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Pandemic Blog
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HillHouse Pandemic Blog

Sunday, January 11, 2021 9:30 p.m. - It has been an eventful few weeks since Christmas, both at HillHouse and politically. On January 4th we began biweekly covid testing for all staff and that will continue until DHHS guidance changes. HillHouse expects to hear from Guardian LTC Pharmacy this week about our covid vaccine clinic date, which we so hope will be this week or next. We understand from news reporting that the vaccines are in the state, but the roll-out has been slower than expected. This Sun Journal article today is informative.

We currently have half of our 90 staff who have agreed to get the vaccine. Of course, we would like this number to be higher, but it is consistent with what has been seen across health care settings nationwide. Vaccine confidence is low as public health messaging targeted specifically to direct care workers has been lacking. We have encouraged family members to send letters of support to our staff and convey the sense of urgency that truly exists for families.

Covid is still rising around Maine and as a result residents must still refrain from all group activities. All staff continue to try and spend extra time with residents for socializing, but quiet days coupled with cold winter weather is challenging.  We urge families and community members to reach out with cards and letters. mlc

Thursday, December 24, 2020 8:30 a.m. - We are all working hard to maintain a tricky balance between being excited and energetic for the holiday and pressing the urgency to staff of being extra cautious at Christmas family gatherings. In the interests of keeping HillHouse safe from covid, we have asked staff to refrain from gathering with people outside their households or if they do gather, to be as careful as possible keeping masks on, maintaining physical distance, and practicing good hand hygiene. We have posted family cards and emails urging caution and expressing gratitude for staff efforts.

Our HillHouse Heroes #SaveOurResidents campaign is underway and we have hung these posters throughout the building. We have heard from Guardian Long Term Care Pharmacy that skilled nursing facilities will be vaccinated before assisted living, so HillHouse will likely be scheduled for the covid vaccine clinic in mid-January. This depends, of course, on the supply of vaccine to Maine. As of this writing, supplies are less than requested and expected and there is uncertainty about how this will impact administration of the vaccine around Maine’s long term care facilities.

In the meantime, however, we are urging staff to read about vaccine safety and we have posted information and provided links to the CDC website. Many staff are concerned; despite the scientific community’s evidence of vaccine safety, there is so much disinformation on social media that people are easily caught up in it. We will continue to seek out ‘trusted others’ who can convincingly convey the message of vaccine safety for direct care workers. This fascinating podcast from MedPage highlights the troubling efforts that the anti-vax community has made to undermine confidence in the convid vaccine.

Sunday, December 6, 2020 8:30 p.m. - It seems best to reinstate the Pandemic Blog now that covid cases are rising sharply throughout Maine and here in Sagadahoc County. Based on the current 28-day rates, Maine DHHS guidance requires long term care providers to again suspend all visits (except for window visits, including those in our sealed foyer), suspend group activities, and non-essential medical appointments. We are still allowed communal dining as long as residents are seated 6’ apart, as we have done all year. In addition, HillHouse staff are required to wear eye protection at all times when around residents, so we have offered staff a few options for safety glasses and face shields.

We are anxiously awaiting further news on vaccine distribution. There is mixed news this weekend out of Washington. The Trump Administration has said vaccine distribution for long term care settings will begin in late December or certainly by mid-January. The incoming Biden Administration sounds less hopeful and has expressed concern about the lack of a comprehensive vaccine distribution plan. While each state has submitted an Interim Vaccine Distribution Plan (click here for Maine’s), states are relying on the federal government’s procurement of the vaccine supply from the manufacturers and distributors once the FDA has approved them for emergency use. We are partnering with Guardian Pharmacy - our pharmaceutical supplier - to administer the vaccine. If Guardian is unable to do so, then Walgreens Pharmacy is the back-up provider.

This coming week we will prepare our internal covid vaccine administration plan modeled on the steps HillHouse has taken each year when CHANS administers the seasonal flu vaccine. We will poll the staff and encourage each of them to get the covid vaccine as soon as it is available so that residents are protected. We are searching for ways to persuade staff who may be hesitant and mistrusting of the speed in which the covid vaccine was developed.

The good news is that resident life is proceeding as normally as possible and the Social Services staff are rising to the occasion with 1:1 activities and hallway activities to keep the mood festive during this holiday season. Santa will be visiting at lunch on December 18th and handing out presents for all residents. Until then there will be lots of festive music, special holiday treats, and plenty of decorations. The staff are still doing short drives  in town with just one resident at a time to see the holiday lights.

