These are unpredictable, and for many of us, unprecedented times. As the country strives to contain the coronavirus, we must all work together to do what we can to stop the spread of COVID-19 and keep our communities safe.
While COVID is a reality for the foreseeable future, we at SALMON Health have learned a great deal since the virus first appeared. Read further to learn the changes implemented since the first outbreak and the plans we have in place to address a resurgence. You can be assured that we will continue working to make the lives of our Residents as safe and happy as possible as we all navigate this pandemic.
[su_quote cite=”Jason Wallin, Director of Dining Services, SALMON Health”]There is a ton of work that goes into dining—and staff members across the board have really impressed me. So many have come into work each day, knowing there was a possibility of a positive case, and have helped Residents and added some joy and normalcy into their routines.[/su_quote]
As we addressed the transition of dining services during the first COVID peak, our team put safety guidelines in place that could be used for the unforeseeable future. Here’s what we did.
- Switched from communal dining to room service, which included nicer, safe meal packaging.
- Started constantly sanitizing while making the meals and during the packaging process.
- Revamped meal process for delivered meals. We received the orders, safely made and packaged the meals, and delivered orders to Residents’ rooms. Staff members involved in meal preparation and delivery were always in the appropriate personal protective equipment (PPE) including masks, gloves, and face shields.
- Created close bonds with Residents by making room service as fun and memorable for them as possible, and giving them human interaction. Dining and wait staff enjoyed seeing Residents several times a day and socializing with one another.
In the past several weeks, and with a lot of planning, we have started safely and gradually re-opening communal dining. The transition has been slow to ensure that we are being thorough in our processes. With our revamped meal procedures, we:
- Schedule specific times for Residents to go to the dining rooms or restaurants. This ensures there are never too many Residents congregating at once, allowing them to keep a safe distance from each other.
- Station a hostess at the front of each dining room or restaurant who greets Residents, makes sure they’re wearing their masks and has them sanitize their hands.
- Make sure Residents only take masks off once seated at a table.
- Position clear partitions on each table between Residents sitting together.
- Use single-use paper menus.
- Constantly sanitize between different waves, including tables and other areas.
- Establish one-way traffic flow in and out of dining rooms and restaurants.
- Have Residents sanitize their hands on the way out of the dining areas.
What else we’re doing now
We are making the dining experience more fun. Staff love creating theme-based meals, with happy hour carts loaded with special drinks and appetizers. We’ve had Mexico and France themes, holiday-based events as we did for the Fourth of July, celebrations for more obscure international days like World Rose Day, and barbecues. We’re in the process of planning special holiday meals for the coming season.
What we’ll do in the future
In the event of a positive COVID case with a Resident and staff member on campus, communal dining would be immediately shut down and reverted back to room service. We now have processes in place to make the transition smooth. Communal dining would only open back up after a 14-day period with no positive cases with surveillance testing of both Residents and staff conducted during this time. In the event of switching back to room service, we would do something special for Residents’ birthdays like bringing up a cupcake and singing happy birthday, or delivering a fancy cocktail.
During these times it is more important than ever to make sure that all of our Residents are living the best life possible. Creating and structuring programs and activities that enrich the experience of our Residents is a top priority at SALMON.
[su_quote cite=”Diane Tonelli, OTR/L, MHA, CDP, CADDCT, Clinical Director of Tapestry Program, SALMON Health”]All programming at each service level focuses on SALMON Health’s six areas of wellness: emotional, environmental, intellectual, physical, social, and spiritual.[/su_quote]
We ensure that every day, multiple times a day, Residents have social experiences and are engaged. A lot of effort goes into programming and ensuring that Residents are healthy in all six areas of wellness. During this time, all staff members are consistently in proper PPE when engaging with Residents, including face masks, face shields, gowns if necessary, gloves, and more.
Each service level remains focused on video calls, and indoor and outdoor visits to continue the sense of community and connection. Here’s how else we keep Residents engaged, at all levels.
- Independent Living Communities – Residents have the ability to be outdoors, in small, socially-distant groups. Staff members offer a variety of activities to ensure that Residents are interested and engaged. We focus on intellectual and physical activities, like yoga (either through an in-house TV channel, in the hallways, or outside) and board games (in a safe fashion).
- Assisted Living Communities – Socialization, engagement, and physical exercise are prioritized, with engagement centered at the apartment-level. This enables staff members to check on Residents, and engage with them apartment-to-apartment bringing craft carts, themed snacks, and newspaper carts, and also offering Friday afternoon happy hours. At the outdoor-level, we encourage small, safe group-activities such as the virtual Boston Marathon and Walk to End Alzheimer’s. These activities create goals, which is especially important. Across the community, we foster involvement in a range of activities, such as art groups, intellectual exercises with Vigorous Mind, fitness through SALMON Circuit Strong, a signature program created by SALMON’s physical trainers for optimal chair exercises.
- Assisted Living Memory Care – Activities in these spaces mimic what is happening in the assisted living communities but the focus is on the emotional support of Residents by providing comfort for anxiety relief and other struggles. We engage Residents in interest-events, such as painting, craft creating, and sorting and folding, which are all mentally stimulating activities for Residents diagnosed with dementia or Alzheimer’s.
