Greenwood Court, Stratford
On March 30, a resident in the retirement home presented with a high temperature. The resident was tested for COVID-19. Universal masking and cohorting of staff was initiated. The next day March 31, another resident presented with a high temperature on the dementia unit. Swab results came back that same day. Both residents were positive for COVID-19.
Strategic actions were immediately implemented to isolate all residents in both of the affected areas. Staff were in full personal protective equipment (PPE) with all residents isolated as much as possible. All meals, medications and other services were provided only in the residents’ rooms. Fortunately, the design of the home provides private rooms with a shared washroom in only one semi-private room on the dementia unit. Isolation was easier to enforce, except on the dementia unit where this was more challenging. One resident who could not be prevented from wandering, also wore PPE.
Most residents presented with high temperatures, and were found to be COVID-19 positive. On April 23 all residents and staff were tested. Throughout the course of the outbreak, six residents and ten staff members tested positive for COVID-19. Unfortunately four residents lost their lives due to COVID-19 - the initial case, the retirement resident and three LTC residents.
Teamwork is so critical! Initially, the management team looked at their processes and decided the priorities for the home. They tried to decrease the workload for frontline staff by reducing medication passes, adjusting documentation requirements and prioritizing resident care. Greenwood Court was fortunate to have a Nurse Practitioner, Wendy Dunn who was able to write orders and process them to assist with the nurses’ workload and ensure quality resident care. Each manager was given clear roles in the management of the outbreak. This included PPE oversight, staffing and communication with families, residents and staff. At meal times, it was "all hands on deck" from management to frontline staff.
Communication with residents and families was essential. Management team members gathered email addresses for key contacts from all families. Daily updates began on March 31st. These emails informed families about the number of cases in the home and the measures being taken. An update of the residents who were ill was also provided, as permission had been obtained to do so. A dedicated phone line enabled families to call in and ask questions, and a staff member was assigned to respond to these calls. The answers to these questions were also included on the daily updates. The home found that the number of phone calls to the floors decreased significantly with this approach. It assisted front line staff in their ability to manage their workload more effectively. The nurse caring for the COVID-19 positive residents would personally call the family daily with updates.
Staffing became a critical issue when the COVID-19 outbreak was declared. Fear was as contagious as COVID-19. Staff were terrified, afraid for themselves and their families. An important lesson learned was that staff needed to be educated and informed as much, or more, than families. It is also important that discussions happen with staff in advance, to better prepare them before an outbreak occurs. They need to consider their situation at home, concerns about at risk health conditions and child care so that they have a plan for continuing to be able to work.
Mental health can’t be forgotten! These are unprecedented times. At no time did Greenwood Court imagine, the intensity of working on the frontline in this battle. Many have worked 12+ hour days with very few days off in order to meet the needs of the residents. Resident lives have been lost and dynamics of relationships within the home have been tested. The home will be arranging counselling for all staff as the intensity of the COVID-19 response evolves.
- Prepare before you are in outbreak, speak with your staff. Educate them and listen to their concerns. Problem solve what you can.
- Staff who were COVID-19 positive who wore PPE (droplet precaution) did not transmit COVID-19 to any residents.
- If a resident is unable to follow instruction and stay isolated, have them wear PPE if possible.
- Common symptoms for residents were elevated temperatures (greater than 38 degrees) and cough. The fever persisted for 5-8 days and often peaked through the night. We found that between day 5 and 7 the residents would either rally or succumb to the virus. We saw wider diversity in symptoms for staff.
- Palliative care did not include suctioning or nebulizers to avoid aerosolization. CPAP was held for residents (even those symptomatic) because of the high risk of aerosolization to protect staff.
- Ensure that PPE is utilized correctly for the protection of staff and residents. Education and monitoring of technique is essential.
- Hand hygiene is extremely important, and needs to be practiced and reinforced.
- Do not let your guard down!
- About Greenwood Court –
Greenwood Court is a Long Term Care (LTC) and Retirement facility located in Stratford Ontario, consisting of 45 LTC beds and 18 retirement home beds. The LTC portion has 2 units, a 30-bed unit and a 15-bed dementia care unit. The COVID-19 outbreak occurred in the retirement home and on the dementia care unit.