This is a good time for all family members and friends to send cards and letters -- they are good for the soul AND they provide another opportunity for staff to pay a visit to a resident! mlc   

Saturday, September 26, 2020 8:30 a.m. - I’m not quite sure how a month passed in the blink of an eye, but it did. I had earlier - mid pandemic - signed contracts for my usual teaching responsibilities this Fall and I have been busy getting the semester underway. September 30 is also the end of HillHouse’s fiscal year and there are additional bookkeeping and accounting duties as a result.

Following up on our last Family Zoom call, here is a photo of the North Wing Garden space as of this moment. The contractors are on hold awaiting another shipment of the black grid material which is laid beneath the grass so that wheelchairs and walkers will have a firm surface. We hope the work will continue this coming week so the grass can be seeded and the mulch spread in places where there  will be spring planting . We are also finalizing a new north wing fire egress that will run from the north wing exit out to the old brick house driveway. The design and installation is a challenge given the steep grade of the land and the ADA requirement for a slope restriction of 1” in 20” (without a ramp and railing).

I also promised a link to the brand new Coronavirus Commission for Safety and Quality in Nursing Homes report. I have not had an opportunity to fully digest it, but will do so in the upcoming week. There is complimentary commentary on Twitter, but recognition that the report does not go far enough in addressing the isolation and loneliness issues facing older people residing in care homes.

Contemporaneous with the Commission’s report, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for Nursing Home Visitation which allows indoor visits under strict conditions. This guidance does not apply to HillHouse since we are regulated by the State of Maine, not the federal government, but we are following it closely and we are hopeful that Maine will issue similar guidance for assisted living facilities (ALFs). Please know that any limited indoor visiting on top of outdoor visits, window visits, Zoom and FaceTime visits and regular phone calls adds a layer of logistical complexity to the work of the Social Services department - so we ask for your patience!

We are in the process of asking each resident about whether they wish to vote in the upcoming November election. Our Social Services staff have approached each resident and asked if they wish to vote. If they indicate “yes”, we have requested an absentee ballot on their behalf. Some residents who wish to vote are not yet registered in the north Bath district, so we will work on that as well -- and we may need your involvement. Absentee ballots will be delivered to HH by the City the first week in October. We are reviewing our interview process for inquiring whether a resident has the capacity to exercise this fundamental right; we want to be certain we offer every opportunity within the legal framework for voting rights for people with cognitive impairment.

Be reminded that CHANS nurses will be at HillHouse on October 16th to conduct the annual flu clinic. We will reach out with permission slips as soon as CHANS makes them available to us. CHANS has confirmed that the high-dose seasonal flu vaccine is not available.  If you want more information about the high-dose vaccine, please reach out to the resident’s primary care physician.

The children of staff members are returning to the classroom and along with that come occasional reports of positive covid cases in local schools. This is unsettling to us and we are working on testing rubrics so we can best meet the twin conflicting, but critical, goals of keeping HH residents and staff safe from covid and managing the daily staffing demands. mlc

Sunday, August 30, 2020 8:00 p.m. - Will we ever get used to Maine weather that goes from oppressively hot to down-jacket-cold in the span of a few August days? Earlier this week, outdoor visits were cut short because both residents and visitors were cold; yesterday, there was torrential rain, and today one visiting tent blew over entirely in the brisk wind, despite the bucket of rocks weighing it down! We have now had a preview of outdoor visit challenges yet to come. I have ordered a new 10x15’ tent (with a window) so that both resident and visitors can be under one “roof” and still be 6’ apart. A single tent will make it easier to close in from pouring rain and easier to heat once we find a safe heat source (and a regulatorily compliant way to get power to it).

It may be of interest to readers that skilled nursing homes that are certified by CMS (the federal Centers for Medicare and Medicaid Services) are currently working through the federal (and state) phased reopening plan which requires, among other things, a testing plan for residents and staff, adequate staffing, and sufficient quantities of non-reusable PPE. This guidance does not apply to assisted housing sites like HillHouse, but the Maine CDC briefing this past Wednesday gave us the impression that it is being discussed. These Wednesday briefings are now on hold for an undetermined period of time, so it is difficult to say when and how we will receive continued updates.

