Inside One Nursing Home’s Fight to Keep COVID-19 Out

Providence Mount St. Vincent in Seattle is a large senior community for older adults. Known as “the Mount,” it is home to more than 400 adults who need some type of help with their daily living activities or require 24-hour care. The Mount has 215 skilled nursing beds and 109 assisted living apartments. It also has a transitional care unit for people discharged from a hospital who need rehabilitation services and/or additional nursing care before going home. There is also an on-site preschool for 125 children. Before the pandemic, the Mount provided inter-generational art, music and other programs that older residents and children participated in together. The pandemic has prompted a temporary suspension of the inter-generational programs.

Each of the Mount’s 500 caregivers has been responding to the COVID-19 crisis in different ways. Here, U.S. News profiles two of them: The nursing assistant who was inspired to care for residents infected with COVID-19 after his father suddenly died of the disease, and the clinical director who developed safety protocols under pressure to prevent the spread of the novel coronavirus.

Dorin Dobresenciuc | 38 | Certified Nursing Assistant

Losing his father suddenly to COVID-19 in April threw Dorin Dobresenciuc into a well of sorrow — and inspired him to care for nursing home residents suffering from the deadly disease.

In early April, as the COVID-19 pandemic slammed the U.S., Dobresenciuc worked as a caregiver at a nursing home in Seattle while worrying about his ailing father more than 5,300 miles away in Italy.

The elder Dobresenciuc had fallen ill, afflicted by a bad cough. His wife — Dobresenciuc’s mother — and other family members urged him to go to the hospital. But at the time, hospitals in Italy were in crisis mode, overwhelmed by COVID-19 patients. Believing that his condition wasn’t so bad, his father decided to ride out his illness at home. Within 48 hours, his condition worsened, and he was admitted to a hospital.

The elder Dobresenciuc never left. Two days after he entered the hospital, he died of COVID-19.

“His poor body just gave out,” Dobresenciuc says. “I knew he’d died, but I couldn’t believe it.” He was in his mid-60s.

As soon as he learned his father had died, Dobresenciuc tried to take a leave of absence from his job as a nursing assistant at the Mount. He made three separate flight reservations, but was unable to travel because the Italian government had virtually shut down air travel as part of its effort to blunt the spread of the novel coronavirus.

[Read: Meet Rana Awdish, a Critical Care Doctor on the Coronavirus Front Lines.]

His inability to mourn with his family deepened his sense of helplessness.

An outpouring of support from his colleagues at the Mount helped buoy his spirits. Seemingly every coworker — some of whom he didn’t know and had never met — reached out to Dobresenciuc to offer condolences and support.

A month later, he saw a chance to fight back against the deadly new virus when his contract with Providence was expiring. At the time, he was working as a traveling certified nurse’s assistant, going to different nursing homes throughout the country as needed, then moving on, typically after about three months.

Dobrensenciuc started working at the Mount in October 2019. Now, he was being offered a full-time position on the team.

By then, he had grown to love working at the Mount.

Dobrensenciuc accepted the offer to join the Mount’s staff — and volunteered to work in the nursing home’s COVID-19 unit.

“I wanted to do something for others that I couldn’t do for my dad,” he says. “In my heart I had this feeling, I wanted to fight against the monster that is this virus. I had a desire to fight COVID and make a difference.”

Before the pandemic, Dobrensenciuc typically wore scrubs at work. Now and then he might have worn a mask if he was caring for a patient with a communicable disease.

In May, to prepare for working in the COVID-19 unit, Dobrensenciuc and another nurse practiced donning and doffing personal protective equipment, including an N-95 mask, full gown and disposable gloves.

“It was a whole lot of work, and it was challenging because it was new,” he says. Dobrensenciuc, 38, had trained donning and doffing protective gear in nursing school, but had never had to wear it as a caregiver.

The Mount hasn’t had a resident test positive since May, so Dobrensenciuc’s stint in the unit was brief. Most of the residents in the COVID-19 unit were in their 60s to 90s. None were on ventilators, but many needed oxygen masks to breathe, he says. Some had difficulty finding a position that allowed them to breathe.

“You could see the fear in their faces,” he says.

In the COVID-19 unit, many of Dobrensenciuc’s tasks were the same as they would be in long-term care — he took vitals, made sure residents were comfortable and brought them food.

