The Challenge: Social distancing, changing regulations, changing consumer needs, and financial pressures force providers to rethink existing service models and policies. They are reinventing themselves along the way.

Member Story #3: Helping Families Cope with Loss and Grief

Member Story #2: PACE Remains Open Through Coronavirus Crisis

Member Story #1: PACE Provider Adapts to Lockdowns With “Hopemobiles”

Member Story #3: Helping Families Cope with Loss and Grief

In long-term care communities, resident deaths have always been a fact of life. The coronavirus crisis added a new element: Along with additional deaths in some places, the shelter-in-place orders affecting nursing homes made the process of saying goodbye, and grieving, immensely more difficult for residents and families.

During the pandemic, providers have had to adapt to a new normal in which personal interactions, in many cases the most intimate and sorrowful ones surrounding death, must be done remotely.

For Tina Zimmerman, associate director of spiritual life for Chelsea Retirement Community, Chelsea, MI, the pandemic “changed a lot about how we do things, and help families grieve.”

“Our tradition is that on All Saints Day [Nov. 1], we honor all of those who passed away in the past year, naming names and lighting candles,” Zimmerman says. “This year we did it in April, and will do it quarterly from now on. We thought this was necessary because families can’t have closure—can’t have funerals or family gatherings anymore.”

The April service was recorded and streamed for residents and families, and the recording of the hour-long service is available here.

Led by Rev. Dr. Julie Kilmer, Chelsea’s director of spiritual life, the service included the names of all residents who had passed since Nov. 1, 2019. The organization’s executive leadership took part as well. Families were invited via email, and almost 400 people tuned in to see it live.

“It was also important for us to name those who passed away who were not COVID-19 positive,” Zimmerman says. “Their loved ones could not be with them either.”

Chelsea’s Spiritual Life staff traditionally makes condolence calls to family members. During the pandemic, says Zimmerman, the tone of those calls has changed: “People are grateful to know that someone was watching over their loved ones and to pay attention to who they were. We are inviting family members to share who their Dad or Mom was, and what they meant to them. To invite that sharing is one really powerful and necessary way to grieve. That kind of sharing is crucial for families, but also for workers, care staff, and other residents. They are used to gathering together for memorials and funerals. So if we can’t do that, it’s important to do individual stories.”

Zimmerman says that when a person is actively dying, only 2 family members are allowed to visit in person at any given time.

“In the case of larger families this can be really sad,” she says. “Our staff is always very determined that they will care for residents at the time of death, and this has been no different; they make sure the residents’ hair is brushed and her face washed. One worker made sure a resident’s toenails were painted, as she always had.”

Zimmerman tells the story of one dying resident, none of whose family members could visit her because all of them were immunocompromised. “One son could only come to the window,” she says. “It’s good to be able to say to that son that ‘Mom knew you loved her, and knew you were here.’ This is a compromise, but it’s not a complete loss.”

Member Story #2: PACE Remains Open Through Coronavirus Crisis

Huron Valley PACE, Ypsilanti, MI, operated by United Methodist Retirement Communities (UMRC), has continued to serve its members throughout the coronavirus crisis. It’s the only PACE in Michigan—out of 14—that has been able to keep its day health center open.

“Dementia doesn’t take a break during COVID,” says Sonja Love Felton, Huron Valley PACE executive director. “It’s very hard for families, even in the best of times, to care for their loved ones with dementia who may roam or become agitated. [We have] remained open to provide care and respite for our participants as well as families. Many simply don’t have any other options for care for their loved ones.”

The organization has offered overnight respite stays for 11 participants so far, and has increased its efforts to provide care and services in participants’ homes. Team members have logged more than 850 home wellness visits, which include help with a variety of activities of daily living (ADLs). Well over 3,000 meals and nutritional supplements have been delivered to 170 participants. Farm-fresh meals are prepared by Zilke Farms and frozen for delivery. More than 5,300 medications have also been delivered.