On a recent stroll through Twitter, I found this NYT article about the success of local ‘strike teams’ responding to covid outbreaks at nursing homes. While our small Sagadahoc County Emergency Management Agency (SCEMA) does not have the capacity to coordinate this level of effort, nor does the HillHouse senior staff, it might be a perfect project for a group of local family members to take on. Some of you may have the time and mental space to embark on a public-private project with local law enforcement, health care, and private volunteers and plan for a rapid response should HillHouse or any of the other small facilities in the area have an outbreak and need immediate hands-on help. Give it some thought; I would be willing to help brainstorm and make connections with Sarah Bennett at SCEMA, and Chris Cummings at Bath Fire Dept, and the Lower Kennebec Age-Friendly Community volunteers.  Many of you have asked how you could be helpful, and this might be a perfect way. mlc

Saturday, August 15, 2020 9:00 a.m. - The overwhelming mood lately - everywhere, it seems - is one of weariness, exhaustion, frustration, sadness, withdrawal. The Covid news is alarming, the political news is downright surreal, and the ‘light at the end of the tunnel’ seems quite a long way off, if not out of sight entirely. The Irish poet, David Whyte, tells a story in his books about a conversation he once had with a Benedictine monk friend of his who said “the antidote to exhaustion is not rest, it is wholeheartedness”. I have been thinking a lot about this lately as those of us in the service industry are increasingly challenged to maintain energy and enthusiasm for our work, while staying informed and updated about the pandemic uncertainties and the very real difficulties ahead as we move into the autumn months and the flu season that accompanies them.

For us, maintaining wholeheartedness requires continual reorienting to the primary purpose of our work - creating a beautiful, comfortable, and safe space for our residents and staff. Every day we search for opportunities to make things look better; we are cleaning out, painting, replacing tattered furnishings, trimming grass in the overlooked places, and constantly tidying and organizing. Sometimes it is a large project, like cleaning up around the barn; other times, it is a small task, such as organizing files. This is - and will be - an ongoing slow effort as there is much to do and we cannot divert too many resources away from direct resident care; but it is happening daily. For example, new furniture, ordered before the pandemic, has finally arrived and our library space is looking lovely!

Our north wing garden installation is scheduled to begin in late August and that project will surely inspire us all. We have waited many years for this project to begin - there were many fits and starts - and while we will only do the earthwork, path installation, and fencing this year, in the spring we will begin all of the planting so that by next summer it can be in full use. Our goal is to create an easily accessible, safe, and beautiful space where any resident can walk (or wheel) in and out at their leisure.

Re visiting, there has been so much nationwide public discourse on loosening restrictions for visiting in long term care facilities, but no definitive move in Maine as of yet. Paula Span, a writer for the New York Times, published a piece just yesterday on this important topic. She interviews several aging policy experts who cite the harmful impact of prolonged social isolation and loneliness on older people. For those of you who are feeling particularly activist, you may wish to write to your legislators on this issue. Maine could follow the Minnesota model that allows some family members to be designated as essential caregivers so they can visit inside the facility. I am keeping my eye on Minnesota to better understand how this guidance is being implemented and whether they are experiencing challenges with it. I suspect many states have their eyes on this bold, but admittedly risky, initiative.

As I mentioned in our Family Zoom call last week, the Maine CDC is currently not issuing covid test swabs to residential care facilities, though I am not sure whether that relates to test availability, lab capacity, or something else. For now, our covid response remains the same: if we suspect that a resident has covid, we will isolate him or her in our designated isolation wing with our rapid response team staff members while we contact Midcoast Health System for testing and report to the Maine CDC for further guidance. mlc

Thursday, July 23 9:00 p.m. - In the Family Zoom call today we talked about the tragedy (and it is a tragedy) of being unable to be close to or hug those who are dear to us. We want to create some safe hugging mechanism. I knew I had recently seen one on social media and I have now found the article. This is a screenshot (the article is behind a paywall, though accessible through your library resources), but it appears to be simply a sheet of thick plastic. We will start thinking about how we can create something similar that we can easily disinfect.

The WSJ article describes what many of us already know about isolation and loneliness: it precipitates grave physical, emotional, and cognitive harm. We are left with a tradeoff of harms, all of which pose serious potential consequences. It is beyond frustrating that after five months, there is nothing to mitigate risk.

Regarding outdoor visits, please go ahead and schedule as many as you wish (for the time being). As we look at the schedule, there are still openings for next week, and several for the following week, even as many folks have confirmed weekly, recurring visits. If we find that we need to change this policy, we will post here.

We are waiting to hear back from the Maine CDC about the availability of test swabs that we can keep on site. Now that we have standing orders from most of our residents’ health care providers, we want to be able to implement those orders as quickly as possible, should the need ever arrive. More on that as it develops next week. mlc

Tuesday, July 14 2:30 p.m. - These two weeks have gotten away from me. They have been eventful in that during that time two much-loved activities staff members have given me their resignations. Both Brittany Morrell and Jen Stuart have resigned leaving a substantial gap in our ability to conduct outdoor and Zoom or FaceTime visits. We have advertised for their positions and we will interview this week and next. While we want to fill those positions quickly, we do not want to rush the hiring given the important - and expanding - work that must be done in this department. We are working on a transition plan that will put me and our Deputy Administrator, Kellie Stinson, in an oversight capacity until we get new staff hired and settled in. I will send out an email in the next day or so with further details about changes in our process for scheduling outdoor, window, and Zoom visits. More soon on that front.

