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To Test…or Not to Test?

July 22, 2020  |  Elizabeth Wright is the founder of the award-winning, innovative memory care community, The Moments, in Lakeville, MN.

While this blog was nearly ready to post, Minnesota’s Governor Walz and Health Commissioner Malcolm, among others, addressed how they have handled COVID-19 in long-term care facilities and their successes in a July 21, 2020 press briefing.

They claimed repeatedly that this update was not a victory lap—at least they got that right. As owner and operator of The Moments Memory Care Community, or in their terms a “provider”, I do not see what they have accomplished as a victory.

July 21, 2020 Press Briefing — MN Department of Health Commissioner stated:

“All long-term care facilities with even one confirmed case of Covid-19, or two people showing symptoms “SHOULD” do facility-wide testing.”

The Semantics of The Commissioner’s Statement Above Are Important.

The use of the word “SHOULD” leaves the decision to test facility-wide to the provider versus if the Commissioner had said “MUST” or “REQUIRE”, it would be mandatory for all providers to test facility-wide.

Should You Expect More from The State Government?

Absolutely! Regardless of which assisted living or memory care facility you choose for your loved one, you MUST always expect exceptional care—especially during a pandemic! The Moments Memory Care stands for nothing less than exceptional care, beginning with testing early and often. We implore all other long-term care providers to follow suit.

It is safe to say that 2020 has been a very strange and stressful year for everyone! Recapping the first half the year seems to be redundant, unhelpful and depressing. Instead we are looking to the future and how we can navigate through the COVID-19 threat in memory care and assisted living facilities going forward. Specifically, we will discuss what role testing for COVID-19 should play in the choice of which facility is the appropriate fit for your loved one, what role the Minnesota Department of Health’s (MDH) list plays in decision making and signs a facility is prepared for COVID-19.

Let’s be honest, as Minnesotans we generally take a passive-aggressive approach to our everyday life. However, when making a care decision for your loved one, being less passive and more aggressive in your advocacy will help not only your decision-making process but dispel some of your concerns in making the move to an assisted living or memory care community. It is very important to request information and fully understand a facility’s testing protocol and what they do if they have a positive test before making your final decision.

To Test…

If a facility has never tested, how do they know if they are COVID-19 free? Let’s dive deeper here and dial in to memory care specifically.

Many of our residents can no longer communicate what we see as simple matters; a sore throat, runny nose, a fever or just not feeling well—symptoms that you and I would recognize may need medical attention or COVID-19 testing. It’s not that they do not want to tell someone, it’s that they do not have the ability to do so. While we do daily temperature checks of our residents and staff, if the ability to convey discomfort is not present then how can we be sure we are seeing the signs early enough to protect the rest of the community and contain it?

Over the past several months we have seen differing reports about asymptomatic COVID-19 positive people and their ability to spread the disease. One day they can, the next day they cannot. Confused? You are not alone!

Why take the chance that an asymptomatic person may be able to spread the disease throughout a facility? There is still no concrete evidence that an asymptomatic person cannot spread the disease. Which leads to the possibility of unknowingly spreading the disease throughout the facility.

As stewards of our residents, we need to be advocating and ensuring that their safety is of the utmost importance. This means that we need to test our residents and staff on a regular basis, we need to find those asymptomatic positive cases, isolate, care for, and retest to limit their exposure. We MUST test often to ensure resident and staff safety.

…or Not to Test

If we know these possibilities exist and that our residents cannot self-advocate, then why would a facility choose not to test? The simplest answer is that there is a stigma attached to having COVID-19 in a congregate care setting. The majority of the news coverage, rightfully so, has been focused on the deaths in these types of facilities and the MDH even began publishing a “list” of long-term care facilities who have had COVID-19 exposure. 

“The List”

The list issued by the Minnesota Department of Health (MDH) is made up of long-term care facilities with more than ten residents in which there has been an exposure to COVID-19. The MDH considers a resident, staff member or visitor with a COVID-19 diagnosis as an exposure. However, what the MDH list does not provide is the context for the exposure.

While I feel the list issued by the MDH is an important resource for anyone searching for a memory care or assisted living community, the list lacks differentiators as to how cases were discovered.

The MDH List of Long-Term Care Facilities with COVID-19 Cases Does Not Tell You:

  1. How many positive COVID-19 cases were in the facility?
  2. Were the positive COVID-19 cases asymptomatic?
  3. Did the facility choose to test prior to symptoms or was there a symptomatic case that required reporting and further testing?
  4. Did the facility complete facility-wide COVID-19 testing per the guidance from the MDH?

