Nursing homes and assisted-living centers remain particularly vulnerable during the pandemic, but thanks to Meghan McCann, UNC Medical Center’s Vice President of Operations, Laura Hanson, MD, MPH, professor of geriatric medicine, and community teams with a proactive approach, residents and healthcare personnel have been supported in the communities that UNC Medical Center serves.
“I’ve never been prouder of the place I work, and our people,” said Hanson of efforts to do what was needed to support nursing homes and assisted-living communities in the early days of the pandemic.
McCann took the lead, coordinating with leadership teams and outpatient staff at the Respiratory Diagnostic Center, instituting a daily huddle that included skilled nursing facilities, nursing directors, medical directors, community health departments, EMS and emergency medicine.
“When we started, we were in crisis mode,” said McCann. “We had no formal relationships and we needed to quickly figure out who to work with at each facility, and assess needs early to prevent negative outcomes. We wanted to be sure facilities had the tools and information they needed to feel supported in their environment. In an outreach role, we provided guidance to facility leaders, to help them provide better care and protect patients impacted by the pandemic.”
This proactive approach meant daily huddle teams were able to monitor PPE supply, offer guidance on separating people effectively, and be sure that wellness checks were provided for staff. As testing began to ramp up, UNC sent swabbing teams to facilities to test residents and staff, and then returned the results in 24 hours. Hanson played a key role in the planning, working with at risk populations and their families, to care for patients according to their goals and values.
“Meghan brought me in to support residents in nursing homes who might experience COVID, and to partner with families by providing tools and information for advanced care wishes,” said Hanson, medical director of the UNC Palliative Care Program.
This meant recognizing that if a patient became severely ill with COVID, they had a choice that could be recognized in advance, to either stay in the nursing facility, remaining comfortable and in familiar surroundings, or go into the hospital.
“It was an extremely stressful time, with limited visitations, and providers really wanted families involved. But we were able to arrange video visitations, which were better than not visiting at all.”
Then as facilities became more stabilized, the huddles became less frequent, and learnings from the daily gatherings evolved into a playbook that could support system-wide care.
“If we had not held the daily huddles, the spread of the virus could have been worse,” McCann said. “When a director of nursing reached out asking questions, we were able to pull in an infectious disease specialist to answer them. Without Dr. Hanson’s calming presence, having conversations with family, patients could have been placed in positions that did not honor their wishes, and the system could have been overwhelmed.”
To recognize UNC Health’s long-term care guidance and response, the Chatham County Board of Health awarded UNC Health its “Community Health Partnership Award” on June 22. Mike Zelek, MPH, interim health director at the Chatham County Public Health Department acknowledged the partnership with UNC.
“Chatham County and all of us at the health department have benefited tremendously from your partnership throughout the COVID-19 pandemic, especially with regard to testing and LTCs, and additional initiatives like labor and delivery services at Chatham Hospital further highlight UNC Health’s importance to the Chatham community.”