For those of you family members who may have missed our Family Q & A Zoom meeting last Thursday, I can send you the video file to view; just send me an email. Thank you to those who participated; it is extremely helpful to work through your questions and make note of your concerns and your suggestions. We will adjust our visiting schedule time slots for those of you who want shorter visits, but in the interim, feel free to tell us how long you want to visit and our staff can help transition the resident out of the visit.

Betty is working on obtaining standing orders for Covid testing as urged by the latest Department of Health and Human Services guidance. The Department has asked all long term care providers to be prepared for having a covid positive staff member or resident so we can mobilize quickly to obtain the necessary testing. HillHouse is working with Midcoast Health System to train HillHouse nurses to administer the swab test (refresher training for some) so that we have in-house capacity. There are still many logistics to work out, such as obtaining the swabs, administering the test, choosing a lab that provides fast results, and delivering the test swabs to the lab in a timely way. As I mentioned in the Zoom call, we are hoping to receive best practice guidance from the Universal testing pilots currently underway with the Maine CDC and DHHS. mlc

Wednesday, July 1 8:30 p.m. - We have had three days of outdoor visits this week (mostly in the pouring rain!) with good success. We will continue to improve our processes in the upcoming weeks to get a smooth flow and respond with greater agility to people’s differing circumstances. Thank you, everyone, for cooperating with the many rules that we must impose to be compliant with the state guidance. As always, we welcome your suggestions. Please email me or bring your ideas to the next Zoom Family Q & A on Thursday, July 9th at 2:00 p.m. Please note that all outdoor visits must be scheduled in advance so we can be sure to have staff available to conduct the check-in and monitor the visit, as required by the guidance.

We are currently working with an infection control nurse consultant from Midcoast Health System to review our pandemic-related policies. She spent a long time in the facility last week and provided a follow-up report. She was impressed with our preparedness plans and our decision to keep a wing on our ground floor available for isolation should we have covid-positive residents. She did encourage us to have residents wear face coverings when in common areas and around other people, so we have now stocked the clean linen room with dozens of bandanas that staff will make available to residents each morning for use during the day (and laundered each night). This is really tough and makes communication difficult, but we will do our best. We will also try to create even greater distance in the assist-area of the dining room which may mean slightly staggering the timing of the evening meal, which tends to be more condensed in time than at breakfast or lunch. And we will continue in our efforts to improve hand hygiene among all residents. That has been, and will be, an ongoing effort.

The national covid scene is sobering, as you all know, and we are disheartened about the outbreak at BIW and nervous for HillHouse and for our community. We ask everyone - staff and families alike - to be ever vigilant when in and around Bath. There is no additional news this week about the universal testing pilot program, but we are exploring options for having our own nurses trained to do the covid swab test. We are not certain about the availability of test swabs if no one in the facility is symptomatic, but being able to administer the test on-site would be one additional way to be prepared. Family members and staff should feel free to let us know your views on universal testing in the facility; there are pros and cons, for sure. We hope to see many of you on the Zoom call next week. Spread the word and bring your questions and ideas! mlc

Wednesday, June 24th 7:30 p.m. - We sent an email this week about our outdoor visits program which will begin on Monday, the 29th. If you have not already heard from any of the HillHouse Activities staff about scheduling an outdoor visit, please send them an email or give them a call. They are fielding a lot of requests and many questions as we get underway, so we would all be very grateful for your patience. As mentioned in yesterday’s email, we will be hosting biweekly Zoom Q & A sessions for family members, so please feel free to attend and bring your questions. Refer to the email for the link (since this is a public facing document), or send me an email for the link. The sessions will be every other Thursday at 2:00 p.m. from now until early December. If the pandemic quiets down, we may move them to once each month, and if there are local spikes or if we get covid in the facility, we will have them more often.

The Maine CDC covid briefing for long term care facilities is held every Wednesday afternoon. In today’s briefing we learned that there is a 5-facility pilot program for universal covid testing currently underway. This means that 5 Maine facilities (we do not know which ones) are working with the Maine CDC to conduct regular (not certain of the interval) covid testing on all residents and staff. Our understanding is that they are trying to sort out which swab tests work best with an older, more frail population; what challenges or obstacles must be overcome; who can or should be doing the swabs; what are the protocols when staff or residents are positive for covid; what are the best practices for managing a universal testing program on an ongoing basis? I will post here as more information becomes available.

