Witherell Family Council Seeks ‘Essential Caregiver Policy’ to Improve Resident Life during Covid

On Monday the Nathaniel Witherell board of directors met on Zoom. Medical Director Dr. Frank Walsh said 25% of staff and residents are tested for Covid-19 each week.

He said one employee had reported not feeling well and had gone to her doctor where she tested positive. He said she was later tested and the result was negative. She is now back to work.

Oct 19 Witherell Board meeting via Zoom.

“Currently we have nobody here who has tested positive,” he added.

Dr. Walsh said the census at the Town-owned nursing home was below capacity with 162 residents out of a 202 bed capacity, though a similarly sized nursing home in Greenwich had an even lower census, with just 74 residents.

He said 46 residents at Witherell had been treated and recovered from Covid.

Executive director John Mastronardi, MPA, LNHA, said all Covid tests had come back negative in the weeks of Oct 5 and Oct 12, but there was one positive patient case on Oct 14, which he said “reset the clock,” shutting down indoor visitation for two weeks.

Mastronardi said outdoor visitation for Covid negative cases would continue, and if there were no new positive cases, restrictions on indoor visits would be lifted on Oct 29.

“With that newly reported case, the facility had to roll back to phase 1,” he said. “In phase 1, to clarify, compassionate care visits are suspended. We’ll allow visitation for residents who are actively dying.”

The cost of weekly tests are funded by Centers for Medicare & Medicaid Services, a federal agency within the US Dept of Health and Human Services. Yale New Haven Health System processes the tests without a fee.

Larry Simon, chairman of the board of directors, said the board is in the process of updating their written visitation policy, which will be published to the Witherell’s website, including whether visitation is allowed indoors or outdoors.

Amy Badini, co-chair of the Family Council, was given 5 minutes to speak.

Nursing homes are required to have Family Councils by the ombudsman’s office. Their purpose of Family Council is to help families support one another and to improve resident life at long term care facilities.

Badini acknowledged the board of directors’ desire to increase the Witherell’s census, but said families also wanted to see their loved ones as much as possible.

“Without a family and resident-friendly plan, no one wants to leave their loved one in a nursing home today, to never or rarely be seen again,” she said. “That’s the crux of this.”

“What we’ve learned from the past 8 months is this is not just about prevention control,” she added.

Badini suggested the Witherell’s Covid task force focus on improving resident life in addition to infection control.

“We are offering to help with visitation,” she said. “We can volunteer as transporters and supervisors, allowing the recreation staff to go back to delivering recreation activities – particularly taking them outside on these awesome fall days.”

Badini said Nathaniel Witherell might increase its census and distinguish itself as a leader in the field by creating an essential caregiver policy.

Badini referred to the essential caregiver policy of the State of Minnesota.

“MDH also acknowledges the unintended consequences of prolonged physical separation and isolation on a resident’s overall health and well-being. Although technology can help decrease loneliness for some residents, technology is not a sustainable replacement for in-person contact.”

Minnesota Dept of Health’s Essential Caregiver Guidance for Long-term Care Facilities

“It’s not just ‘open the floodgates,'” she said. “Essential caregivers would be treated like staff. So if they needed to be tested along with 25% of the staff, once a each week, by the end of the month, essential caregivers would fall into that policy.”

Badini said the Family Council understood that the administration and staff were operating with the backdrop of the pandemic.

“Together we can get through this and make the final years of residents at Nathaniel Witherell the most enjoyable as possible,” she added. “Let us help you address the extreme loneliness and isolation that they’ve all been experiencing over the past eight months. It’s devastating.”

She said the Leading Age website maps out an Essential Caregiver policy.

Mr. Simon acknowledged that visitation was a key factor in a better patient experience.

“I know you want to be a part of the Covid task force, but I don’t think that’s the appropriate place for you to be,” he said, adding that new board member Melissa Gibbons had asked to be responsible for the patient visitation experience.

“I’m thinking I’m going to form a patient visitation committee of one. She (Gibbons) is going to work with John (Mastronardi)…The Family Council is not responsible for the operation of Witherell,” he said. “The town is responsible. The staff is responsible. We want your input, but you don’t run the nursing home.”

Board member Joan Merrill, BSN, RN, CMC, a Certified Geriatric Care Manager, said she’d listened to a number of people from the Family Council.

“I think that they’re frustrated because the visitations haven’t really been planned according to the site they go on,” Merrill said. “I think they’re frustrated because they haven’t seen their family members for so long. I can’t understand why some other nursing homes are allowing visitations moreso than Nathaniel. I don’t think they’re going against policy of any sort – they’re just opening it up a little bit. Maybe we’re a little too conservative?”

Director Mastronardi said he participates in meetings with Leading Age and had asked them how many visits other facilities were allowing.

“What they told me was eight to ten, which falls in line, per day, with what we’re doing,” he said.

“I don’t think we’re not falling in line with the same number that our peers are,” he added. “I do understand the concerns about your loved ones. Rest assured that the physical, emotional and well being and safety of every single resident is of utmost importance to our team.”

“I trust my team,” he added. “Everyone on this call should try to trust them too.”

“Would you agree, however, that some of the burden could be taken off the staff so they could focus more on the care of the residents?” Merrill asked. “These people are very aware of how to protect themselves. They would go through some training and be Covid tested, etc. I don’t think they’d step beyond their responsibilities except to help with transport.”

Nadia Benson, RN, at the Witherell disagreed.

“I think we’ve managed to keep our numbers so low because we’ve been so vigilant. The moment we let our foot off of the gas we’re opening ourselves up to going backwards to April and March,” Benson said. “It’s something that needs to be considered very seriously. We’ve managed to keep the numbers (of Covid cases) almost non existent.”

Board member Richard Kaplan said nearby facilities south of Greenwich in New York were not allowing any visitation other than through glass or an iPad.

“The issue around vigilance around visitation is so important,” Kaplan said. “I sometimes think visitation is almost more important to the visitor than the visitee.”

Mr. Simon said visitation takes many forms.

“It comes in the form of Facetime, outdoor visits, indoor visits, and we need to fine a way – if other nursing homes are giving 12 visits a day, and you only have 70 patients that’s one thing. If you have 160 patients, we have to find a way to give at least once a week to people, if not more often, and find a way to do that in a way that meets everybody’s objectives.”

Mr. Simon said the board would explore ways to work together and improve family interaction.

“I agree that’s an important part of the whole healing process, part of the assisted living, skilled nursing process of interactions,” he said. “Elevating this to a board level shows we’re taking this with a higher level of interest.”

Nurse Benson and Director Mastronardi both expressed concerns about the Family Council’s push for a role for essential caregivers, especially with the onset of the flu season and recent rise in Covid cases in Greenwich (8 cases in Greenwich Hospital last weekend).

“We have to distinguish between flu cases and Covid cases,” Mastronardi said. “We don’t like this any better than families do, than the residents do. We don’t like saying no.”

“We’re walking a fine line between keeping cases low to no, and “opening up the floodgates to a very unsavory scenario,” Mastronardi said. “We really have to be careful.”

Mastronardi said he would like to know how many residents had no family or friends to visit them.

“If we can create a list of those who don’t get any visits, it would be a great function of the Family Council along with us to provide visits to them, to folks that don’t get visits,” Mr. Simon said.

The next meeting of the Witherell’s board of directors is on November 16, 2020.