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A Covid Outbreak at a Long-Term Care Facility Attacks Body and Soul

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Heather P and cat
Heather P,
Michigan

“It's almost like that change in our regular life affected them to the point where they just kind of gave up and let their physical ailments take over. It's been hard. We're very tight. The patients are all really close to each other. We're like this big dysfunctional family. And we've had a lot of loss.”

Before the covid outbreak at a long-term care facility, Heather and her grandmotherHeather is a recreation therapist at a long-term care home for veterans. Most of her 23 patients in her unit have post-traumatic stress disorder and progressive diseases like Parkinson or multiple sclerosis, and everybody has wheelchairs. The facility also has a hospice unit and a dementia memory care unit, with everybody being part of a pretty close-knit community.

Her patients normally set their TVs to CNN or FOX News, so back in February the stirring of the Covid-19 virus brought a lot of talk amongst the patients and staff. At that time, their unit was in the midst of an influenza outbreak, so they were already quarantined. It made the pandemic feel more real.

Four years before, Heather had been diagnosed with severe asthma. Hearing about the virus set off panic attacks. Not only was she around a vulnerable population but she herself could become greatly impacted by the virus and even die. They were worried about a covid outbreak at a long-term care facility.

“I feel like it’s not really fair in a way, because I’m still young and I still have a lot going on. I just moved in with my boyfriend. I’m ready to have a future with him and everything. It kind of put the kibosh on that because I’m chronically ill and I’m trying to do my best for myself.”

In the beginning of March, the facility imposed more restrictions. Patients were no longer allowed to go outside except on the patio, which meant all of the field trips she used to take them on, like going to museums or ballparks, were cut out. Visitations were stopped, and volunteers weren’t allowed in, so the only interactions the patients had were with staff.

“It’s already hard to be a patient in a nursing home or a long-term care facility because a lot of them don’t have family or friends to come see them. Their social interactions are through the staff and with each other. It can be really lonely for them in that aspect. It’s also difficult to adjust to losing your freedom. I mean, you go into these places and you have nurses and doctors making these suggestions and these decisions for you and how your life’s going to be. You have a dietitian telling you what you can eat and what you can’t eat. That’s something that’s a really hard adjustment to begin with and you add on that there’s this worldwide pandemic going on. That loss of freedom is even worse now because you can’t go outside. You can’t go on your trips. The volunteers that came in to see you aren’t coming in to see you. It’s a loss, but it’s tenfold.”

It was also hard on her because her patients would ask her when they would be able to take trips or have their favorite volunteer come see them, and she would have to reply that she didn’t know and it wasn’t possible.

Despite the restrictions, it didn’t feel like the facility gave enough guidance on how to handle the virus. There were explanations about the things that were going to put in place. A checkpoint was placed at the front gate. Temperatures were taken every day. They were given paper surgical masks to wear. However, it seemed the guidelines lacked urgency.

“I can’t tell you how many times a day I had to remind their staff, like: ‘This is the new guidance. I don’t know if you heard it, but we’re all supposed to be wearing masks around the patients.’ It’s just what we have is a failure to communicate, and that was very worrisome.”

Patients were tested for Covid regularly, but not the staff. But the only way the virus would be brought in was through a staff member, and once the virus got to the long-term care facility, it would be hard to control. The patients often could not physically do the steps they were required to take like hand hygiene or even remember the steps like not sharing things or keeping space with each other.

Heather didn’t feel safe. They had a lot of fragile patients that could die with the virus and a lot of staff who had health issues, like her. Communication between the staff just wasn’t there. A staff member would disappear and everybody would wonder where they had gone, and then when the staff member came back, she would find out that they had tested positive.

The anxiety was overwhelming, and she had more panic attacks. Fortunately, her boyfriend provided great support as well as her parents. She also found that playing disc golf helped calm her down.

“I’ve been trying so hard to stay strong for my patients because they got scared too and there’s nothing they could really do. I feel like they’re kind of like sitting ducks almost.”

Heather’s job duties adapted to the pandemic. She was still running group activities with them, but she kept them socially distanced and didn’t use as many supplies or share things as much as she used to. She made a point to find things that were more meaningful for them, like taking them outside into the fresh air, gardening, music, or doing arts. A good movie that made them really laugh helped too.

In April, Heather found out her grandmother’s nursing home had a Covid outbreak. Her grandmother and grandfather had moved into the nursing home the previous summer, and she was their only grandchild. Prior to Covid, she had been making it part of her routine to visit them once a month. Within a couple of weeks, 20 residents at the nursing home had tested positive.