We are still looking for permanent staff in every department. While the current BIW strike has allowed us to temporarily fill a few positions, for the sake of the greater community and the BIW families, we hope the strike does not last long. Please pass along any referrals for people you know who are looking for work. If you follow us on Facebook, you may have seen this recent Maine Public article about how the generous state and federal unemployment benefits have impacted long term care providers looking for workers. mlc

Friday, June 12th 11:00 a.m. - The outside world is changing quickly. The Rural Reopening here in Maine is moving forward in the midst of public demonstrations and racial tensions, spikes in covid cases in hotspots around the country, and vocal divisions among those who want fewer restrictions and those who want more -- or at least to maintain the status quo. The world’s teeth seem on edge. Local long term care outbreaks in Androscoggin County are making us understandably nervous.

We had another covid-related All Staff Meeting here at HillHouse yesterday to update all staff on our continued planning efforts and immediate concerns about local retail reopening and the added risk for all of us working in long term care. We have asked staff to be extra-mindful of safety precautions as they venture out again; our hope is that many (most?) will voluntarily curtail their own outside activities to reduce risk of transmission here at HillHouse.

There is visitation news from Maine’s Department of Health and Human Services. Late on Wednesday, the 10th, we received guidelines for outdoor visitation in assisted living settings. We have discussed internally whether we want to cautiously expand visitation and include outdoor visits and while there are many logistics to work out, we agreed that residents and families would be grateful for the opportunity (and the results of the HillHouse family survey bear this out). The visits must be tightly controlled and will have to be very limited (due to limited space and staff), but we hope to pilot a limited visiting schedule beginning on July 1. We will send a family email next week with further details as we work out internal coordination among the activities, nursing, and facilities departments, all of which are likely to have a role in assisting with training, scheduling, monitoring, and disinfecting.

If you are a family member reading this, please bear in mind that, among other requirements, the visits must be scheduled in advance, in designated spaces only, supervised by facility staff, at a 6’ distance, and all parties must wear masks at all times. Please give us some time to create a policy and a protocol before requesting a visit. Implementation of new processes - especially those with such potential risk attached to them - always takes longer than expected! Thank you in advance for your patience. As always, be in touch with any questions; we are always happy to hear from families. mlc

Wednesday, June 3rd 8:00 a.m. - I had an appointment in Portland yesterday and I took advantage of the drive to listen to one of my favorite podcasts, NPR’s Throughline. Naturally, I chose the episode on the 1918 Spanish flu (named after Spain only because it was one of the only countries without a media ban on the outbreak). I do recommend it, although since it was recorded early on in the pandemic (March 26), it is far too hopeful about our country’s ability to unite against this viral common enemy. Now that we are 3 months into it, we are witnessing the unfortunate societal rifts that result from systemic inequities.  Mostly, though, I want to call everyone’s attention to the sign behind the nurses in the podcast cover photo below: “If I fail, he dies”. When I heard that phrase, and later saw this photo, my stomach knotted at the weight of the responsibility on all of us working in long term care, trying so hard to protect those most at risk. While we are following the guidance as best we can, the greatest threat comes from the community and from any staff and visitor unwillingness to take as many precautions as possible when in public spaces. Local businesses must enforce facial coverings and physical distancing so risk is reduced for everyone -- and we, the consuming public, should hold them accountable. Despite the nationwide tension right now, local commitment will go a very long way in insulating us all from covid risk.

We have begun asking family visitors to call ahead and schedule their visit at a particular time so that we can better manage the available visiting-window areas as well as staff availability to assist with phones and/or white boards. The Activities staff is still the main contact for scheduling and you can call our main number (207-443-6301) or email Brittany, our Activities Supervisor. We have opened up an additional visiting window at room G3, which can be best accessed from the old driveway in front of the brick house. We will add some signs this week. We are also seeing that other facilities around the country are building plexiglass visiting huts, so we will look into that as well -- it is great that folks are thinking outside the box (!) about how to increase contact with older people living in facility settings. As always, thank you for your continued support and please email us with your questions, concerns, ideas. We want to hear from you. I will post soon about the results of the family survey.  mlc

Monday, May 25th 9:30 p.m. - Thank you to all families and other visitors who have navigated the awkwardness of visits through the glass and talking on cell phones or with white boards. We do have other, slightly less accessible (for you) spaces to visit more privately (e.g. outside the north wing living room, or outside the ground floor solarium or apartment), so let us know if you have that need or desire. Some families have brought lunch and dine together through the window -- which is very lovely. We have a few spots we can set up for you, so let us know if that is something you want to schedule.

