across the state are taking preventative measures to protect residents from infection with coronavirus, influenza, and other viral diseases. Randy Bury is president of Good Samaritan Society and he's joining us on the phone now with insight. Randy Bury, thanks for being here. Appreciate your time.
Randy Bury: You're welcome. Thanks for having me.
Lori Walsh: Tell us a little bit about Good Samaritan Society first and the scope of services that you provide in South Dakota. Let's start there, please.
Randy Bury: Sure. Well, just over a year ago now, Good Samaritan actually merged with Sanford Health, so we're a totally owned division of Sanford Health. But the society as a standalone company, the Good Samaritan Society operates in 24 states, has about 270 facilities with about 7,000 people in our skilled nursing, and about 2,000 in assisted living. So, it's a large, national, long term care company with several facilities in South Dakota.
Lori Walsh: Where are those facilities located, all across the state?
Randy Bury: Across the state, yes. Three in Sioux Falls that maybe a lot of folks are familiar with. Three skilled facilities in Sioux Falls, and then several others scattered across the state, all the way out to Rapid City where we have a pretty significant operation.
Lori Walsh: All right, let's talk about a pandemic. And this is not something that you're not starting from scratch from in a nursing home. Tell us how this preparation is sort of consistent with the things that you already do, and then let's talk about how it's a little bit different. So, tell us a little bit about how every influenza season, just day to day operations you worry about things like infectious diseases.
Randy Bury: The prevention of COVID-19, what you do to prevent it in that regard, it's very similar to the flu and you do the same. You wash your hands, you stay home if you're sick, you try to distance yourself, what they refer to as social distancing. So the prevention side is similar. What is so very, very different is the impact of the virus. I mean, there's no vaccine, so nobody is out there carrying an immunity to it so it spreads rapidly. And then especially among the elder population, just the deadliness of this disease. We believe it's running about 20% in a fatality rate in the elder population. So, with no vaccine and no real treatment for it, that's what makes this so particularly dangerous and scary for longterm care.
Lori Walsh: How do you prepare then? Where do you begin and what kinds of measures are important to be taking right now? We have cases in South Dakota, but we don't have as many as other states do. So, we've had seven weeks, I think to really prepare. What are those preparations looking like?
Randy Bury: In preparation, I compare it almost to a professional athlete, that even though they're a professional, they keep practicing the basic skills. It's kind of like that for us. In preparation, it's just making absolutely sure you're following all the regular infection control practices and policies, and emphasizing, reemphasizing. But then with this particular issue, because of the reasons I mentioned earlier, we're stocking up, making sure that we've got adequate supplies of things like infection control supplies and equipment. We're fortunate there that we're part of Sanford Health so we've got a little deeper supply chain there to rely on. And then a couple of days ago we took the action at the recommendation of our national professional organization, OCHA, and we have now restricted visitors. The VA has taken a similar action in their longterm care facilities across the country where we are prohibiting visitors. It is a visitor ban. I mean, make no mistake. Yet, at the same time we also know that there will be unique circumstances.
It might be an end of life type scenario or some unique situation that you can't even anticipate where we would allow somebody in our building to go see their loved one. But we're really approaching it more from a ban, because that is the only way to protect people is to keep them as isolated as we can and protected from this virus. And frankly it's the quickest way for us to get over this as a country, as a nation, is to practice all of these things and social distancing. And of course, even in the last 24 hours you've seen a lot of change there with it. NBA suspending games, and now this morning closing the Capitol grounds in D.C. to visitors. And so, those sounds like drastic measures, and I guess compared to where we were a couple of months ago, they are drastic. But it's the only thing. It's the only thing that is going to try to what they describe as flattening the curve and mitigating now the virus. We're way past preventing it from getting into the country. Now we're just trying to deal with it.
Lori Walsh: Are there test kits available? Is it the same as for the rest of us, where in a nursing home if somebody is experiencing some kind of symptoms you go through the South Dakota Department of Health? What is that process if a resident is demonstrating some kind of symptoms or we know that they've been exposed to someone else with the virus?
Randy Bury: That's exactly right. And we're really fortunate in the state of South Dakota, because the relationship between providers in this state and the Department of Health, I mean basically if you've lived in this state any amount of time, we all know each other personally. I mean, so if you rely on those relationships, you rely on close communication, and we absolutely coordinate with the Department of Health and we certainly would. Now we're very lucky. It's kind of a knock on wood. I mean, we have not had, and at this moment we know of no positive cases in any of our facilities, and that's across the nation. But I think we'd be naive if we weren't preparing and anticipating the day when that will change, and we will identify a positive COVID-19 resident in one of our facilities. But you're exactly correct, we will definitely work closely with the Department of Health.