“I had this sinking feeling. My grandma had part of a lung missing. She had beat lung cancer eleven years ago and since then she didn’t have health issues, but I had this feeling like if she comes around it, she’s not going to make it.”

The bad news came. Her parents called her and told her that she had pneumonia and was taken to the emergency room. She was being put on 17 liters of oxygen, which Heather knew, due to her medical background, was an obscene amount of oxygen.

It had been her grandmother’s wish to not be put on a ventilator. The doctors gave her one to two days to live, but she was allowed to go back into the nursing home and be warded off from the rest of the patients except her grandpa. Fortunately, the nursing home changed their bubble policy so that her dad and his siblings could be with her. Heather knew, though, that with her own illness and people she worked with, that wasn’t an option for her.

After five days of holding on, her grandmother died on May 4th. Heather’s grandfather took it really hard. He was already depressed, and this just made it worse.

In June, the governor ordered testing for long-term facility staff, so Heather’s facilities started testing nursing staff, but still many of the other staff didn’t fit into that category, like her.

About a month later, a few nursing staff tested positive in one of their weekly tests. During the same week, one patient tested positive. Within twelve hours, another patient was positive. By the end of the week, they had eight positive cases. The following week, three or four more patients and staff were positive. Half of her unit’s 23 patients were exhibiting symptoms. Anybody who tested positive was taken out of the area and moved to a separate Covid unit.

They had an outbreak.

“I know that the tests are supposed to be pretty reliable, but we had people with fevers and coughs and things of that nature. It wasn’t until after those positive test results started coming in that they ordered staff to wear heavier PPE with N95s under the face shields; still no gowning ever.”

The facilities increased the cleaning, and the recreational therapy staff was pulled from the unit for a few days. The whole response seemed more like a scramble to cover their hides and try to control a fire already there than preventative in nature.

“My supervisor had to fight with the head honchos of the facility to get us tested, and she said, ‘They’re not going on the floor and working with patients until they can get regular testing because if they’re essential employees, they need to be treated as such.’ And I’m really thankful for my direct supervisor because she advocates so well for us.”

Heather is not sure if anything was said to her patients when the virus started coming through the units. They were observant and heard things that they were not always supposed to, so they certainly knew what was going on. They had to be nervous. The staff restricted them to their rooms, which was completely different than how they had been running things this whole time.

“Unfortunately, given the nature of these people’s life experiences, anxiety is always part of their every day. They’re dealing with a lot of past demons, but I found that a lot of them were depressed. They felt more isolated, obviously, because they were. A lot of them started acting out with being verbally aggressive, refusing to take their medications. And you could see how it was starting to really affect them that way.”

The outbreak lasted about three weeks, and then the facility gave its staff the okay to remove N95 masks and face shields.

Heather’s facility was lucky to not have lost anybody due to Covid as a result of the outbreak. However, many patients are still having residual coughing fits. Lung issues are already a common thing as well as breathing problems. But the coughing is abnormal, and patients are very tired.

Since March, though, her facility has lost six or seven patients.  

“It’s almost like that change in our regular life affected them to the point where they just kind of gave up and let their physical ailments take over. It’s been hard. We’re very tight. The patients are all really close to each other. We’re kind of like this big dysfunctional family. And we’ve had a lot of loss.”

In July her grandfather also, out of the blue, had appendicitis and passed away. With her grandmother having passed away back in May, the losses have all been more personal.

When she hears people talk as if Covid-19 is only taking those whose time was up already and those with health issues, she finds it a really sick way of looking at things. She gets to live a pretty normal life. She just needs some extra medication and has to watch out for overexerting herself. It’s not her time.

“With my veterans, yeah, they live in a long-term care facility. Yeah, they’re older. Yeah, they’re disabled, but they still have life in them. Don’t discount that.”

Her anxiety issues are getting better. She thinks that what caused her to have panic attacks was the uncertainty of the future. She’s had to stop planning five or ten years down the road and just start taking things day by day. But, she recognizes that a Covid outbreak at a long-term care facility attacks body and soul.

“Let’s just get through today. Let’s just do the best we can for right now, and then we’ll move on as it needs to.”

Read more about the details of how Covid took Heather’s grandmother and how her grandmother was a sassy lady. Or watch more stories on fuconomy’s youtube channel.