A Look Inside Long-Term Care During the COVID-19 Pandemic

Dr. Kenny Kubitschek shares his experience in overseeing a nursing home amid the current public health crisis.

Dr. Kenneth Kubitschek is the chief medical officer of GPM, Corp. He also serves as the medical director of Stonecreek Health & Rehabilitation in Asheville, North Carolina, and oversees an internal medicine office in the area.

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UPDATE: May 18, 2020 – Two members of the Stonecreek Health & Rehabilitation kitchen staff have independently tested positive for COVID-19 following exposure to affected spouses and family members. The facility administration has decided to test every resident and staff member at the facility immediately to prevent the further spread of the virus. Fortunately, the five-person kitchen staff does not work directly with Stonecreek residents, which could help inhibit an outbreak. The facility also continues to follow strict safety policies regarding the use of personal protective equipment, restricted visitor access, resident isolation, and more.

 


Long-term care comes with its unique set of challenges, from its living community infrastructure to the high-risk population it serves. And in many ways, the current COVID-19 pandemic has exacerbated these challenges. Life Care Center of Kirkland, a Washington state nursing home, reported the first cases of the virus in the US. As the coronavirus continues to spread, long-term care professionals are faced with the difficult task of protecting nursing home facilities nationwide from a similar fate.

Dr. Kenneth Kubitschek is one of these professionals, serving as the medical director of Stonecreek Health & Rehabilitation, a nursing home in Asheville, North Carolina. Within five days of the coronavirus making it into national news headlines, he felt a dramatic shift at both his internal medicine office and the nursing home. At his office, patients were afraid to come in for appointments, staff were confused as to how they could go about securing and utilizing test kits and personal protective equipment, and he was faced with the responsibility of rapidly developing new safety policies based on constantly changing information. The nursing home faced even more concerns.

“Every patient that’s in this facility is high-risk,” he said. “The real challenge is if something were to occur, how do we successfully separate patients in a living situation like this, especially when many of them have dementia and tend to wander?” Add the potential for facility staff, who come in and out of the building daily, to serve as vectors of the virus, and the stakes move even higher.

Dr. Kubitschek quickly instated policies that modified the typical practices of the facility in a multitude of ways. He worked to secure adequate personal protective equipment for all staff to maintain their safety and the safety of the patients they cared for daily. Dr. Kubitschek heavily restricted visits from family members and other folks outside the facility – and faced a lot of resistance from them for doing so. He required that all staff be monitored for fevers and other COVID-19 symptoms before entering the building each day to prevent an exposure, and he developed a plan of action should a positive case present itself within the nursing home.

“We haven’t had an outbreak at my facility,” Dr. Kubitschek confirmed on April 21, “but without adequate testing, you don’t know what you don’t know.” Since Stonecreek has not witnessed any coronavirus-like illnesses or deaths among its patient population, it will continue to adhere to these new policies to protect its people. For instance, patients are dining alone in their rooms rather than eating in the cafeteria together, a shift that has led to unintended weight loss in some patients, likely due to a lack of motivation to eat in more secluded environments. With that said, no negative health consequences, such as an increase in falls or pressure ulcers, have been observed at this point.

Meanwhile, the facility staff are facing these unprecedented times admirably – “with fear, but fortitude,” he said. They have been remarkable in taking on the new challenges of their jobs in positive ways and really stepping up to the plate when they know the risks posed to themselves and their families. “I’m really happy with the job that they’ve done in taking care of the situation,” said Dr. Kubitschek.

The facility is also embracing telehealth in as many ways as possible to further protect its patients and staff. Telehealth technology has proven particularly beneficial in the behavioral health space, as geriatric psychiatrists are able to check in on their various patients effectively from afar. And gatherings like monthly quality assurance meetings are being held virtually to avoid congregating staff in the same area.

However, it’s not all smooth sailing. As telehealth visits increase, two questions remain: How do we bill for telehealth? And how do we ensure that we have the staff to support telehealth processes? Various insurance companies and the Centers for Medicare & Medicaid Services adhere to different regulations, so confusion reigns as to what providers can do. And even though telehealth promotes safer remote work, facility staff still need to be present to hold the tablet screen in front of patients so physicians can converse with them. “They’re not capable of doing this on their own,” said Dr. Kubitschek. “It takes resources, which puts further strain on the system.”

While these are trying times for long-term care practitioners, Dr. Kubitschek noted that they can keep working successfully with software solutions like GEHRIMED and CareTeam. GEHRIMED, our EHR platform, allows providers to access patient data regardless of whether they are in a facility. “Having GEHRIMED as your backup to take care of these folks and know what’s going on is extremely helpful,” he said. And CareTeam is a great communication tool that can help nursing staff and physicians continue to collaborate and access necessary data to take the best care of their patients.

Looking ahead, as the virus peaks and tapers across the country and states begin to relax social distancing policies, Dr. Kubitschek’s primary hope is that we can navigate the remainder of this public health crisis without a recurrence. He already feels a tremendous amount of pressure from families who want to see their loved ones, and as time marches on, he will have to prepare to open the facility to them again. Unfortunately, finding the balance between the desire for human contact and the need for minimal virus exposure is a tough task that has yet to be mastered.

Looking for the latest COVID-19 updates as they relate to long-term care? Visit our Coronavirus Developments page, and keep an eye on this space for future posts.