- Rehab and Skilled Nursing Communities – Programming focuses on room-level wellness programs that support physical and emotional needs. Each day has a new theme or activity to keep Residents interested and engaged. For example, we recently had a Harvest Festival, where Residents got to view pumpkins while enjoying food and drink. We also ensure there is something creative and interesting to do each day, like making flower arrangements or discussing current events.
- Memory Care in Rehab and Skilled Nursing Communities – Residents at this level are all at different stages in their Alzheimer’s or dementia diagnoses. While the activities mirror a lot of what is happening at the rehab and skilled nursing level, there is a large focus on comforting Residents. Many Residents here have advanced medical issues and anxieties.
What else we’re doing now
We are not just running programs, we’re now responsible for the emotional and physical well-being of Residents, and this new perspective will continue for a long time. We are stressing the importance of mental health well-being. Although this is always important, there is now more of a spotlight on checking on Residents to make sure they’re okay emotionally, not just medically. The staff serves as a support system and helps Residents overcome a multitude of issues.
What we’ll do in the future
Engagement doesn’t always happen in a group setting. Staff members are now a key part of Residents’ lives to ensure that they stay engaged. Their commitment to Residents speaks volumes and helps support mental and physical well-being across the communities.
Proper and attentive clinical care is vitally important at all times but takes on additional significance during this pandemic.
[su_quote cite=”Deborah Freedman, RN, BSN, MS, Director of Clinical Services, SALMON Health”]I can’t express how much the nursing staff has done for Residents. They truly have been on the front lines during this pandemic and have made such personal sacrifices to come in every day and care for Residents and help their teams as much as possible. There’s not one specific story that comes to mind during this time because all nursing staff members have been unbelievable—the long shifts, staying late to help out, providing love and care for Residents during such a dark time has been astounding. They’ve been through so much and still come in every day for the Residents.[/su_quote]
Nursing staff continue to follow pre-pandemic protocols to ensure the safety of Residents, including proper hygiene and hand hygiene, typical medical precautions, and more. We are also:
- Performing testing – One of the most impactful steps we’ve taken is our consistent staff and Resident testing. We have also found different testing sources for faster turnaround times for results. Instead of one week (at the beginning of the pandemic), we can now obtain results in 24 hours. We continue to use the most accurate testing method when evaluating our residents, patients, and staff members: the PCR test.
In addition to the guidelines in our rehab and skilled nursing and assisted living communities, we perform surveillance testing of our home care employees as well as Residents and staff members of our independent living communities, all of which are excluded from the Department of Public Health (DPH) guidelines.
We continue to test more than is mandated by the DPH. We want to be as safe as possible and will continue these testing efforts.
- Following guidelines – We have also continued to follow DPH guidelines on room changing and co-horting. As of now, anyone that tests positive is sent to our former COVID-only campus, Beaumont at Worcester. There, we have one floor still reserved for COVID patients only, where state-of-the-art technology is being used and the most trained, experienced staff work. By doing this, we are removing Residents from the general population immediately to avoid potential spread and ensure that they are receiving the best care possible.
These Residents stay in the specialized care unit for ten to14 days, receive the best care from the experts, and return to their original community with a negative COVID test. We are fortunate to have this resource available.
- Leveraging educational resources – Because of our work with the state in creating the nation’s first COVID-only facility, we had and continue to have access to the best education possible. Staff members from UMass Memorial Hospital, who specialize in infection control and pandemics, trained all of our staff members on the proper use of PPE and additional information on pandemic prevention and procedures.
Nurses consistently wear the appropriate PPE when interacting with Residents, including face masks, face shields, gloves, and gowns. There are also PPE donning and doffing stations in each community.
The additional education and re-education of our staff members continue to be extremely important. Whether it be protocols on wearing masks, recommendations of additional PPE, or guidelines for reducing spread to family members, staff are constantly learning and understanding any information related to COVID to keep themselves and Residents as safe as possible.
What else we’re doing now
With the limitations on visitations, the nursing staff has become surrogate family to Residents. They constantly provide them care, comfort, and engagement. Even though we have visits, family and friends don’t get to come as often as they used to and aren’t as hands-on-involved, so nursing staff does it for them. They fulfill Residents’ emotional needs and go above and beyond to make sure they’re okay. They really have become family.
What we’ll do in the future
We will continue to follow new DPH and state guidelines as necessary. The new advancements of testing, co-horting, PPE acquirements, and more have all helped prepare us for a resurgence of the virus. The unique partnership we have with the state and UMass have afforded us different resources as we continue to navigate this new normal.
Brian Ashe, SALMON Health’s Regional Maintenance Director, has been hard at work implementing the processes and products necessary to ensure quality indoor air in all of the inside spaces on our campuses.
