Lori Walsh: Since the first confirmed cases of the novel coronavirus in the US, we've been talking about how COVID-19 could devastate the residents of America's nursing homes and longterm care facilities. Elders are at high risk for death from the disease spread throughout nursing homes proves difficult to contain due to the nature of the contagion. In fact, the nationwide death toll from COVID-19 in US nursing homes and longterm care facilities has now topped 10,000 and South Dakota facilities have not been spared from confirmed cases. Families are separated from their loved ones. Elders are sheltered in place. Care providers are working under extremely difficult circumstances, taking care of people they have come to care deeply about, and yet the news is not all grim. Heroic efforts are underway to prevent outbreaks, contain outbreaks, and save lives. The story is far from over and the ending is not inevitable. Randy Bury is president of the Good Samaritan Society and he joins us again on In The Moment. Randy, welcome back. Thank you for being here.
Randy Bury: Well, thank you very much for having me.
Lori Walsh: I want to start in kind of an unusual place because as people call for us to get back to work and for economies to open, we're hearing these things about, at some point, you need to thin the herd or whatever, and it bothers me because... So, I want to start by asking you why our elders matter? Why is it worth it? Because I think it's easy to forget that in these places where so many lives are gathered, the wisdom and the compassion and the things that are sort of living in these nursing homes, let's start there. Why does it matter in the first place that we go through these efforts to take care of this population?
Randy Bury: Well, and let's just be realistic about it right up front. If it weren't for our elders, none of us would be here. So, first of all, we owe them that. Secondly, you think of the generation that's in the nursing homes. One of our residents just recently celebrated a hundredth birthday and he was a turret gunner in a B-17 bomber. So, you hear stories like that and you remember a lot of these folks too, they're children of the depression. I mean, they were born into difficult times and they have done well and many accounts describe them as the greatest generation. So, if we as a younger generation aren't willing to try to support and protect them, then I don't think it would say much for us.
Lori Walsh: And it's difficult to even say... I had a hard time even articulating the question because it just seems to me such an obvious thing if we have to answer that. But as you do read and hear people talking about things, it's worth repeating, I guess, for those who have forgotten. So, thank you for that. Let's talk a little bit about some of the difficulties and almost the impossibilities at the situation. You joined us before to talk about preparations, having some extra time and some connections with Sanford Health, which is a huge benefit for Good Sam Society as Sanford owns Good Samaritan Society now. But tell me about some of those best practices that we're learning as we move further along in this story about containment and treatment, and how are those best practices really limited with what we can accomplish?
Randy Bury: Sure. This whole event has been described as a war, and I think many of those aspects are true. We're being attacked. I mean, especially the elder population. And so our first thoughts are defense, keeping it out of our facilities, doing everything we can to keep it out of the doors. And so doing things like implementing the visitor restrictions like we did back in March, screening employees for symptoms and temperature, screening the residents multiple times a day for temperature to try to keep it out of the door, but then if you do have it, have a system in place so you can do an early detection of it, masking our employees and those kinds of things, the direct care givers, all of those things we do to try to defend and keep it out of our buildings.
Of course, we're not immune to it, just like many, many other facilities and companies across the US and the globe. And so once you have it in your building and now we do, now we have buildings with positive cases, then it's all about minimizing the impact of it, keeping the residents healthy, trying to isolate the ones that are positive down a dedicated wing, trying to do things like dedicated staff to that wing and that population. I can tell you as of today, and of course it's a snapshot in time, the numbers change. But currently, we've got 64 residents that are positive, would test positive for COVID today.
Now, that's... For a little bit of context, that's spread over 269 facilities in 24 States and about 13,000 to 14,000 senior lives that are under our care. So, percentage-wise, it's not a big part of our population, but we've taken the approach from day one that one case is one too many. And so we constantly try to do everything we can to minimize that number. Interestingly enough, of the 64, 27 of those are here in Sioux Falls have based on the events last weekend at the Sioux Falls village. So, a large percentage of them are right here in Sioux Falls.
Lori Walsh: Yeah. And how many staff have been infected in that Sioux Falls village.
Randy Bury: At the village, I think we're at 21. 21 staff at the village, and there again for context, we've got 42 employees total, with 21 of those being at the Sioux Falls village.
Lori Walsh: All right. So, let's talk, Randy, about- No, go ahead.
Randy Bury: Well, I was just going to say, as I said, one case is one too many, but I can tell you that with few exceptions, the patients or the residents that we've had that have tested positive are doing pretty well clinically. You see the stories on the news at night about multiple large numbers of deaths and those things as a result of the virus in a longterm care facility. We have not seen that. And I... Boy, I don't take that for granted. I mean, we work really hard and our staff is doing... You said in your introduction, heroic efforts that are taking place and that's absolutely correct, but we're so far... So far, we're doing well in terms of the severity of the illness.