Last week we placed our usual PPE order of 1000 surgical masks from the Maine CDC. Long term care settings only ever receive 20-40% of what we ask for,  and we use 50-60 per 24 hour shift, so we must order 1000 to get 250. The shipment arrived, as it usually does, within a couple of days, but we did not receive surgical masks, we received KN-95 respirators (I have one on in the pic below) which, we later learned, was a substitute for the surgical masks (presumably because they were not available - we don’t know). The KN95s are the Chinese equivalent of the US N-95 masks that are in short supply all over the country. The KN-95s are designed to be heavy and quite tightly fitted to the face to avoid exposure to toxins or infectious agents. It is effortful to wear these masks and very difficult for the staff to communicate with the residents and with one another while wearing them. I applaud their willingness to keep them on all day despite the discomfort and we are hopeful that we can get the surgical masks with this upcoming week’s order.

We are now more closely monitoring staff and resident hand hygiene and we have adapted a hand hygiene audit tool from the federal Agency for Healthcare Research and Quality (AHRQ) so we can find the gaps and address them as best possible. It can be challenging to frequently wash the hands of some residents, but we are committed to doing better. I offered my own hands for the new handwashing poster 😉 mlc

Sunday, May 17th 11:00 a.m. - Spring has sprung this week, thankfully, and we have all been outside more often. We have had the fire pit going with s’mores and singing and we have had golf cart rides, and walks around the now-quiet circle. We have put up a rope and a sign at the circle informing everyone of our ‘No Visitors’ status, except for closed-window visits (with cell phones). As always, you are free to schedule a visit in advance or you can call us when you arrive and we will bring your family member to one of the four visit-windows. This is not an ideal situation by a long stretch, but we know it is better than no visits at all!

This past week we sent out a survey to family members inquiring about their views on several covide-related issues, including visits outside, at a distance, and with additional protections such as use of face coverings and screening of visitors. If you are a family member or close friend of a current resident and you would like to fill out the survey, please email me at mlciolfi@gmail.com and I will send you the link. We will collect survey responses until the end of May and then I will post the results, probably in a brief report so we can best preserve privacy of those who responded.

We are all very nervous about the current implementation of Rural Reopening that includes Sagadahoc County. We are uncertain what more we can do to reduce the risk to our residents and staff as staff spouses and adult children slowly return to work in the community. We continue to screen all staff for symptoms and we continue to wear face coverings inside the building. We are hopeful that the State’s new partnership with Idexx will offer opportunities for testing, but we have had no official word from the Maine CDC on that front as of yet.

Finally, can you help us get the word out that we are hiring in almost all departments? We have had little luck with online job postings such as Indeed.com and Facebook, so we think that word-of-mouth might help. We are quite in need of at least two licensed nurses (RN or LPN), Activities staff, and Housekeeping staff. If you know anyone who is interested, please refer them to the “Employment” tab on our website to fill out an application. We are looking for kind, patient, experienced individuals who are willing to give up their pandemic unemployment benefits to do the important work of serving others.  mlc

Sunday, May 10th - Mother’s Day 7:00 a.m. - Happy Mother’s Day to all of the mothers reading this page! It is surely so very bittersweet that we may be in touch with our mothers by phone, by Zoom, or on the other side of a window, but not be able to visit in person and hug them and hand them our gifts. Families can come to HillHouse today to visit through closed windows. You can just drop by and call us from outside or you can call ahead to make a planned visit. We have set up chairs outside four windows (2 on the right side of the front door and 2 on the terrace) and we can use our cell phones to call you so you can talk on the phone. We also have white boards available if, for whatever reason, the phone is not the best option for communicating.  Please do keep the windows closed; we know this is frustrating, but it is the safest thing right now - until we know more. We ask that you wear a mask when moving around the circle if there are other people out there, but of course you are free to remove your mask during your visit.

You will see that we have now roped off the circle; we are discouraging driving right up close to the building since on warm sunny days residents are often outside. Some residents can wear masks but many cannot due to health or cognitive conditions and we want to protect them as best possible.

