Lori Walsh: The federal government has called for testing of longterm care and skilled nursing home residents and staff. Longterm care facilities have faced difficult challenges mitigating the virus. Data now suggests at least 20% of the U.S. COVID-19 death toll is from nursing home-related infections.
Dr. Joseph Reese is a geriatrician and the Avera eCARE Senior Care Medical Officer. He's joining us today to talk about what testing means for Avera facilities and how the process is set to unfold. Dr. Reese, thank you for being here. We appreciate your time.
Dr. Joseph Reese: Thank you for having me.
Lori Walsh: We're going to get at how something this large scale gets rolled out, but first, let's talk about why it's necessary. What is the big picture here and how does testing fit into that big picture?
Dr. Joseph Reese: Well, what we're finding with COVID-19 is that some patients do not have symptoms of illness, and so that makes it a little bit difficult to slow the spread of the virus when you have asymptomatic carriers. Our most vulnerable population, as you mentioned, 20% mortality in nursing home patients, is hard to avoid them coming into contact. The thought behind the testing is trying to help find those positive cases and try to have them not come in and bring and expose the nursing home patients to the virus when they may not even know that they have the illness. It's not on their fault that they don't understand that they are sick, but they don't have any symptoms and are still carrying that virus around and potentially could spread it to our nursing home population.
Lori Walsh: Yeah. As many times as we hear that message, people still have a hard time remembering it. You can hear how many times a friend says, "Yeah, I'm pretty sure I don't have it," and you always have to say, "Well, that's the whole point. If we knew we had it this would have been a lot easier to fight off." So it's not as if there's no testing in nursing-
Dr. Joseph Reese: Yeah, we would be easier to stop the spread that way. Sorry, go ahead.
Lori Walsh: There's already been testing in facilities of course, but this is a broader scale. What changes, how is this expansive testing going to increase the picture of what we know?
Dr. Joseph Reese: Well, we are anticipating testing most of the residents and most of the staff that work at the nursing homes, and that will give us a little bit of a snapshot into seeing how many asymptomatic residents and staff members we have and then trying to help mitigate that further spread as we talked about. I think that's what we're going to be seeing from this picture, is maybe give us a little bit of an idea on how many asymptomatic staff and/or residents there are currently in our population.
Lori Walsh: How many facilities are we talking about for Avera? How large scale is this?
Dr. Joseph Reese: This will be all the South Dakota facilities. I don't remember exactly how many we have off the top of my head, but it's going to be over 15 facilities.
Lori Walsh: Okay. What's the process? Do they do that testing themselves? Does someone come in and do the testing? How long will it be before they get some kind of results?
Dr. Joseph Reese: The process will be somebody coming to the facility to assist with that testing. At some of the larger facilities, that staff may be right there on site and be doing that testing themselves. But the results will take about 72 hours, maybe a little bit longer than that to come back. The testing is a little bit slower than the standard testing as these are not somebody that has symptoms, so they are being run a little bit differently than the more symptomatic patients, the higher urgency patients.
Lori Walsh: Sure. What happens then if somebody tests positive? Let's start with residents. How is it handled if a resident tests positive? Especially because it's very likely that person might be asymptomatic or not having symptoms show up yet.
Dr. Joseph Reese: Most of the facilities, or the Avera facilities, have been creating a process currently to try to help mitigate that spread. The staff have been wearing masks and face shields and those types of things to help try to lessen the amount of spread in case somebody does test positive, let's say, during this all system-wide testing. At that point, then they would put further protections in place. That individual may be moved into a separate area in the facility that are specifically designated for positive residents. That allows us to keep them isolated from negative residents. That also allows us to conserve some of our personal protective equipment because we'll have that area designated and only patients that need that extra personal protective equipment will be in that area, as opposed to sometimes if you keep them on the general floor that makes us use a little bit extra personal protective equipment. That is the thought process behind a positive patient or resident.
Now, if we have a lot of positive residents on one wing, that may change our philosophy, depending upon the building's characteristics, but for the most part they'll be cohorted with other positive residents, trying to distance them from those that are negative.
Lori Walsh: Yeah. Staff members, if they test positive, what are the next steps there?
Dr. Joseph Reese: The staff members will be asked to stay home and they will be asked to stay home for 10 days from the positive test, as long as they remain asymptomatic. If they develop symptoms during that time, it may be a little bit longer depending upon how long they have symptoms. If they remain asymptomatic 10 days, they'll be home.
Lori Walsh: Are you able to, if you have an isolation area, ensure that staff members who work in that area are not going to other areas? I mean, how hard is it to isolate inside a nursing home from an isolated wing or an isolated spot to a spot where you're trying to ... That must be tough.
Dr. Joseph Reese: It definitely can be difficult. Sometimes they're converting areas of their building that may not have been used in the past for patient care now back into patient care rooms, maybe they were used in the past and now are being used as a storage or something like that.
Trying to maintain consistent staffing is also a little bit difficult, especially if we have several staff members out because they have tested positive. We do our best to try to maintain consistent staffing as much as we are able to and I think we've been fairly successful so far, though we'll see how this proceeds over time if the pandemic continues on for longer than this year and however long it does last.
Lori Walsh: Right. Give us an idea of communication with families, because you have privacy issues, but you also have families who are deeply involved with their loved one's care. Now you have massive testing, or large scale testing I should say, so you're adding something to the mix. Certainly family members are going to want to know test results and test results in the facility. Talk a little bit about the relationship with family's members throughout this journey, and then specifically as test results come in, how is that communication going to work?
