UPDATED May 6
 
Pat Merryweather, PDG Rotary District 6450, has been asked by the Illinois Department of Public Health to write a weekly newsletter for dissemination to Rotarians. The IDPH is trying to reach every person in Illinois and felt that Rotarians are community leaders and have a great outreach. Pat has been on the IDPH Infections Disease Committee for ten years. Read on for useful information on the COVID-19 and International Perspective. Read on for information on Everyone's Role, Symptoms, Stop the Spread, and Why Social Distancing is Important.
 
Pat's latest update is presented on a 7 minute video which can be viewed here
 
 
April 6 Newsletter 
Gratitude for Health Care Workers
 
We know that many of our readers are affected by COVID-19 and many know someone that has been infected with COVID-19. When we talk about the volume of confirmed cases or deaths from COVID-19 --- it is not about the numbers. It is about the people that have been infected or died - Spouses, partners, mothers, fathers, grandmothers, grandfathers, sisters, brothers, daughters, sons, aunts, uncles, cousins, friends, colleagues.
 
While we brace for the very hard days ahead, we thank those that are risking their lives in caring for us and protecting us and our loved ones.
 
This special edition will focus on:
  • Key Recommendations and Guidance to Nursing Homes, State and Local Governments
  • Visitor Rules in Hospitals and Nursing Homes
  • Preparing Patients/Residents for COVID-19 Hospitalization - Advance Directives and POLST
  • Helping Families Help Loved Ones - Plan Ahead
 
Key Recommendations and Guidance to Nursing Homes, State and Local Governments
On April 2, the Centers for Medicare and Medicaid Services (CMS) released recommendations for nursing homes and in turn, for state and local governments. Each state, and even some local organizations, will adapt these rules to their environment. As soon as the guidelines are released, we will send an update.
 
These recommendations were developed in response to the increase in the number of residents living in nursing homes or assisted living homes that have been diagnosed with COVID-19 or have died as a result of COVID-19. As residents in nursing and assisted living homes are in close proximity to each other and have shared caregiving and nursing staff, the ability for a virus to transmit from a resident with COVID-19 to a non-COVID-19 resident is quite high. It is also important to keep in mind that nursing home residents are frail and many have the high risk health conditions associated with increased likelihood of COVID-19 complications. Given the scenario of high risk residents living and congregating in close proximity to each other, it is critically important to assess residents for symptoms of COVID-19 and to act quickly and test residents with COVID-19 symptoms as one is taking precautionary steps, including Personal Protective Equipment (PPE).
 
Key components of the April 2 recommendations by CMS and Centers for Disease Control and Prevention (CDC) include:
 
1. Nursing Homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control. 
 
2. As long-term care facilities are a critical part of the healthcare system, and because of the ease of spread in long-term care facilities and the severity of illness that occurs in residents with COVID-19, CMS urges State and local leaders to consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests.
 
Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories. These laboratories may also choose to enter facilities to conduct COVID-19 testing.
 
3. Long-term care facilities should immediately implement symptom screening for all.
 
4. Long-term care facilities should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
 
5. To avoid transmission within long-term care facilities, facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability, and work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.
 
To view all of the April 2 detailed recommendations by CMS and CDC within the above categories, please click Here
 
Visitor Rules in Hospitals and Nursing Homes
Hospitals and nursing homes have restricted visitors due to the possibility of exposing visitors to COVID-19 or visitors being asymptomatic or carriers of COVID-19. Many hospitals will allow a partner of a mother delivering a baby as long as the visitor is screened and does not have COVID-19 or symptoms of COVID-19. Unfortunately, patients with COVID-19 are typically in isolated units or intensive care units where no visitors are allowed as access is restricted to hospital staff.
 
In order to protect nursing home residents, on March 13, CMS immediately restricted all visitors and non-essential health care personnel from entering nursing homes, with the exception of individuals making a visit for compassionate care (end of life, etc.). However, visitors for compassionate care must make arrangements with the nursing home in advance and follow proper hand hygiene and wear personal protective equipment. No one with a sore throat or the COVID-19 symptoms will be allowed to visit. Additionally, CMS issued guidance for continuous assessment of residents, staff, compassionate visitors, and surveyors for COVID-19 symptoms. Nursing homes must also cancel communal dining and all group activities, such as internal and external group activities  For detailed information, click here 
 
Before you make any plans to visit someone in the hospital or nursing home, look at their website as most healthcare organizations have posted their visitation policy during COVID-19 on their website. If you cannot locate their visitation policy on their website, call the facility to see what it is before you make a trip to visit a loved one.
 
Many hospitals and nursing homes are being creative in supporting the needs of the residents to talk with loved ones and are setting up conference calls, videos, facetime, skype, and other ways for residents and families to interact. We all know how important the support of families and loved ones is to a hospitalized patient or a nursing home resident. It is never too early to plan for the unexpected and consider how you would communicate with a loved one if they were hospitalized or in a nursing home.
 
Preparing Patients/Residents for COVID-19 Hospitalization - Advance Directives and POLST
While we are all working to reduce the likelihood of acquiring or spreading COVID-19, many are taken by surprise when they do get COVID-19. Most young and middle age people, and even older persons, do not have Advance Directives. Since 2008, April 16 has been recognized as the Natonal Healthcare Decisions Day with a mission of "to inspire, educate and empower the public and providers about the importance of advance care planning."
 
Advance directive is the general term that refers to the various documents that could include a living will, instruction directive, health care proxy or health care power of attorney. To see your state forms available through the AARP website, click Here
 
Many states require that nursing homes or patients with terminal conditions have a POLST Form completed by a physician and resident or patient. POLST (Provider Orders for Life-Sustaining Treatment) form is intended for a person who is seriously ill or with a life-limiting illness. It is a signed medical order reflecting a person's wishes that travels with the person across settings of care that must be honored by all healthcare providers. To view the POLST form for your state, click Here
 
Helping Families Help Loved Ones - Plan Ahead
There have been many stories and videos on news and social media about how helpful hospital or nursing home staff have been with families as a loved one is hospitalized or in a nursing home. Some staff have helped patients at end of life hear their loved ones on the phone telling them for the last time how much they loved them and will always remember them. These are very emotional times for patients, families, and the healthcare staff.
 
Some families are equipping a loved one with a smart phone or ipad before they enter the hospital or nursing home so they can facetime or skype with them. Many families are recording the favorite music of patients with dementia or Alzheimer as the patients somehow connect with their favorite music as it provides them comfort. Others are sharing memorable moments or recording favorite poems or prayers so that the patient or resident does not feel so alone.
 
There are many creative and innovative ways to stay connected. All of the videos and social media report that no matter how hectic and tired the healthcare staff are, they always rally to provide that important connection between families and loved ones.
 
 
Resources
 
Centers for Disease Control and Prevention (CDC) - www.cdc.gov
 
Centers for Medicare and Medicaid Services (CMS) - https://www.medicare.gov/medicare-coronavirus
 
 
Illinois Department of Public Health - http://www.dph.illinois.gov/
 
 
Any questions, contact Pat at dg6450pat@aol.com