In case you missed it, there is a NYT piece in today’s paper with photos taken by residents of an assisted living facility in Colorado. We all say it all the time, but these truly are such challenging times for every single one of us, and older people cut off from loved ones are impacted particularly hard. Please let us know if you have suggestions on how we can help you be in touch more often or more effectively. Meanwhile, be safe and be well. mlc

Monday, May 4th 8:30 p.m. - Some of you who work in hospital or environmental settings may know the federal law around the use of N95 masks for respiratory protection. The occupational safety regulations require that anyone whose job may require the use of an N95 mask must have a medical evaluation and be “fit-tested” for mask use because the mask can interfere with normal respiration. At the start of the pandemic, upon hearing of the scarcity of - but the need for - N95s, HillHouse put in a request for them through the only channel available to use, the County Emergency Management System. We were told that we could not obtain N95s until we were fit-tested, but our local Fire and Rescue (wonderful people, thank you for all you do!!), did not have the fit-testing solutions. Weeks passed. Finally, 10 or so days ago, Bath Fire and Rescue emailed to say they had the fit testing solutions and as soon as we had our medical evaluations in hand, they would come out to do the testing. Occupational Health Associates agreed to perform the medical evaluations for our Rapid Response Team members, and within  a couple of days, 6 of our staff were approved for N95 use. We have a dozen masks available and have now requested 50 from the Maine CDC. I’m not sure we will get that many - or any - but we are relieved to have gotten this far, given the scarce fit testing resources. As with all things covid, we certainly hope we do not have to use them. Use of respirators is unfamiliar territory for most - or maybe all - long term care settings such as nursing homes and assisted living facilities, so we are learning along with our community colleagues.

An update on outside visitors: As the weather has warmed up and windows are sometimes open during the day, there has been some confusion about what kind of visitation is allowed at HillHouse. Visits from family and friends continue to be restricted to visits through a closed window (with use of phone or white board). This policy has not changed since the start of our restrictions in March, though there have been a couple of exceptions for compassionate care, which we make on a very limited, case-by-case basis. We have now added a barrier at the entrance to the main circle to restrict the entry of cars when residents might be outside on warm days. If you wish to visit through a closed window, please call ahead and we will arrange to have your family member brought to one of several window locations around the building where these visits can take place. Thank you so very much for adhering to this policy. If you have any questions, please call and speak with the Administrator or the Nurse Manager. As Maine begins to “reopen”, we are fearful that our community may see a spike in cases. We would ask all HillHouse staff and family members to strictly adhere to Governor Mills’ order and also press the businesses you patronize to make sure they are adhering to state mandates for the reopening of their types of business. Thank you in advance for doing so. mlc

Wednesday, April 22nd 11:30 a.m. - Update on cloth masks for residents: we have not yet provided masks to residents. Today we will create a more thoughtful process for figuring out how best to take into account (1) each resident’s health and cognitive status, (2) their tolerance for wearing a mask, (3) how much assistance each would need with appropriate use, (4) each resident’s ability to express a preference, and, (5) when decision-making is impaired, how we can best involve family members. More on this later in the week.

For family members dropping off supplies and packages, you have two options: you can leave packages on either on the table set up outside the maintenance entrance (in front of the double doors) or the one outside the main entrance. If we are not expecting you, it may be best to call ahead and let us know where you are leaving the package. As an added precaution, we have been spraying packages with disinfectant before bringing them inside. mlc

Friday, April 17th - This is the first day that we have felt that we have enough plans in place and have done enough thinking through of the most likely scenarios (that we can possibly anticipate) and we can consider trying to get back to some of our regular routines, such as our drafting our weekly staff newsletter and planning for outdoor clean up and gardening. While we do not know what tomorrow will bring, we have followed the guidance and tried very hard to do the right thing for our residents and staff. On Tuesday, the 21st, we will extend masking to our residents (most of them at least) and launder their cloth masks daily. We will do our best with residents who have dementia or other impairment that would make it difficult for them to keep a mask on all day. Our staffing has been mostly quite good but we will try to hire a few extra staff for per diem hours should the need arise in the weeks ahead. mlc

Tuesday, April 14th - Today we institute universal masking at HillHouse. All staff will be required to wear a medical mask during their shift. HillHouse will provide one mask per day per employee. This process has been suggested by our colleagues at Mid Coast Health System and we have adapted their protocol to life at HillHouse. Since it is the staff who are engaging with the outside world during off-hours, if Covid gets into the building, it will likely be from one of us. Universal masking is one effort we can take to try and prevent that. HillHouse continues to receive several very generous donations  of cloth masks from community members and we have distributed a cloth mask to each employee for use on personal errands in public. We have asked staff to use those cloth masks whenever they are out in public places. Our employees have been very accepting of these new rules and we are grateful for that. The daily staff screening will now include a question about whether they are using a cloth or other mask when in public. We have also begun thrice-weekly temperature readings for all residents to help us keep on top of resident symptoms. When we feel confident that we can maintain a ready supply of thermometer probe covers, we are likely to go to daily temperature readings. mlc