As part of our plan to keep the air in SALMON’s buildings healthy, we reviewed airflow on campuses to identify steps to improve indoor air quality and an air quality test was performed in June 2020. Here is what we are doing:
- Maximizing fresh air – Outside make-up air is regulated with an electronic sensor to let in maximum ventilation at all times. We have also opened all outside make-up unit dampers to maximum capacity
[su_quote cite=”Cambridge Air Solutions”]Make-up air is designed to “make up” the air in your interior space that has been removed due to process exhaust fans. This type of HVAC solution pulls in fresh, tempered air from outside your building to replace existing air that cannot be recirculated. A make-up air solution is recommended for buildings where environmental conditions warrant a greater need for ventilation not only to improve the quality of air within the building but also protect the health of those inside.[/su_quote]
- Replacing filters – Air handlers and HVAC units are equipped to use HEPA or MERV 11 filters. Filters are now replaced more frequently for a variety of units and applications.
- HEPA (high-efficiency particulate air) filters work by forcing air through a fine mesh and trapping harmful particles.
- The MERV system, standing for Minimum Efficiency Reporting Value, is designed to inform consumers about which environmental pollutants MERV-rated filters can trap. The system ranges from 1-16, with the higher end trapping most particles.
- Cleaning air handling equipment – We regularly clean the air handling units. One of the cleaners used is Nu-Calgon, which is a ready-to-use, non-abrasive, one-step cleaner and disinfectant for evaporator coils in small air conditioners, commercial air handling equipment, HVAC cooling coils, and refrigeration equipment. It has received EPA registration.
In addition, it has been tested effective against a wide variety of disease-bearing organisms, including salmonella typhi, methicillin resistant staphylococcus aureus (MRSA), pseudomonas aeruginosa, listeria monocytogenes. When used on environmental, inanimate hard surfaces, it exhibits virucidal activity against coronavirus when the treated surface is allowed to remain wet for two minutes.
It has also exhibited virucidal activity against Tuberculocidal activity, Hepatitis A Virus, Hepatitis B Virus, Hepatitis C Virus, Rhinovirus type 39, HIV-1, and more.
What we’ll do in the future
We will continue to monitor indoor air quality and be ready to make other adjustments to the current protocol as required to ensure safe and healthy indoor environments.
Housekeeping and Laundry
Key in all of the actions we are taking is making sure that the living and common spaces in all of our communities are made and kept as free from the virus as possible.
[su_quote cite=”Honorico Castro, Regional Manager of Housekeeping Services, SALMON Health”]Meticulous cleaning guidelines have not only kept Residents and staff members safe but have allowed for a safe space for family and friends to visit.[/su_quote]
We have been diligent in implementing new processes to help keep our Residents healthy. We have:
- Increased sanitation at all SALMON communities.
- Introduced new products to help disinfect, including electrostatic foggers and sprayers, microfiber mops, one-use microfiber wet or dry pads to reduce bringing germs and other bacteria from room-to-room, and HEPA-filter vacuums, which differ from conventional vacuums in that they contain filters that are capable of trapping extremely small, micron-sized particles. Also, we have always used hospital-grade disinfectant, now it’s used in all building areas.
- Enacted new policies, including tracking sheets for every area of buildings and a checklist to make sure everything in an area has been properly cleaned.
- Improved laundry procedures. The laundry department extended hours and adjusted areas in order to consistently collect, process, wash, dry, and hang Resident clothing and materials, as well as reusable PPE materials. We have also adjusted rooms and times so there’s never any cross-over between the two materials, resulting in laundry being done from 6am-11pm in some buildings. Housekeeping also cleans and disinfects washers and dryers and laundry areas when necessary.
What else we’re doing now
Our routine schedule is as follows:
- Housekeeping staff works according to the schedules of the community, usually from 7am-3pm and then additional personnel from 6pm-11pm.
- In the morning, the housekeeping staff removes all trash from the building, vacuums with HEPA filter vacuums, and replenishes paper towels, soap, and hand sanitizer.
- After all breakfast is complete, the staff cleans and disinfects dining surfaces with disinfectant and electrostatic foggers, sweeps and mops floors, cleans bathrooms, and performs the process again after lunch and dinner is over.
- Throughout the day, we consistently clean and sanitize high-contact areas, employing a specific protocol when using electrostatic spray that involves leaving the cleaner on a surface for ten minutes to activate effectively. We also use spray and disinfectant to clean rehab and gym equipment per request.
- Daily cleaning of Resident rooms following our eight-step room cleaning procedure is conducted. We also replenish any supplies they may need, and sweep and mop floors.
After each cleaning tracking sheet is filled out, housekeeping managers conduct daily quality assurance inspections to make sure that all items are completed and each area is cleaned properly.
What we’ll do in the future
We are committed to consistent education and training on cleaning procedures to augment our knowledge on what to do when there’s a COVID case. This infection control training has included handwashing, proper use of PPE, review protocol on staying home when a staff member isn’t feeling well, and more.
We will consistently check with clinical directors for the Center for Disease Control guidelines and always adapt cleaning procedures accordingly.
The health, safety, and well-being of our Residents is our top priority. We will continue to educate our staff on new protocols as they become vetted and available to help keep our Residents safe – and to discuss innovative ways to keep our residents healthy and engaged.