Social workers or other assistants help with delivering meals and medications. The clinic was open for people who need it, and OT/PT visits were held.

Grants from the Michigan Health Endowment Fund and United Way of Washtenaw County enabled Huron Valley PACE to boost its telehealth abilities. Participants can now visit remotely with the PACE clinical team, and social workers also host virtual caregiver support groups.

Donations from local businesses and organizations have helped the organization stock PPE, including face shields, masks, gowns, gloves, shoe coverings, and hand sanitizer. About 150 of Huron Valley PACE’s 200 participants have received COVID-19 testing, thanks to test kits provided from MLabs.

Felton tells the story of a PACE participant who had been exposed to someone with COVID-19, and the difficulty of finding a nursing home that would admit him.

“One nursing home decided to accept our participant, and told us we had to bring the person at 6 p.m., and then when we got there, we waited an hour and a half because none of the staff would come out to accept the person. The driver had to take the participant up to his room, and later we received a call informing us that they wanted to send our participant to the hospital, though the person didn’t have the virus.”

Huron Valley PACE then decided to convert its center facility to a 24/7 site, and also provide respite care for those caregivers who need it.

“We ended up having about 20 beds,” Felton says. “We have a secure area for dementia patients, so anyone with COVID-19 symptoms went there on one side, the other side was for people not with the virus. We got partitions from an ice rink, and we separated things off, with beds, pillows, nightstands, staffing, and food.”

Team members made masks and gowns, and figured out how to make face shields out of the plastic liners from paint trays.

The governor allowed day facilities to offer childcare. Huron Valley was able to set aside a separate part of the building to accommodate it.

Out of 193 participants, Huron Valley PACE has had 13 positive coronavirus cases, and 12 of those participants already lived in nursing homes. The 13^th participant, who lives at home, caught the virus from a family member, but has recovered. There has also been one death, a participant in subacute care. Only one employee got the virus, and has recovered.

Felton salutes her dedicated employees.

“We had a few staff who didn’t want to do it, and they took personal leave,” she says. “But the rest of the team thought, if we don’t do this, who will? This is what we signed up for. As ED, I kept bringing this back to our mission: Who’s going to deliver their medicine and food if we don’t?”

Member Story #1: PACE Provider Adapts to Lockdowns With “Hopemobiles”

Hope Healthcare, Ft. Myers, FL, provides hospice services in its own hospice houses and in patients’ homes, a PACE, and other home and community-based services. It has had to adapt to the cessation of its one-on-one, personal contacts during the pandemic.

According to Dr. Samira Beckwith, president and CEO of Hope Healthcare, one innovation her organization is piloting was inspired by her childhood experience with bookmobiles.

“For years I’ve thought we should have a sort of traveling provider,” Beckwith says. “I thought of bookmobiles when I was young, that were so cool. We have PACE buses that I’ve always called ‘Hopemobiles.’ Why not have a nurse on board, with different test equipment, who could go from home to home to provide services that we otherwise would [provide in] our PACE clinic?”

Hope Healthcare is using one of its buses, with a nurse practitioner and a driver. The bus is sanitized after every visit, and the one-way glass windows offer privacy.

Beckwith says she is thinking about other applications for this model, which could continue permanently after the crisis is over—activities, screening events, and more.

Beckwith was a guest on one of LeadingAge’s Coronavirus Daily Member Update Calls. She discussed many more issues relating to hospice and other home and community-based services, and how Hope Healthcare has dealt with them. Listen to her presentation here.

Visit our COVID-19 resources section for more resources.

LeadingAge wants to hear from you! Tell us stories of how your organization is adapting and innovating to manage with the coronavirus crisis. We are looking for stories about: staff management, worker welfare, and recruitment; childcare; care and services for residents and clients; personal protective equipment (PPE); communication; adaptation and reinvention of service models; food services; advocacy; resident engagement; and more.

Contact Gene Mitchell at gmitchell@leadingage.org or 202-508-9424.