Valley View/FMDH Address Concerns Surrounding Employee Safety

It has been a long five months for Valley View Home. Since the governor’s directives were issued in March and the Center for Medicaid/Medicare Services issued guidance for long-term care facilities during the COVID-19 pandemic, a toll has been taken on the care providers, staff, residents and loved ones associated with the facility.

As a direct result of the pandemic and the restrictions meant to keep the populations most vulnerable to the coronavirus safe, many of the residents have not directly interacted or had physical contact with their loved ones since March. The only exception to that rule has been comfort care—meaning a resident was considered within days of death—and other extraordinary circumstances.

In response to those restrictions, many family members have expressed frustration over measures to prevent infections at the facility by barring visitors, and they have pointed to instances in which the nursing home staff have not strictly abided by the governor’s directives such as wearing masks and social distancing.

Addressing those concerns, Valley View Administrator Wes Thompson sat down with The Courier to discuss, not only the policies in place to protect residents and employees at the home, but the procedures to enforce employee safety while off duty. Thompson also discussed the home’s financial situation and the effects the pandemic has had on Valley View’s resident census, employee retention and the bottom line.

Procedures to Protect the Home:

Thompson first discussed the ban on visitation at the home saying, “Honestly, Valley View gets to cop out on that, because we are simply abiding by CMS guidelines. We are following every one of those guidelines to the best of our ability.”

He added that the only possible way the facility will have visitation approved by CMS in the near future would be if they received point of care testing and could test everyone already inside and entering the facility regularly, if all the residents could physically wear masks and if the residents wanted to allow visitation.

Thompson said that even if those conditions were met the facility would not allow visitation out of respect for the residents’ wishes. A recent resident council meeting asked them directly if they would want to allow visitation if all the requirements for point of care testing and safety were met. Of those residents attending, all of them voted against allowing visitors into the facility even with testing, PPE requirements and strict safety procedures.

“So, even if we do get all of [the CMS guidelines met], we’re not going to allow visitation inside the facility,” said Thompson.

Inside Valley View Home separate measures are being taken to combat the potential spread of the virus from staff to residents and from resident to resident. Due to a recent possible exposure to an employee that was described as "a remote chance of infection" by Thompson, the residents were placed on a 14-day quarantine period where they were more or less limited to their rooms. That procedure was taken out of an abundance of caution and no one associated with the facility has tested positive for the virus as of press time.

During those two weeks, Thompson said the home is taking extra steps to ensure that residents are taken care of through direct care, activities, enjoyable meals and being alert to mental health and other issues that arise from isolation. He clarified that no resident is “restricted” to their rooms and they are free to come and go from their rooms without being stopped.

What the policy means is that common areas and the dining facility were secured, and activities limited to avoid gatherings and direct contact. Thompson added that unlike most facilities he has heard of, Valley View did not cancel activities but actually increased them to give residents a chance to enjoy their time one on one with activities staff.

“We actually increased activities [staffing],” said Thompson, “so that they can have more one-to-one with our residents.”

The home also requires a negative test for COVID before allowing a new resident into the facility. The resident must then undergo a 14-day quarantine within the facility and then test negative again before moving to their permanent home at the facility. That policy has reduced the home’s census, but Thompson stressed the importance of a strict policy to protect the residents already at the home.

Procedures to Protect From Employee Infections:

In addition to requiring and expecting all employees to abide by the governor’s mandates on social distancing, mask use and avoiding large gatherings in excess of health guidelines, the home has additional measures in place to screen for, detect and mitigate exposure while on duty.

One such example is temperature checks. Employees undergo screenings not only when they arrive at work, but they are rechecked for fever and symptoms halfway through their shift. Any detected symptoms mean the employee is immediately sent home and asked to get tested or quarantine for 14 days.

The facility uses an automated machine that scans those entering for fever and, if detected, alerts the individual, snaps their picture and the employee proceeds to the staff room only to be double checked and evaluated by the attending nurse on shift. If the exam and a secondary temperature check confirm signs of COVID, they are sent home. If they are cleared by the nurse, they begin their shift.

As for after hours, Thompson admitted that there are no requirements for employees to disclose instances where they did not abide by public health directives in their off time. He did say that any violation of those policies, if discovered by the home, would lead to a 14-day suspension without pay in order to protect the residents from the virus. That means that employees are required to follow all public health directives to guarantee resident safety.

As a result of recent events, the home has implemented the policy of requiring off-duty compliance with the governor’s and public health officer’s orders and enforcing non-compliance with a 14-day non-paid leave policy.

“My expectation of employee behavior after hours is what every employer in this pandemic hopes and dreams and thinks about every night before they go to bed, if their lucky enough to get a good night’s sleep, because all we do is stress on it,” he said. “We hope that every single employee conducts themselves even more vigilantly than abiding by state and government guidelines and procedures. Instead of six feet, I’d like to see ten feet; instead of a mask just dangling, I’d like to see that it’s covering the nose and mouth; and as an employer I would wish they just simply would not go to any bar or restaurant that has too many people where you know that even if you try to keep yourself isolated they’re going to get close to you. But my expectation is that they would [do more].”

Thompson ceded that it was impossible to require employee behavior after hours and that enforcing those expectations was impossible, but it is within his power to control whether or not those employees are allowed back at work if they violate the governor’s orders. He insisted that any employee known to have ignored those guidelines was not allowed in the facility and that, of the cases brought to his attention, all were working from home already and were not returning until their 14-day period had passed.

The same is true for employees who were believed to have come in contact with positive cases. Any suspected exposure means the employee is sent home and, even if they test negative, are required to stay home for the 14-day period.