Until recently there was no guidance on how a facility could be removed from the list. The new guidance states a facility can be removed after 28 days from their last positive test. What it does not address is whether or not there is a testing requirement during these 28 days. With no guidance or requirements on testing, a facility could choose not to test and be removed from the list.

What we know is that without facility-wide testing, there is no way to know if you are COVID-free. In late April, The Moments instated bi-weekly, facility-wide testing and will continue with this testing protocol whether we are on the list or not! We feel “not knowing” is too great a risk for our residents and staff.

Is MDH unintentionally incentivizing facilities to not test their communities? How do we solve this and how do you, as an advocate for your loved one, make a well-informed decision for their care? We cannot truly protect our residents, staff and their families if facilities do not test for fear a positive case will land them on the MDH list.

While on your journey of searching for the right community for your loved one, make sure they are testing voluntarily and regularly. If you find a community of interest, but it’s on the MDH list, ask them for the positive case details and their ongoing commitment to testing and safety protocols. And, if you are told that a facility is COVID-19-free, always ask if they have had past cases, and if they are still testing.

What Happens When a Positive Test Occurs?

While testing is the best tool we have, it is equally important to understand what a community does to protect the residents and staff when they have a positive test. Understanding each facilities protocol for containment should help alleviate your concerns when there is a COVID-19 positive resident or staff member.

At a minimum, all facilities should follow the CDC guidance below on containment.
Isolation of a positive resident and step-by-step care protocol should always include:

  1. A dedicated caregiver dressed in PPE (an isolation gown, gloves, fresh facemask and face shield) prior to entry.
  2. The dedicated caregiver should dispose of the facemask, gloves and gown in a dedicated container prior to exiting the room.
  3. Upon leaving the room, the caregiver will put on a new facemask and protective eyewear and disinfect visible skin (hands and arms).
  4. Disinfecting of the resident’s room should be completed daily with the same level of PPE disposal as the dedicated caregiver.
  5. The resident should be isolated for a minimum of ten days and two negative tests within 24 hours of each other.

Spread Prevention

Other important factors to discuss with each facility are their preparedness plan and their specifics to prevent COVID-19, outside of testing. It is important that you are made aware of how often they clean and disinfect each resident room, the common areas and what they are doing to ensure a staff member or visitor does not bring COVID-19 into the building. At The Moments we instituted health screening of all staff members and visitors in March including temperature checks prior to each shift and daily for our residents. Long before it was “cool” we required all staff members to wear facemasks at all times due to this disease spreading through aerosolized particles. Because we were proactive in preparing for COIVD-19 we were able to source plenty of PPE to ensure we did not run out.

How Can a Facility’s HVAC System Limit Exposure to Covid-19?

Cleanliness and disinfection should not be limited to surfaces but also the air circulating throughout the building. As a newly constructed building, The Moments has clean air changes six times per hour. This process removes the old stale, potentially sick air and replaces it with clean air. Most building’s HVAC systems provide two clean air changes per hour. However in this case, the more air changes the better!

Visiting Your Loved One

Not being able to visit a loved one is one of the most heartbreaking realities of COVID-19. Not unlike our young children, the lack of social interaction for residents can be detrimental. This is why as soon as we could, we scheduled outdoor (socially distant) and window visits for our residents. While visitors have not been allowed in for months, we finally received guidance for allowing in building, family member visits! The preference, of course, for most facilities, including The Moments, is to utilize outdoor visits so the residents can get the love and comfort they deserve while maintaining as safe a facility as possible.

We know that unfortunately COVID-19 is with us for the foreseeable future. The ability for a facility to adapt and reimagine interactions should be key in your decision. Which is why we added additional outdoor spaces with new patios, gardens and sitting areas for family members to spend that much needed quality time with their loved ones.

In Summary

Hopefully, you are more prepared to begin the search for your loved one’s next home. Taking with you some or all of the advice provided, I believe, will serve you well when completing your research and making your decision.

Is the long-term care facility testing? How often are they testing? How did the facility end up on the MDH Exposure List? How does the facility react when a positive test occurs? Does the facility have “enough” PPE? Are they disinfecting not only the hard surfaces, but the actual air circulated through the building. How is the facility providing important family interactions?

My wish for you during this process is that you are at ease knowing that your loved one will receive the highest level of care and love wherever you decide is best. I know this process can be emotionally difficult during normal times and you will likely ask yourself “Am I doing the right thing?” Let me tell you, taking the first step recognizing that your loved one needs additional care, that you may not be able to provide, is doing the right thing. Providing your loved one the opportunity to continue to flourish, knowing they are safe and cared for is the best decision you can make. Preparing yourself with all the facts to make this decision will help put you and your loved one at ease. At The Moments we believe that making this move should not be your last resort, but your first choice.

JULY 22, 2020

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