Dan Reingold is the chief executive of RiverSpring Health and a prominent national figure in the field of aging services. RiverSpring includes The Hebrew Home at Riverdale, a 750-bed nursing home in the Bronx, N.Y.
The New York State Department of Health reported on March 30 that more than 1,000 residents of state nursing homes, including nearly 700 in New York City, had been sickened by the coronavirus pandemic. Officials said nursing home residents accounted for nearly 15 percent of the state’s 1,218 coronavirus-related deaths at that time.
Gerontology Institute Director Len Fishman talked with Reingold on March 30 about the challenges of managing a nursing home in an area experiencing the nation’s largest COVID-19 outbreak. The following transcript has been edited for space and clarity.
Dan Reingold: A colleague used the expression that we’re in a whiteout. It feels like that – when you can’t see further out then the length of your hand and you put one foot in front of the other, get your footing secure, and then move the next foot forward. It’s really been quite staggering in terms of the magnitude. We don’t have the right equipment, we’re improvising, and so there’s a little bit of a feeling that we’re fighting a war without all the right ammunition.
LF: How do you think nursing home issues are being taken into consideration in the broad conversation about COVID-19?
DG: While hospitals are clearly the focus of so much of the media attention, and more particularly the public policy right now, I do hope that the focus will start to include long-term care. We’re taking care of entire populations that are the most at-risk and we’re not given the same gear, equipment, Personal Protective Equipment, that hospitals are given. There’s close to two million people living in long-term care, and I’m not even talking independent living. We’ve got to be able to take care of them, knowing we may not have a hospital as an alternative place to send them.
LF: Your state has directed all nursing homes to accept people who have tested positive for COVID-19. How are you handling these kinds of patients and residents?
DR: We actually didn’t wait for the mandate. We began last week to create a dedicated COVID unit, which we’re opening today in partnership with New York Presbyterian Hospital. Our feeling is let’s just go and do the right thing. That is to create a unit that can manage their needs coming out of the hospital and supply it with all the necessary protective gear we have.
LF: How many beds?
LF: How are you staffing this unit?
DR: The way we would staff any other unit, except we will have more equipment on that unit. We’re dedicating the requisite and sufficient amount of equipment to the staff there. And obviously we’ll help the staff. We’ve stepped up as they’ve stepped up from the beginning.
LF: Will all of the people occupying beds on this unit be hospital transfers?
DR: Initially yes. Then we’re thinking as cases come up positive in our population, we move them to that unit so we can concentrate equipment in one location, rather than having people don gear and then take it off and then put it back on. There’s very limited gear. The main concern for us is gear.
LF: Will you have ventilators in the unit?
DR: We don’t have ventilators. These will be people who will have been weaned off a ventilator.
LF: What are the specific Personal Protective Equipment problems that concern you?
DG: It started with masks and they continue to be a challenge because of the pent-up back orders. Gloves we seem to be okay on. The other difficulty is protective eye gear, face shields and disposable gowns, which people need to protect their clothing and bodies from exposure. Face shields and gowns right now are the most acute shortages.
LF: Do you imagine that you might enlarge the COVID unit or create another one?
DR: Yes. We’re talking about adding a second floor, which would be a 40-bed unit. In my opinion, having a second unit is a better way to provide care. And we’ve already quarantined other floors so it would be easier for us, if we did get a positive case, to simply move the resident to a floor that’s set up for COVID-19.
LF: Do you expect other facilities around the country to create COVID-dedicated units like yours?
DG: They’re either going to do it voluntarily or be forced to do it. Or their beds are going to end up being empty and they’ll be in very dire financial straits. Right now, the only people coming out of hospitals are likely COVID-positive.
LF: My understanding is that the state of New York has also directed that nursing homes are not allowed to test people coming from hospitals if they are stable.
DG: This reminds me a lot of the beginning of the AIDS epidemic in 1986, when nursing homes were petrified about bringing somebody in who might have AIDS. At that time, nursing homes were told that you can’t ask people if they have AIDS. But what you can do is treat everybody the way you would treat anyone, which is to take proper infection control protocols and implement them across the board. That’s what I think people have to do.
LF: How is your staff’s morale? Are you having people not show up?
DR: We are having a much higher rate of people calling out than we normally do. Some of it may be related to childcare issues. Some of it may be that we take a very hard line that if you don’t feel well, stay home. But then the third reason is, there’s probably a lot of anxiety out there. On the flip side, I’ve been making a point of walking every floor and speaking to every employee and they inspire me.
LF: Family and other visitors for your long-term care residents have been prohibited. How are you helping residents stay connected through that?
DR: We’ve developed a very robust interactive process of Facetime, Skype, Zoom. We have our therapeutic activity staff going to the floors and showing residents how to activate those things so that they can talk to their families. In addition, we’re doing a lot more activity programming on the floor – actually I shouldn’t say a lot more, all of it is being done on the floor. But in particular with the family, it’s about managing the technology, showing residents how it works and helping them get up and running.
LF: You are a national leader in the effort to prevent elder abuse and you were a pioneer in providing shelters for these elders. How is the pandemic affecting this problem?
DG: We’re seeing anecdotal increases in elder abuse, as we have in child abuse and domestic violence. We have families that are sheltering in place together, probably for the first time in a long time. Now there’s three million people unemployed who may end up having to go back to somebody else’s home or going to an older adult’s – a grandparent’s home. When you then factor in the anxiety and the fear and frustration, possibly the economic pressures, the recipe for elder abuse is much higher than it was before.
LF: Have the reports you get increased?
DG: We are definitely getting more referrals for shelter than in the past. We take that as being because of the current situation but it also could be a product of public awareness.
LF: A final thought, what else would help you, along with other nursing home managers and staff, get through this period emotionally?
DG: It would be good to know when the end date of this is coming. I think part of the anxiety and challenge in running a healthcare institution right now is not knowing when it’s going to end. When the surge in the hospital ends, ours is probably just beginning.