“People need to understand that employees don’t want to put themselves at risk,” explained Thompson. “That’s not anyone’s intent, it’s not, but it happens and it’s going to continue to happen for all healthcare facilities. The only thing we can ask for is for them to man up and let us know, which is hard to do, especially if there’s a single income family and they know it’s going to hurt their bottom line. Fortunately, I have a good amount of mature staff that are working diligently with my human resources to get this accomplished.”

“When, Not If”:

Thompson speaks about a coronavirus outbreak in Valley View as an inevitability. “When, not if,” he said, when discussing the outlook for infection. The facility has run on the intent that they will prevent the infection from reaching residents until a treatment or a vaccine is discovered, but Thompson has little doubt that as infections spread the disease—even with all the procedures in place—will reach Valley View Home.

When that happens, Thompson is unsure what the outcome will be. He knows that the facility will do what they are currently doing to mitigate the risks. Residents will be encouraged to isolate; visitors will remain barred; and employees will be screened and expected to mitigate their risk of exposure outside the facility. But a response is an unknown. In facilities where COVID-19 has wreaked havoc, the response was a matter of mitigating further infection, but treatment and vaccination are still too far in the future to plan for.

Thompson said he is encouraged by the fact that he is able to communicate with other long-term care administrators, learn from them and share ideas with them on how to affect a positive outcome from the coronavirus pandemic.

“What we’ve learned together—combined—is that when, not if, when a facility does get exposed to COVID-19 the first thing that goes down is staff and what happens to these poor facilities is that the residents are now being taken care of by people who have no rapport or investment with any of them.”

He added that often times the replacement caregivers are contract nurses from out of state which exacerbates the risk of infection or members of the National Guard which is disquieting to many. “None of these are good for residents,” added Thompson, “who have spent their entire time living in that home with certain staff.”

To limit that outcome, Thompson said the home is trying to split staff from working within the facility and not working within the facility. By way of example he highlighted maintenance, activity and dietary staff which he has limited inside the facility at the same time. He has also tried to keep a portion of staff and nurses in reserve in case of such a scenario.

The Bottom Line:

The most immediate effect of the COVID-19 pandemic on Valley View has been fiancially. In response to mitigation efforts and procedures the home has implemented policies that have taxed the facility's resources and hurt the “bottom line” as Thompson referred to it. Mitigating those impacts has been a series of policies and relief packages doled out by the state and federal governments.

“In 2019, it was an amazing year,” said Thompson. “The census was outstanding, the bottom line was phenomenal, the Medicaid rate increased, everything was going great... and then the pandemic.”

The administrator said that the numbers at this time are difficult to define and VVH is operating on a day-by-day basis. The initial budget plan had to be scrapped and expenses like overtime, PPE, added staff and safety procedures have taken a toll. The home is spending an additional $50,000 to $70,000 a month in added expenses.

To illustrate the significance of those numbers, the levy passed in 2018 to assist the home financially was only for $300,000.

“That expense is related to having to pay tons of unemployment,” explained Thompson, “and things people don’t think about, myriad of disposable utensils, extra linen, tons of extra PPE, and more importantly tons of time.”

Thompson explained that even though added safety measures only take about 30 seconds, the cumulative effect over all the staff, multiple times a day wreaks havoc on payroll expenses. Couple that with employee attrition and a lowering census, the effects become serious.

The financials are not all doom and gloom explained Thompson, the federal government has offered temporary relief through federal programs that absorb some of those costs, but they are only temporary. To jumpstart financial security during the pandemic, the home received $290,000 as a grant in April for the increased operating expense. Since then they’ve received the payroll protection program loans, also received an extra $40 per Medicaid bed. That total adds on between $32,000 to $41,000 extra income a month.

“So, if you remember at the beginning of this conversation I told you that we have an extra 50 to 60 thousand dollars in operating expense,” reiterated Thompson, “we’re also getting an extra increase of 30 to upwards of 40,000 as well. So, that bottom line isn’t bleeding yet.”

Thompson delivered the dilemma facing the home in as concise way as possible while discussing the 14-day quarantine for all new residents—a fact he says has pushed the census down but is necessary because his response needs to be perfect. “Again, I need 100 percent,” explained Thompson, “not 99.9 percent, I need 100 percent safety before we allow that resident within my regular population.”

Thompson emphasized across the interview, that perfection applies to all of Valley View’s procedures regardless of the costs.

Concerns regarding employee conduct after hours were also raised surrounding Frances Mahon Deaconess Hospital staff. In response to the Courier, FMDH released the following statement included here in its entirety:

“Frances Mahon Deaconess Hospital’s vision is to be the best place to work, the best place to practice medicine, and the best place to receive care in rural America. We work every day to attain this vision, and while we cannot dictate what staff do outside of the workplace, we want you to know that FMDH is committed to providing you the safest and best care possible. This means that all of our employees follow very strict precautions while inside of our facility. Every FMDH employee is required to daily monitor and report their temperature. Additionally, all staff wear cloth, surgical, or N95 face masks, depending on the situation. Personal protective equipment such as gloves, gowns, and eye protection is supplied and used appropriately to care for each and every patient that enters through our doors.  We have altered policies regarding use of sick pay, encouraging staff to stay home when any symptom or possible concern is apparent. We have also expanded remote worker opportunities, keeping staff off site when possible. In addition, we are in constant communication with staff regarding the latest pandemic news and research from the CDC and other health authorities. We are honored to be able to serve this community, and take the responsibility of providing the best care possible extremely seriously.”