Key Takeaways from an Assisted Living Facility Owner

In the early days of the COVID-19 pandemic, we were shrouded in the darkness that utter uncertainty inevitably brings. As an assisted living facility operator during a global pandemic that affected residents in Florida facilities to the tune of 35% of all Florida deaths, more was unknown than known. And while state government offered little transparency in a way that would yield the sort of guidance needed to navigate the pitfalls of a public health crisis, I made the conscious decision to take action.

Being Proactive, Rather than Reactive

I had started following the COVID-19 news in January of 2020, when few had even heard of it, and with increasing urgency in February. We conducted refresher trainings with our staff during this time, and began stocking up on PPE supplies and tracking back-orders.

As I evaluated the risk profile explained by the CDC and the definition of community spread (even though our Governor would not publicly acknowledge that Florida was experiencing community spread), it was obvious we were living through it. I felt a responsibility to read the signs and take continued action, regardless of government inaction. Before we were required, I began screening visitors and vendors for possible exposure. In doing so I ensured open and honest communications with our residents and families, so they would understand that we were being proactive. “Better safe than sorry” became a motto used often during that time. Now, I look back with appreciation for the support of our families, who understood these efforts and adjusted quickly to the new means of communication. We proactively scheduled Facetime video calls with each of our families using our in-house I-Pad.

In March, we cross-trained staff to have the ability to act in various roles in the event we would encounter a shortage of staff due to sickness. We also updated our emergency plan for creating a self-contained wing, should we need to care for known COVID-19 infected residents who could not be discharged to a hospital due to lack of available beds. This included creating our own version of “negative pressure” rooms. We scheduled “shopping runs” for our residents to place their “personal shopping orders” with a designated staff member who was prepared to carefully minimize their exposure while conducting these shopping trips on their behalf.

As always, I remembered that knowledge is power. And as such, we maintained regular open and honest conversations with our staff, establishing trust and commitment. Each person committed to maintaining a “bubble-like” lifestyle to help shield us from exposure that would eventually bring the virus into the workplace. I also invested in hardship stipends so that each staff member would be able to “stock-up” at home with the supplies to keep themselves and their families safe.

By the first week in March, we had closed our doors to guests and all but essential vendors, before the State mandated such actions.

Facing Uncertainty with Stress Management, Information, and Communication

It became obvious to us by May that this emergency was unlike anything we had been accustomed to in the past in preparing for, and managing, emergencies caused by hurricanes (a fairly common occurrence in the state of Florida). Unlike past storms, this was not like a period of preparation, experiencing the storm, and responding to the aftermath within a period of a month or two. It was clear our periods of preparation, experience, and response to COVID-19 each had no real end in sight. We also saw with abundant clarity that we were not dealing with the geographical, relatively limited path of a hurricane, and that this worldwide global pandemic would require far more resources for recovery.

We understood that this uncertainty would lead to stress and fear not only among our residents, but also among our staff. As a consequence, in addition to cross training our staff, we began coaching them on various coping skills to manage stress more effectively. We routinely asked not only how they were doing, but also how their families were navigating the incredible amount of stress that was building in us all. We sought to help them balance those challenges in the face of our commitment to live in a “bubble” in the interests of protecting each other and our residents.

Further, I continued to maintain a rigorous data and information evaluation schedule that entailed daily reviews of several primary information sources, such as the CDC and the Florida Department of Health, as well as disseminators, such as the Health Care Association and the Florida Assisted Living Association. Often, this resulted in an exercise in “information overload” that left me completely exhausted, but ultimately, better informed than if I waited for other, largely unreliable, sources to provide information. I needed the ability to make adjustments to our operating protocols in a moment’s notice, and needed reliable, accurate information to do so. I was also able to use this information in my ongoing communications with our residents and their families, so that they could make the most informed decisions, and trust the fact that we were doing the same.

The Common Threads of Crisis Management

As we tentatively approach the other side of this life-altering event, I can say with humility and fulfillment that I was able to lead through the uncertainty of that first surge with no infections and no deaths from COVID-19 in our staff or residents. With gratitude, I thought about the common threads in the actions we took:

Leading with my heart, as if my mom was living in my ALF, through this and with my mind, by following facts-based guidance.
Detailed attention not only to the problem, but also to the management and resolution,
Reliable, accurate information gathering and dissemination by vetting sources,
Proper training and communications,
Early investment in resolutions (PPE, hardship stipends), and
Thorough coordination among all the key stakeholders.

When I examined these common threads, I realized that we did, and still do, have some certainty after all. These are no different from navigating any crisis, whether it has a foundation in health, finance, business, education, natural disaster, or career. It reminded me that we have the resilience not only to manage a crisis, but to educate ourselves through the process. This is one of the key takeaways I will choose to remember from an unforgettable time.

Until next time, stay safe and, please stay educated – lives depend on it!

We are living through daily unprecedented actions in an uncertain time. We hear updates from the federal government, state government, school districts, professional sports teams, and retailers on nearly an hourly basis. We feel the need to help and protect those most vulnerable. Our instincts tell us to get out there and do something; band together with our friends, our community, and take concerted action. However, this unique instance mandates the exact opposite–stay home, stay isolated, and wait. Our call to action is … inaction.