To boost the spirits of patients, sometimes he and other staffers played music and danced for them, part of a strategy to inspire those who were feeling well enough to get out of bed and go for a walk.

“I would have done that for my father,” he says.

[Read: Speech-Language Pathologists Join the COVID-19 Front Lines.]

Every time a patient was discharged from the COVID-19 unit, staffers lined up to congratulate them. Dobrensenciuc made a point of being on hand for every discharge, even if it was before or after his work shift.

With COVID-19 exacting such a terrible toll, it’s important to celebrate any cause for optimism, he says.

“If we don’t give the patients hope, we have failed,” he says.

Tanisha Mojica | 49 | Director of Clinical Services

Two weeks before the novel coronavirus became a household name, officials at the Mount were already preparing for the new threat.

In February, an infection preventionist with Providence, the nonprofit Catholic health system of which the Mount is part, advised Tanisha Mojica, director of clinical services, about the looming threat.

By the end of that month, Mojica and the Mount clinical team had launched new protocols including daily temperature and oxygen level checks of all residents to be sure no one was showing subtle signs of infection.

As the pandemic heated up, Mojica and her staff stayed up to date on the rapidly evolving advice from the Centers for Disease Control and Prevention and Washington state health authorities.

“We made a lot of changes early on,” Mojica says.

For example, in mid-March, Mojica and her team decided to suspend visits to the Mount, which upset relatives who’d no longer be able to see their loved ones in person. “This was a very difficult decision, and we made it quickly,” she says.

On March 27, the Mount reported a single confirmed case of COVID-19 at the facility. By April, there were 15 residents or short-stay rehabilitation patients and 10 caregivers who had tested positive.

In the first few weeks of the pandemic, seven residents died of the new virus. Most of them had an underlying condition — like diabetes or heart disease — that made them more vulnerable to serious complications from the new virus.

“As our numbers went up early on, there was constant pivoting, setting up hot and cold zones,” she says. Hot zones were areas where residents or rehabilitation patients who’d tested positive were quarantined for two weeks to blunt the spread of the new virus. Cold zones were areas where no one had tested positive for COVID-19 and no one was quarantined.

“At the beginning, staff were terrified. They weren’t clear on the use of PPE (personal protective equipment),” she says. The Mount also needed to stock up on protective gear like N-95 masks, gloves and gowns. The Providence health system provided significant amounts of protective gear.

Mojica, a former oncology nurse, is accustomed to multitasking and making decisions that have a ripple effect on a system, not just a handful of people.

Quickly, she and her team arranged to test all residents, staff members and rehabilitation patients for the new virus, to see just how widespread it was. In short order, they developed an on-site, drive-through system to test all 500 caregivers weekly. Staffers who tested positive were instructed to quarantine at home for two weeks.

Mojica and her team took other measures. Before the pandemic, the Mount had three primary entrances and exits. Mojica shut down two of them, making it easier to conduct temperature screening and symptom checking for all staff and other essential personnel. She also shut down the Mount’s salon, cafeteria, and its medical clinics for dental, optometry and other services. She suspended new admissions to the rehabilitation unit, which typically accepts 1,200 patients annually.

Once the Mount got a sufficient supply of masks, Mojica required that all residents and staffers wear them at all times.

[Read: Unsung Heroes Fight the COVID-19 Pandemic.]

The measures worked.

By June, the Mount resumed admitting rehab patients and new residents. Officials have temporarily suspended admissions several times when caregivers — most of whom were asymptomatic — tested positive. In October, the facility also started allowing outdoor, socially-distanced visits with family members supervised by staff.

No resident has tested positive since May.

While the battle against the new virus is still being waged, Mojica says she never doubted the Mount’s response.

“I knew it would be tough in the beginning, but I knew we’d get through it,” she says. “The employees here are among the most dedicated I’ve ever worked with.”

She singled out the work of Kaylea Watkins, the Mount’s own dedicated infection preventionist. Watkins quickly developed infection-prevention protocols — which she updated multiple times to adhere to constantly evolving federal, state and local guidelines. She also trained caregivers on the proper use of protective gear.

“It takes a village, and I’m part of a remarkable village,” Mojica says.

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Inside One Nursing Home’s Fight to Keep COVID-19 Out originally appeared on usnews.com

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