Lori Walsh: You mentioned a ban on visitors, but many of these people are assisted living or they're allowed to leave and come back. Sometimes in a group activity or sometimes just they have their own cars and they can go somewhere. Is there any kind of ban on leaving or requests for people to stay put?
Randy Bury: No, and I'm really glad you brought that up because that's an important distinction and I kind of fall into the trap sometimes. I talk about visitation bans and things like it's everywhere. The visitor restriction is specific to our skilled nursing, or what most people refer to just as your traditional nursing home. For assisted living that is not in place, visitor restrictions. Now, because as you said, these folks are fairly independent and it's more of a residence for them. But, we are giving them the same guidance and we are very much discouraging visitation and trying to limit it, try to give people the facts and kind of having a self enforcement. Because again, if you wanted to take the most conservative approach, I will tell you if I had a parent in assisted living today, because just by definition that typically means it's a more elderly individual that perhaps has some medical condition, if I had a family member in assisted living, I would not want them out traveling in the community and I would not want them receiving visitors that weren't a really essential part of their daily life. Because it's just, again, it goes back to trying to limit the spread of this virus.
Lori Walsh: What does quarantine look like in a nursing home? Is that something that you're sort of already set up to do or would people have to move to different rooms in the facility? How are you prepared for that?
Randy Bury: It's when we say no visitors and those things. Life within the building doesn't change a whole lot. I mean, they're all in their same room and their same group of residents, usually those become communities, they all know each other, they're friends.
Lori Walsh: I meant if you had somebody who has symptoms and they needed to wait for a test result, for example, what would happen then?
Randy Bury: That's a very specific policy. If somebody tested positive, if they became ill to a point where they needed further care, obviously we take them to a hospital. What they're encouraging us, which I think is good policy, is that if they test positive but they're not exhibiting symptoms that require any kind of hospitalization, they're asking us to treat them in place. Which is a good idea, because if we don't do that and we just simply start shipping everybody as a hospital that's positive, we're going to overrun the hospitals in all likelihood. So we've got very specific protocols around, we would move them to a private room, we would keep the door shut, we would limit the number of caregivers going in and out of that room, we would practice basically isolation type procedures with that resident. And so yes, what you're describing is basically almost like a quarantine within the facility.
Lori Walsh: Right. And staff have already been trained for that. They have the personal protective gear. How do you protect your staff members?
Randy Bury: Well that's a concern. I mean, today, sitting here today, I can tell you we've got adequate supplies and equipment. The concern of course is that if the entire country starts having positive cases that need either hospitalization or taking care of them in place in facilities, that that's going to get difficult to do. Now, I can tell you, just a week ago yesterday I was invited with a small group from longterm care to meet with Vice President Pence and he wanted to know what our concerns were. One of the high concerns we lifted up was the exact question you just asked. I don't think we'll have a countrywide so much a shortage of equipment and supplies, but it'll be a location shortage.
If a location has today suddenly identified two or three residents that were positive and went to an enhanced infection control level, they will go through their supplies a lot more rapidly than they normally do. And in that case we're going to need to have a supply chain that can keep them supplied. And if that starts happening around the country, the Federal Government may need to step in through executive orders and start mandating where some supplies are going to be taken to get them to the area of need. The vice president was very open to that concept, he understood the concern. And so there again, we're trying to be proactive, I think in our approach to this.
Lori Walsh: Have you ever had anything like this before that you can harken it to? And have we learned anything from how this coronavirus and COVID-19 is playing out in China, or South Korea, or Italy? Are we looking to other nations or to our own history for lessons learned?
Randy Bury: Well, I think our own history is a guide. I've been in the business long enough where I've been through the H1N1 virus, the Ebola situation a few years ago, and in some ways this feels similar to that and we're using a lot of the lessons learned in terms of setting up incident command and communication structures real quick and early to make sure we're all connected as a system. So those lessons learned I think are good ones that we're benefiting from. But this feels different. We're a little bit in unchartered ground here too when you just look at the magnitude of it from a global perspective. And the things that, as you mentioned, when an entire country of Italy is basically quarantined, and travel is banned from Europe, and the stock market is closed, the capital is closed to tourists, the NBA suspense, on and on and on, this does feel different in terms of size and scope than what we've experienced before.