Lori Walsh: All right. Let's talk a little bit about what happens once COVID cases are confirmed inside a facility. You mentioned isolation, having a separate area for COVID patients, dedicated staff. Tell me about protective equipment, the PPE. Do the staff have enough, especially in the Sioux Falls village for good Sam. Are there supplies to tend to people and give them the supportive care they need while not having to reuse or go in without PPE?
Randy Bury: Yeah. No, no one is going in without PPE there. As you said, we're fortunate to be part of Sanford Health, their supply chain. There's another kind of behind the scenes heroic group of people, trying to keep supplies because the whole country is dealing with it, and there again you can see multiple stories on a shortage of supplies. I don't think we're ever going to be, at least not in the foreseeable future, comfortable about the amount of PPE. We're not going to be comfortable until we have a big warehouse with months worth of supplies, I think. But I can tell you we're following the CDC recommendations with these COVID patients relative to wearing a mask and a and a face shield. And so yes, I would say we are meeting the requirements, but as I said, I don't think any of us are going to be comfortable until this has kind of passed, but we're holding our own on the PPE side and, yes, people are certainly... Have it available to them.
Lori Walsh: Randy, once there is an outbreak in South Dakota, we have an understanding that there might be more testing of asymptomatic people. Tell us a little bit what happens with testing at the Sioux Falls village or in a nursing home when there might be an outbreak.
Randy Bury: Well, that's what's been kind of interesting about this because as I said, we're in 24 states and the availability of testing varies widely depending what state you're in, where you're at, even within a given state. So, the village is a good example last week where we had a number of positive results back based on symptoms, and we made a decision because we could, because we're part of Sanford Health because the Sanford Health laboratory had testing available. We made a decision we were going to test all employees and all residents. Now, that's a practice that just simply cannot be done at this point in many locations across the country because of the testing, it just isn't available. But we did it because we could, and it was a benefit of being part of Sanford and that's when we saw a significant number of these residents that I mentioned, the 27 were asymptomatic.
I mean, no one knew, including themselves, that they would test positive for this virus. And so I think as testing becomes more available across the country, that's going to be an important tool because we were able to cohort these 27 people because we knew who they were. It was also interesting. I think it's a benefit to the staff for a lot of reasons to be able to test everybody because I think the concern is always... Uncertainty is probably what breeds fear more than anything else. Well, if you have the availability of the testing and you can test all the employees and all the residents, once you have those results back, people take a certain amount of comfort in that, in that, okay, there isn't any unknowns here. We know exactly who's positive. At this moment in time, we know who's positive and who isn't, and we can cohort them down a wing and we don't have to fight uncertainty and the fear that can come with that. So, I was very grateful to Sanford and happy that we could do that, that we could test everybody.
Lori Walsh: Yeah. So, that wasn't an order from the Department of Health. That was something that you did internally through your Sanford connections to say, "This is what we want to do. This is the right thing to do and we're able to do it."
Randy Bury: Correct. That's exactly right.
Lori Walsh: Challenges of moving 27 people around into different areas that had to be sort of a monumental challenge, but one you were ready for because you had planned for it. Tell me a little bit about the logistics.
Randy Bury: Yes. We had asked every one of our locations as part of our planning and our preparation to identify how they would do that, how would you... If you get a positive resident, how do you plan to pull that off? What's your plan and let's talk about it and know it in advance. And so that's very valuable, but I can tell you it's one thing to do it on paper and plan for it. Again, it comes back to those heroic efforts because when you think about a longterm care facility, it's not like a hospital where you're in for an average of four days and then you leave.
In these longterm care settings, that room becomes their home. And so they personalize it. There's things on the wall. I mean, it's where they live, it's their home. And when you talk about like what we had to do last weekend is take significant numbers of residents and kind of play... Upset the apple cart and moving people around in an environment where some of these residents are positive for COVID. I mean, that is a... Just on the surface, it sounds easy and it's a monumental task. And I can't say enough good things about the staff and the work that they did to keep those residents safe.
Lori Walsh: You said clinically, overall, the picture is looking pretty good right now. It's early with this disease. It's full of surprises. But for people who can't see their loved ones and who are thinking, "What happens if my mother has COVID-19," what kind of supportive care are they receiving to give them the best clinical outcomes? What does it look like inside the building?
Randy Bury: You know, that's something, again, we worked really hard at from day one, and it's still... You can never do enough, I don't think, in that area of communication and transparency. Our commitment right away was, first of all, to communicate openly. It's kind of interesting to me as of last week, the CMS decided to make it mandatory that nursing homes should have to tell nursing residents and employees if there's a positive case. Well, that was our plan from day one. And when we did have our first positive resident, the first one within the whole system, we immediately notified all the other residents, we notified all their families and we notified all the staff. I mean, I think open communication is huge. And then also, the second part of communication of course is communication between the residents and their family members because that's disruptive when you go to a no visitor policy.