Friday, April 10th - On Tuesday afternoon we received a shipment of PPE from the Maine CDC. It was worrisomely less than we had ordered and not enough for us to institute universal masking as suggested by our colleagues at Mid Coast. Today, however, we received an unexpected second shipment with an additional 500 medical grade surgical masks. On Monday we will begin masking for all staff in the facility, though we are nervous about how our residents with dementia will respond. We have also received several generous donations of cloth masks and dust masks from our community friends. We cannot overstate how grateful we are to all of you and a big thank you goes out to you from all of us ❤. The cases of covid-19 are increasing in nursing homes and residential care here in Maine and it is a frightening trend. We are stressing to all our staff how critical it is that they and their family members adhere to strict stay-at-home guidance and maintain social distance when on essential errands. We have sent out an email to family members to reflect on their wishes for medical treatment if their loved one at HillHouse has suspected or confirmed covid-19. We included the link to the Respecting Choices resource for assistance. Please let us know your thoughts about this. mlc

Tuesday, April 7th - We put in a request for PPE three weeks ago as suggested by Maine CDC. The request process was changed abruptly last week so HillHouse put in a new request with Sagadahoc Emergency Management Agency (and Sarah Bennett has been very helpful, thank you!). We heard yesterday that our request was acknowledged, but we do not yet know whether this means it has been approved or, if so, when we will get a delivery. We are ready to adopt Mid Coast’s suggested policy of having all staff wear masks, but we need the masks to do so.  We are beginning to issue cloth masks to staff to wear when they are off-duty and have to go into public places (e.g. grocery shopping). We have revised our screening checklist to ask whether staff are abiding by the Stay Safe at Home executive order. We are still free of coronavirus, but preparing as best we can for what appears to be the inevitable in the upcoming weeks.  mlc

Friday, April 3rd - As we look at the pandemic epidemiologic models for Maine and for the nation, it appears that we are heading into 2 or 3 weeks of peak illness. We have set aside four contiguous rooms on a separate wing that will be our “isolation” rooms if any of our residents have suspected or confirmed COVID-19. We have four staff members who have agreed to be part of our “Rapid Response Team”.  Should we have a resident who has to have isolation precautions, these staff members will be on 12-hour rotating shifts for that resident over the course of their isolation. They will be receiving ongoing training on best practices as guidance is updated from the National and Maine CDC. We are very grateful for their willingness to take on this risk on behalf of our residents and we thank them in advance. Members of HillHouse

senior staff participated in Mid Coast Health System’s webinar this morning for long term care providers. They advise that all facility staff wear surgical masks at all times. We will make a PPE request for additional masks through the Maine Emergency Management System, as we have been directed and institute this guidance when we receive the masks. There is a lot going on, but we are buoyed by our wonderful residents, dedicated staff, and supportive families. mlc

Tuesday, March 31st - Today we have decided we must limit even those few visits with residents that were outside at a safe 6’ distance. The alarming increase in coronavirus cases in Maine caused us to rethink this and with the Governor’s new

order this evening, we feel validated in our decision. We will still allow compassionate visits at end of life on a case by case basis, depending on family and

facility circumstances. We will be hiring more Activities staff so we can increase virtual visits. We will be taking steps tomorrow to see where we can create more social distancing among the staff (e.g. break room), though it is a challenge because we all must work closely together to exchange information, assist residents, prepare meals, and maintain operations -- but we will try to bring more awareness to our interactions with each other. We will update our staff screening questions to determine compliance with the Governor’s stay- at-home order that begins on April 2nd. mlc

Saturday, March 28th - Several staff members have agreed to cross-train in nursing and this is providing us a bit of safety net for the uncertainty ahead of us. A few family members and friends of residents have asked if they can visit outside within the 6’ social distancing rule. We are evaluating that request and will make a decision tomorrow, but based on credible media reporting and the continuing upward trajectory of confirmed coronavirus cases in the US and in Maine, we are likely to decline these requests unless there is a compelling reason in an individual case. We will still get residents outside with staff so they get fresh air and see the crocuses coming up. mlc

Thursday, March 26th - We are all fine and staffing is secure; all departments are stepping up admirably to fill gaps. Next week we will begin cross-training a few staff so that we have a safety net in nursing if some aides get sick or have to tend to sick family members. The warm sun today nudged a few residents outdoors with

Activities staff. We have many family members with regularly scheduled Zoom or FaceTime visits each week. We can also, with appropriate permissions, text a short video of your family member to you if you wish. Some family members are visiting on the terrace through the dining room window (each as a phone) and that has worked reasonably well. We have brought tulips inside to brighten things up a bit -- but this is, sadly, an inadequate trade-off for no family members. mlc