Lori Walsh: I was reading a story about what's happening in Italy the other day and the choices that they're having to make about who to treat because of lack of equipment and lack of services. We want to believe that that cannot happen here, that America is more prepared and more organized in that. But it's hard to get our minds around whether or not any system could be overrun. How do you help people walk that line between preparing, having a sense of urgency, taking it really seriously, taking this social distancing seriously, even though it's so disruptive to our daily way of being in the world, but also not to panic and really go to a worst ... Because that can cause anxiety for elderly people, for people who love their elders in nursing homes. It really can keep you up at night as well. So where do you sort of split that hair for people?
Randy Bury: That's exactly the balancing act that we walk, because on the one hand you don't want to incite panic or make it sound like this is the end of civilization. Because the other reality here, and the infectious disease people will all tell you this, I mean, just like we're seeing in China, this is going to peak in the U.S. It's going to peak, and then it's going to start going down and we'll manage our way through this. I mean, it's not going to go on, and on, and on and on. That's not how these viruses work. So, but right now you also have to communicate and be very serious about social distancing and some of these things, because what they talk about in the infectious disease world is, flattening that peak, flattening the curve so that we don't spike way up there like Italy did. So that by taking the actions that we're doing today in banning visitors and not having the NCAA tournament, we're trying to flatten the curve so that we don't overrun our health system, so that we do as much as possible limit the number of positive cases and the number of deaths so that we don't overrun the system. And quite honestly, this is an issue that one day makes a big impact. So I mean, the quicker, the faster this next few days, the next week, the actions we take now will determine how long this runs its course.
Lori Walsh: Talk a little bit before I let you go about when you're in a nursing home or assisted living, in a skilled nursing facility or assisted living, and there is a disruption to the way daily things are done, things are canceled, your family can't come see you, you're worried about things, what's the role of an activities director or a chaplain, or how do you sort of help people deal with the emotional turmoil that can lay on top of other ongoing health problems and concerns about end of life issues? Who are those people who are kind of doing that sort of unsung work right now in [inaudible 00:15:39] facilities?
Randy Bury: Well, I think you've hit it on a real important part. I sit in a corporate office, and I do interviews and I go to meetings, but it's clearly the staff that are on the frontline of this issue, and they're the ones that are bearing the brunt of the virus and they're the ones talking to family members, comforting each other, comforting the families, comforting the residents. And we just had a discussion with this at our incident command meeting in the last couple of hours, and we brought in Pastor Greg Wilcox, who's the head of our mission integration team here for Good Samaritan, and I feel very fortunate because Good Samaritans had a long history of a faith based background. And so we have embedded in our facilities easy access to a chaplain if that's what you need or to those kinds of resources for the exact reason that you talked about.
I mean, it's going to be so stressful on a variety of people involved, again, as you mentioned, that it's the staff, but it's the families, it's the residents. And the more we can have people in place to provide comfort, give assurance, let people know we're doing all that we can ... We talked in our last meeting about we focus on operations and tackling all these operational issues, and so many of us in our backgrounds, we come from such operational backgrounds and sometimes we lose sight of that. And Pastor Wilcox is going to sit in on every one of our daily incident command meetings now going forward just to bring that perspective and make sure we don't lose sight of it.
Lori Walsh: When you talk about that operational frame of mind, you've been through a lot in your career. Can you think back to a time when you really had to go through a crisis, preferably here in South Dakota, that people worked together and it was not easy, but good decisions were made and we all kind of hung in there and did the right thing? You must have seen multiple throughout your career.
Randy Bury: Well, I'm going to date myself. But I mean, I do remember events like the Spencer tornado. I mean, I remember getting the phone call. I was a chief operating officer of the Sioux Falls Medical Center at the time, and rallies around that. The flooding years ago out in Chamberlain and Pierre. I mean, I'll even go back as far as the plane accident that killed the Governor Mickelson and some colleagues. I mean, those are traumatic events where you kind of feel the foundation move a little. But I think South Dakota is a state where people do know each other, we have great relationships. They rally together and you just work your way through it.
Lori Walsh: Randy Bury is president of Good Samaritans Society. Thank you so much for being here with us today, Randy. We appreciate your time.
Randy Bury: Sure. Thank you.