08-06-2020 Doctors Without Borders: Support urgently needed to curb COVID-19 outbreaks in long-ter



THIS KUTE KID IS… Kathryn Ruhno, a graduate this year from Salem High School in Canton, MI. She will be attending University of Detroit Mercy this fall. Her sister, Emily, will be a senior at Salem HS. Katie’s parents are Kellie and Dave Ruhno, 1989 graduates of Watervliet and Coloma high schools. Katie’s proud grandparents are Bill and Vicky McDonald of Watervliet and Bob and Georgia Otte of Coloma. Katie’s family congratulates her on graduation from high school wishes her success and happiness at college.


Doctors Without Borders: Support urgently needed to curb COVID-19 outbreaks in long-term care facilities

The COVID-19 pandemic has wrought a disproportionate toll on one of society’s most vulnerable communities: elderly people living in long-term care facilities. In Michigan, where the international medical humanitarian organization Doctors Without Borders/ Médecins Sans Frontières (MSF) has worked for the last two months, more than 7,500 residents have tested positive for COVID-19 and more than 2,000 have died, representing nearly a third of all deaths in the state. This reflects reports of high nursing home deaths from COVID-19 nationwide. Building on decades of epidemic-response experience, and on more recent experience gained assisting care homes in Europe and South America, MSF supported more than 50 long-term care facilities—including 31 nursing homes and 24 adult foster care homes—in Michigan between the end of May and July 31. “We saw COVID-19 trigger an acute crisis on top of chronic neglect and lack of support to long-term care facilities,” said Heather Pagano, MSF’s emergency coordinator in Michigan. “At the start of the pandemic, long-term care facilities were left to fend for themselves without protective equipment or adequate infection prevention and control (IPC) training. Staff told us that they were overwhelmed and confused, drowning in guidance and regulations on safety measures from many sources, but without the on-the-ground support that can make all the difference.” MSF mobile teams in Michigan provided direct, in-person support to improve IPC measures. The most common topics that MSF addressed involved proper separation of confirmed, potentially exposed, or newly-arrived residents, hand hygiene, and proper use of personal protective equipment. These measures help to reduce COVID-19 transmission in shared spaces. Practical trainings are essential for non-clinical staff as well as clinical staff. This is especially true for environmental services staff that have a pivotal role in infection control, but often do not receive dedicated training. Helping understaffed and overworked teams cope during a time of heightened emotional stress about the constant risk of COVID-19 for staff and residents was another key priority for MSF. MSF’s wellness officer engaged in active listening using a trauma-informed approach and provided stress-reduction techniques to staff and residents. Tools and short activities that the staff could use for self-help or for boosting the morale of the residents were also suggested. Long-term care facility staff faces a dual burden: anxiety and grief in their day-to-day reality, having lost colleagues and residents to COVID-19, while simultaneously enduring stigma in their sector. “We were terrified, but we had 100 souls counting on us and we couldn’t just walk away and lock ourselves in our home like everybody else was told to do,” said Connie Flanigan, director of nursing at Advantage Wayne in Detroit. “We had to figure out a way to get out here and take care of these souls.” “When I hear something that someone says about the nursing homes, I take that to heart because I work very hard,” Flanigan said. “My heart is here. I would like the public to know that when you can’t be here to be their family, we are. And we choose to be. We spend 12 and 14 hours a day here, because this is where we want to be.” Regulation and oversight play an important role in protecting residents and staff of long-term care facilities. However, punitive measures alone will not help under-resourced nursing homes perform better, nor will they address the challenges presented by this unprecedented global pandemic. In-person support is fundamental. “Just being there, in person, helping alongside the staff made a difference,” said Pagano. “Saying you’re not alone, we’re not here to punish you, we’r