COVID-19 created needs in skilled nursing facilities, or SNFs, that included education, training and the sharing of personal protective equipment. Dr. Greg Burke, Medical Director of the Skilled Nursing Facilities Program at Geisinger, pointed out another, more human and heart wrenching need: helping nursing home staff in one facility handle an unusually large number of resident deaths.

“They reached out to us,” Burke said, talking with others about how Geisinger during the pandemic partnered with 125 SNFs in the Susquehanna Valley area alone. “We quickly made a connection with our chaplaincy offices. Our chaplains offered counseling on compassion fatigue and were willing to meet in a socially distanced manner.”

And even though this was not a facility that Geisinger owned, Burke’s partner sent “tons of goodies” for the nursing home’s breakroom.

“This was just fellow health care providers who were really struggling,” Burke said.

Both Geisinger and Evangelical Community Hospital, in Lewisburg, reached out to long-term care facilities to fight the ever-evolving coronavirus in an especially vulnerable population. Janet Tomcavage, Chief Nursing Executive at Geisinger, said the results of a survey identified a number of key areas where regional SNFs initially needed help:

- access to testing

- establishing guidelines for testing

- education and clinical direction

- access to an emergency physician for help in triaging patients

- donations of and instructions on using personal protective equipment (PPE)

- safe and efficient transfer of patients from Geisinger back to a nursing home

- protocol to ensure that patients hospitalized for reasons other than COVID would be tested before returning to the SNF.

Skilled nursing facilities and hospitals needed to work together, Tomcavage said, to best protect and treat their patients. When Geisinger received numerous contributions of personal protective equipment “from wonderful donors,” they shared with the SNFs.

“We really leveraged those donations to the nursing homes to meet some of the gaps,” Tomcavage said.

Likewise, Evangelical Community Hospital recognized the distinctive needs of skilled nursing facilities and offered to help.

“Following the announcement of Health Secretary Levine that all residents and staff of long-term care facilities were ordered to be tested for COVID-19, Evangelical Community Hospital arranged to meet with these valuable care partners in the area,” said Angela Lahr, MHA, MT (ASCP), CLSSBB, Vice President of Clinical Operations.

Evangelical stepped forward to share knowledge and personnel.

“The Hospital presented its ability to collect specimens including utilization of a healthcare worker trained in the collection of a nasopharyngeal swab, which could then be run through the appropriate testing systems,” Lahr said. “As a result, some area facilities elected to utilize the Hospital’s services to complete the required testing. Others engaged third party providers to fulfill the testing requirements.”

Geisinger created biweekly webinars and invited nursing homes to join in for conversations with the Geisinger SNF program, infectious disease specialists and lab medicine. They covered topics like how to clinically manage a patient who has COVID in the nursing home but doesn’t need to be hospitalized and how to segregate patients. To help triage and make quick decisions on patient care, SNFs were given access to an emergency call-in number.

In fact, three Geisinger medical directors were made available to give nursing homes direction, Burke said. Also, seeing a need for rapid diagnostic testing, Burke approached Geisinger’s diagnostic lab and, by April, the hospital was able to provide turnaround times of a day or so.

“I was very happy with our lab,” Burke said. Commenting on the range of services Geisinger offered regional SNFs, he added, “This was all gratis. This was just us trying to help our partners.”

“The lab response was phenomenal,” said Denise Whitmire, Director of Nursing at The Gardens at Orangeville. “With my point of contact, from dropping off testing supplies to the rapid turnaround testing results, which helped us establish our bed management strategies as per the CDC.”

“Every day there was some new guideline recommendation coming out, because every day we learned more about this virus,” Tomcavage said. “With the coronavirus, there was so much unknown. It kept everyone on their toes.”

Burke praised nursing home administrators and chief nursing officers who did “a yeoman’s job” of dealing with the evolving guidelines as researchers and physicians struggled to learn about COVID-19.

“Although March was only a month,” he said, “it was the closest thing to feeling like a year that I’ve ever had.”

n Cindy O. Herman lives in Snyder County. Send e-mail comments to her at CindyOHerman@gmail.com.

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