Dr. Joseph Reese: That communication will be directly with the patients and families. We'll communicate that directly once we have those test results available, like I said, they will likely be more than 72 hours post-testing though may come in at different times. As we get positive test results, those will be directly reported to the family.
We have other lines of communication open right now during this time of the pandemic, trying to help provide some bit of information sharing. At Prince of Peace, we do a weekly town hall call where all the family members, not all of them, those family members that would like to be informed of some of the precautions that we're taking and some of those things that we're doing. We do a weekly and then we report on the number of staff that have tested positive. We also report on the number of residents that have tested positive during that timeframe. We don't typically share where those staff are located or where the residents are located during those calls, but at least you have a little bit better handle on how many of those staff are typically infected. Now, sometimes if a staff member down one hallway is infected, we might call the family members of that hallway and report that to them, that there was a staff member that tested positive on a hallway that their staff member was in.
Again, that's all direct reporting. Then we have other avenues of communication that we're trying to work through during this time to try to help keep those lines of communication open, especially as we're not allowing visitors right now into the nursing homes so that makes it a little bit more challenging. Not all of the nursing homes that Avera is doing are doing the town halls, so maybe as we have some more positive cases, we might see some more of that happening over time.
Lori Walsh: When people are participating in those town halls, what kinds of questions other than simply are there new cases or where are those cases at, what are you hearing people their concerns are and their frustrations and their gratitude? Tell us a little bit about some of those conversations that you can tell us.
Dr. Joseph Reese: Yeah. I think the biggest concern that people have right now are trying to keep their loved ones active and engaged and physically fit and mentally fit during this time when we're in isolation. It becomes very difficult, especially a lot of the nursing home patients have memory impairment and they don't understand necessarily all the isolation and all of that. It makes it very difficult mentally and physically, especially if they're staying in their rooms a little bit more, which they have been doing because of the isolation. So that's been a big concern that people have, and we have been trying to get people, now that the weather is maybe starting to get nicer, it seemed like it was going to but now it's a little bit colder again, but we've been getting them up out in the hallways on their own individually and trying to keep them active as much as possible. We have ongoing activity still, we've been putting more iPads into the rooms so family members can try to get in touch with their loved ones and talk to them over the iPad as opposed to in person.
Those are the kind of things that we're hearing from a concern perspective. A little bit of that concern is also when are you going to allow us to open up the buildings, and I think we'll be seeing more about that here coming up. There was just a big release on Monday of the plan for starting to open up nursing homes, though that was released on the national level and we're not a hundred percent sure what South Dakota is going to do with the national recommendations at this time. So more to come will be had here in the next couple of months, or weeks even, as we start talking a little bit more about that discussion to open up. Those are the main concerns.
I think the gratitude has been a lot of people have been saying we have been doing a very good job of keeping the loved ones from contracting COVID-19, as we have not had a lot of COVID-19 cases, fortunately, in the Avera facilities. So they have been very appreciative of the care and the isolation and trying to maintain the best precautions that we can. We have been screening our staff twice daily with fever, symptom check. We've been screening the residents twice daily with fever and symptom checking and monitoring those in the assisted livings, we're not quite doing twice daily like we are doing and most of the nursing homes. Those are some of the things that they have been grateful for, is all the precautions that we put in place, all the planning that we have been doing to try to help offset some of the risk from COVID-19.
Lori Walsh: When we talk about physical needs that might be virus related and might not be tell us a little bit about eCARE and eCARE Senior Care, how that intersects with care in the nursing home, because there are a lot of things you can't really ignore just because you're trying to keep a virus from entering a room.
Dr. Joseph Reese: Right now, visits outside of the nursing home and visits into the nursing home are discouraged currently under the recommendations from the CMS. The nice thing with telehealth is that allows us to go into these patient's room if they do, let's say, have something that may be not COVID related, maybe they are starting to have a rash or something like that that needs to be evaluated. We can take a camera into that room and evaluate that resident right then and there in the room. That allows us to get a good assessment of what's going on and start treatment if they are not able to go visit with their provider locally, or if the provider is not able to come into the facility and visit with them.
We have the capabilities to see into their ears, we have the capability to see into their mouth. We also have the capability to listen to heart and lung sounds over the camera, so that also allows us to do some bit of assessment without having to send them into the hospital or emergency department where maybe they could contract the virus itself and bring it back to the facility. Again, the options with telehealth allow us to do quite a bit of medical care to these buildings, without them having to leave the building and still be able to have a good assessment and diagnosis.
Lori Walsh: Dr. Reese, as a geriatrician, you care about elders, you care about these people and you have a lot of experience watching them navigate their later years. Before I let you go, in our last 30 seconds, what's your message to family members who are really experiencing this journey for the first time? What do you want them to know about their loved ones in longterm care during the pandemic that maybe they really haven't thought of?
Dr. Joseph Reese: I think the biggest thing for me is that all of us are trying to do our best to keep your loved ones safe. We are working as hard as we can to make sure that they have the best care possible and that they maintain as active and functional life as they can. We know that it's difficult because we aren't having people come in and see and experience those types of things. The staff do care, we are trying to do our best to try to communicate out and be active and involved in sharing that with you, and we will continue that effort and continue to keep those that are in the nursing home as safe as we possibly can, or assisted living or any other environment.
That is I think what my message to them is, that all of us that work in longterm care, all of us that are working and talking about these things are highly concerned and trying to make sure that we have the best care possible and trying to keep everybody as informed as possible for going forward in this spectrum.
Lori Walsh: Not going to stop. Dr. Reese with Avera eCARE, Senior Care Medical Officer, talking about testing in Avera longterm care facilities. Thank you so much, we appreciate your time.
Dr. Joseph Reese: Thank you.