So, we shipped out... A couple of weeks ago, we shipped out a thousand iPads across our system to try to help facilitate things like FaceTiming with family members and we've had a lot of great stories about success with that. Communities have really stepped up. We've had all kinds of different signs of support from families where they stood outside a facility holding up a sign thanking the workers. I noticed there's some signage out in the lawn over at the Sioux Falls village thanking that staff on behalf of family members. We've had little boys show up in a Superman suit and go around to the windows. In one of our locations, we've had a little girl show up with a pony and walk around the building holding up a sign of support for the residents.
I mean, you name it, we've kind of seen it, and it's just... It's really, I think, been heartwarming to staff and to the residents to see that kind of attention and everybody makes sure we're all sending the message that, hey, you might be isolated physically, but there's still a lot of people thinking about you, concerned about you and here to support you as well.
Lori Walsh: It's going to make me cry there a little bit with little kids in Superman suits and ponies trying-
Randy Bury: They will definitely tug at your heart strings.
Lori Walsh: All right, so one of the things we saw that was problematic early on in the COVID-19 American story was the nursing home near Kirkland where they were struggling to find places to... When it was time to go to the emergency room, it was time to get a hospital care, there was a challenge there. Talk a little bit about what happens if somebody needs care, if a resident needs care outside of Good Sam's facility. Do you transfer to Sanford then? And how is that transfer handled?
Randy Bury: Well, and of course it, it varies widely for us because, yes, we're part of Sanford, but of course, being in the number of states we are, there's a lot of our facilities that are in New Mexico, West Virginia, locations where Sanford doesn't have an acute hospital. But I can tell you I don't think the geography has made any difference there. We've had really good cooperation, I think, in our communities between hospitals and longterm care settings. Now, I will tell you we haven't... Again, it's kind of knock on wood, but we haven't had to hospitalize many. We've got a few, but the vast majority of our residents that have tested positive, including Blaine, Washington, which is just North of Seattle, that's our second highest location in terms of numbers. I think they're at like 17 residents. And we have not experienced that where we've had to send them.
And it's not because we hesitate. I mean, if they clinically deteriorate, we're going to move them and err on the side of getting to the hospital sooner rather than later, but we've been really fortunate there. Now, I can tell you, again, full transparency is kind of how we operate. We have had six company-wide out of our 13,000 lives. We've had six deaths of residents that were also COVID-19 positive. And our thoughts and our prayers are with all of those families and also with the staff that took care of those residents. So, it has occurred. But again, as a percentage basis or company-wide, we've been pretty fortunate to not see that high severity clinically that we see in some other facilities.
Lori Walsh: Randy, I know this is speculation, so I don't want to ask you to speculate, but I do want to get at this idea of there's more than luck at play here. As you look around and you sort of see what different facilities, the kinds of decisions they're making, what are some of the reasons that you believe now can help keep those numbers as low as possible? I guess, that's a question without speculation. What are some of the key things that you say, look, nobody's sure about anything in this story and the facts keep changing, but based on what we know today at 11:40 on Tuesday or Thursday, April 23rd, is the best way to keep those numbers down organization-wide.
Randy Bury: Yeah, I think it comes back to our staff and that just relentless pursuit of things like isolating residents, paying attention to PPE, using the PPE that's available, all the things you... Wash your hands, all of those, the infection control. I don't think infection control, it's ever been more critical and important than it is right now. And so we just continually are stressing the importance of those things in many ways kind of the back to basics. I think if you just work extremely hard and, like I said, just relentless pursuit of good practice, I think... And our staff adhering to that, I really believe that's the biggest part of the story for us is that we've had some really good practice observed.
Lori Walsh: Now is not the time to loosen those practices in any way.
Randy Bury: No. They talk about states opening or soft openings and those things. I think longterm care will be the last area... You'll know that we are coming beyond and getting out of this issue when you see nursing homes release the visitor restriction. I think that's one of the clear indicators of a belief that we're kind of getting beyond this because I think that's one of the very last things that's going to happen, again, in the interest of trying to protect that population.
Lori Walsh: This is also a population where there are end of life issues that are non-COVID related. How are you handling some of those end of life conversations with family and loved ones when someone is not infected?
Randy Bury: That's the toughest situation, I think, to put staff and family and the resident in because... Now, end of life is one of the exceptions, but there again, I mean, it's not a case where there's 15 family members standing in the room. I mean, it's very, very restricted even in end of life in trying to keep the other residents in that facility protected. And so, yeah, that's the heartbreaker. I mean, it's a heartbreaking scenario and it just relies heavily there again on the staff and their relationships with those families aiding the best we can with things like FaceTiming and those kinds of tools. But it is, those are some very, very difficult situations, and I feel bad for everyone involved in those, the staff and those families and the resident because it's... That is not easy.
Lori Walsh: Randy Bury with Good Samaritan Society, you are always so available and open and transparent and we just appreciate this time. It can be a rarity to allow someone this much time and to just ask you anything. So, I thank you for that. We really appreciate that and the work that your staff members are doing in this really difficult time. Thank you for being here today.
Randy Bury: Thank you. Anytime.