A nursing home means a lot to a small town. It’s a place to keep loved ones well cared for and living close. It’s a significant employer offering a short commute. And it’s a place where history lives — where many residents’ and workers’ memories entwine.
George, Iowa, has that kind of place in its Good Samaritan Society location. Typically, about 30 people call it home — people who have deep connections in the community.
Mergen has been overseeing the operations of the building, the staff and the residents for almost three years as the administrator. In her work, she appreciates the people the most.
“We have really good residents and staff,” she says, “and our community has always been very supportive of our nursing home. So that’s always made it easy to be here.”
New challenges with COVID-19
When the COVID-19 pandemic came along earlier this year, however, Mergen faced new trials beyond her typical challenges of maintaining staffing and keeping up with changing regulations.
Staff members implemented new processes, such as employee screenings, and took training sessions specific to COVID-19.
Using guidance from the Good Samaritan Society and Sanford Health, Mergen’s location created a plan for three zones in preparation for handling any COVID-19 cases that might arise among residents. The zones, meant to prevent the virus from spreading, help keep employees and residents within an area of active infections or within an area of no infections to prevent cross-contamination.
As the George team readied its zones, some residents and their belongings had to be moved to other areas to make room for a “red zone” that could receive residents if they tested positive for COVID-19.
Communication is key
Mindful of how difficult it was for families to have to be restricted from seeing their loved ones, Mergen prioritized communication. She made sure families were informed beforehand about preparations and updated with changes.
Unfortunately, during a spike of COVID-19 cases in the county after the Fourth of July, Mergen’s communication eventually included the news that the center faced an outbreak. Her team had done all they could to prepare for the possibility, but the reality was difficult. Among the 11 residents who contracted the virus, two died of the disease. Seven staff members tested positive.
The staff members who could keep working were constantly on the run, walkie-talkies at their side. Employees in yellow and red zones couldn’t go anywhere else in the building, so green-zone workers would bring supplies to drop spots for them.
Mergen says the center was affected by the outbreak for a month. Staff found out about the first positive case July 11, and the last day of having a red zone — marking the end of 14 days without a new case — was Aug. 12.
“It feels like that four-week period was about three months long,” Mergen says.
An outbreak — considered to be at least three new cases in a week — in a long-term care center like Mergen’s triggers an infection-control survey by the Iowa Department of Inspections and Appeals. Mergen welcomed that audit because, while it seemed like her staff was following all of the guidelines, she wanted to know if they were missing the chance to do anything better to help prevent the spread of the virus.
The surveyor looked for things such as proper hand-washing, sanitizing, meal distribution and PPE use, along with the staff’s knowledge of PPE requirements.
After a day-and-a-half inspection, the surveyor found that Mergen and her staff were following all of the guidelines as they should be and doing all they could to prevent cross-contamination.
“We were told if it gets in your building, it’s going to be hard to contain. We knew that would be the case. But you still kind of feel like a failure when you’re like, ‘Why is this still spreading?’” Mergen says. “So it was a reassurance to us, for our staff, for sure. And then also to be able to tell the families and residents, ‘They had nothing else to offer us, either.’”
Staff steps up
Through the experience, Mergen says she learned just what a great team she has. She was able to bring in a few additional employees, but a lot of the regular team worked to handle the demands of staffing three different zones during that month.
George is “a very tight-knit little nursing home and community,” Mergen says.
“And I think that’s why, having that personal relationship, (the staff) are so willing to step up and take care of and work those extra hours. They’re exhausted, but they also care so much about the facility and these residents.”
The pandemic restricted families from seeing their loved ones. And for those residents lost to COVID-19 or other natural causes, the staff mourns for them and their families, Mergen says.
“You grieve for the family because we at least got to spend time with their mom or dad, or grandma or grandpa, and they really haven’t been able to,” she says.
Mergen is grateful for the community and family support shown to residents and staff during the pandemic. They received emails of appreciation from families, with offers to help. The center’s medical director sent pizzas. Families and the community sent flowers to the residents. Groups and families volunteered food and other supplies.
Now, Mergen says, things have calmed down. Cases in the county have slowed, and the nursing home hasn’t had any additional cases. Residents have been able to visit outdoors in person with family.
Reflecting on the outbreak, Mergen says her team has gained confidence and learned a lot about what worked and what they might do differently – if necessary – in the future.
“We obviously don’t want to go through it again,” she said, “but at least we know we can handle it if it happens.”
- Resident beats the odds to recover from COVID-19
- Providing home care for coronavirus patients part of the job
- Family thanks nurse for father’s end-of-life care