Currently, the underlying psychology of most individuals, no matter where they are in the world, is one of fear–fear of the unknown, fear of scarcity, and fear of the consequences of a lack of critical thinking ability. This is all exacerbated for the residents of assisted living facilities and for the families who love them. These families have one less freedom they had a week ago. They can no longer decide to visit a loved one whenever they please. In fact, they are being ordered not to do so. The choice was quickly, but necessarily, taken out of their hands, leaving them powerless to make the simple decision to visit their mom, dad, grandmother, aunt, uncle, or other loved one.

To help cope with what is happening in our lives and the world around us, we must better understand the fear that is pulsing through our veins. First, is the acknowledgment that we are feeling anxious because we are scared. Recognize that while fear is an emotion that exists to protect us, it creates uneasy feelings and corresponding physical responses. We should also try to identify the source and what is driving this emotion. Not knowing what is coming next for ourselves, our loved ones in an assisted living facility, our community, our economy, and our country is a terrifying place to be. And, we are there.

Additionally, if we haven’t seen empty store shelves firsthand, we have certainly seen the pictures on the news or social media. Shoppers aimlessly pushing empty carts through a myriad of bare-shelved aisles with dazed expressions on their faces. Is this our new reality? What if we need something and cannot find it for ourselves or our loved ones? Where do we go? What do we do?

When fear increases, critical thinking inevitably decreases. We operate in “fight or flight mode,” powered only by a rush of adrenaline, not by critical thought. Think, for a moment, about when you are facing one of your fears. We do not think logically; we think only about how to survive the situation. While this is essential to our well-being, it is not a place of rational, calm thought and decision-making ability. Rather, the body’s sympathetic nervous system is activated, with physical consequences, including rapid heartbeat and breathing, pale or flushed skin, and trembling, among others. To mitigate that response and return to the critical thinking process, we must practice mindfulness by acknowledging where we are, staying present, and focusing on the body and our breathing.

Nothing is more important in overcoming fear than education. Education means the attainment of knowledge. What it does not mean is inundating ourselves with any and all news media and social media sources. And, when it comes to educating ourselves, we should focus on quality, not quantity. To that end, trustworthy, primary sources of information are the only sources that should be relied upon. In the case of the COVID-19 worldwide pandemic, reliable sources include the Centers for Disease Control and Prevention (CDC), the Florida Department of Health, and the assisted living facility in which your loved one is a resident. Of course, we will all listen to news media, but remember this is a secondary source. Additionally, be cautious of the amount of time you devote to listening to the news, even if it is merely background noise. We cannot overexpose ourselves to constant news, stories, fears, and warnings. Doing so will only increase our anxiety. In fact, we should limit our news updates to once or twice a day.

To ease feelings stemming from a fear of scarcity, educate yourself by reviewing your business or family emergency plan and establish existing inventory. For businesses, before triggering emergency plan orders modeled upon hurricane preparedness and exacerbating supply chain flows, discuss with suppliers what they are seeing in the supply chain. For individuals, evaluate what is needed to have a potential fourteen-day self-isolation window. Literally sit down and count how many wipes, how many hand sanitizers, and how much food and other necessities are needed in the course of a day and extrapolate that by a minimum of fourteen. Then, go to your pantry–it was amazing to me that I had a full week of meals already in my pantry and I did not need to go to the grocery store!

The best way to educate yourself with regard to your family member or friend in an assisted living facility is to communicate directly and regularly with your loved one and the facility, and listen to their direction. Your loved one is scared as well and needs to feel your reassurances and love. A lack of physical connection does not have to mean a lack of emotional connection. When you speak with the assisted living facility, understand that they are also fearful and doing the best they can with keeping you informed, while their primary concern must remain on keeping your loved one safe.

Assisted living facilities are working around the clock to help ensure the safety and protection of their residents. Some of the steps we are taking at our assisted living residence include, but are not limited to:

Following the guidance provided by Governor DeSantis and the Florida Department of Health by restricting visitors for the safety of assisted living facility and nursing home residents.
Restricting vendor access, where only after risk assessment interviews are conducted are vendors providing vital services allowed access.
Operating under our Outbreak Response Plans to: (a) reduce the likelihood of transmission among staff; (b) protect residents who are at higher risk for adverse health complications because of their underlying medical conditions; and (c) maintain business operations so the residents’ care is not negatively impacted.
Being vigilant and screening staff for signs or symptoms of a respiratory infection, such as a fever, cough, sore throat, or shortness of breath. Anyone displaying these symptoms is not allowed to work and sick time is available/being advanced if not yet accrued.
Implementing online training programs to reinforce the infection control practices that the CDC recommends for the facility.
Conducting ongoing screenings, risk assessments, and response planning until the COVID-19 outbreak is confirmed as contained.
Setting up a schedule of “face-time” and phone calls between family members and residents to ensure reasonable access.

I share these steps so that if you have a loved one in assisted living you can have a point of comparison about what reasonable steps you should expect to see and hear, to be able to advocate respectfully and in the spirit of partnership. In a time of uncertainty, we are each navigating the situation as it evolves day-by-day, hour-by-hour and we can rise to the occasion when we come together as partners with shared values.

At Indian Oaks Assisted Living, our values are Compassion First, Proactive Thinking, and Aim to Be Efficient. These values have served us well as we work together to keep one another safe and healthy, while caring for our residents. What are your values for yourself and for those you love? Remember them as you cope with your fears during turbulent times, such as this, and stand strong on the foundation which they provide. We will get through this and learn more about ourselves and each other through the process.

Until next time, stay safe and educated.