the assisted living playbook - geriatric medicine€¦ · the assisted living playbook josh allen...

The Assisted Living Playbook

Josh Allen RN C-ALDan Haimowitz MD FACP CMD

Hawaii ECHO LTSS COVID PreparednessMay 27 2020

Disclosures

• Josh: No disclosures for this presentation

• Dan: No disclosures for this presentation

Today’s Session

• Present our personal experiences with COVID in AL

• Discuss framework for ongoing discussions

• “Everything you wanted to know about COVID in AL but didn’t know exactly where to ask”

• Distinguish differences between AL and nursing facilities regarding COVID response

• Format

Our Experiences with COVID in AL

Josh

• 25 years experience in assisted living

• Registered Nurse

• Certified in AL by the American Assisted Living Nurses Association

• Clinical support to 350+ assisted living communities in over 35 states

Dan

• Free standing Memory-Loss AL : 90% COVID + 40% death rate Corporate not local leadership

• 2 CCRCs under corporate umbrella: outbreak at 1 AL, none at other, extensive local leadership involvement

• Free standing AL w/SNF and IL next door: local leadership initiated by Medical Director

The Playbook

• The Leadership Team• Sending residents home• Staffing• Staff education• Housekeeping• Testing• Cohorting• Medical Resources• Training• Reporting

• Staff lodging• Healthcare provider

notification• Medication management• Advance directive discussions• Hospice• Family communication• Don’t play the Blame Game• Resources (“PPE”)• Taking care of Staff• Taking care of the Leadership

Team

The Leadership Team/Sending Residents Home

• Differences in leadership

• “Interim” Medical Director

• Taking residents home/bringing back

Staff/Staff Education

• True disaster planning

• Typical educational issues

Housekeeping/Testing

• High on the list

• Testing policies

Cohorting/Medical Resources

• Difficulties in AL

• Medical Care in AL

• Establishing priorities with limited resources

Training/Reporting

• Typical issues, but…

• Potentially less-trained staff

• Pearls

• Share reporting burden if possible

Staff lodging/Healthcare Provider Notification

• Ways to help staff

• Different ways to alert HCPs

Advance Care Discussions/Hospice

• Crucial

• More time consuming

• Hospice discussions

Family Communications/Don’t Play the Blame Game

• Liability

• The media

• Best practices

Resources/(PPE)

• Information overload

• Benefits of collaboration

• Identify 1-2 sources?

Taking Care of Staff/Taking Care of the Leadership Team

• Typical issues

• Similarities to “burnout”

• Pride/martyrdom

Things to Think About

• Unusual presentations

• Relationships with local/state/federal

• Standardization

• Get LTC “on the bus”

• Hot topic--Reopening

THANK YOU!!

Josh Allen RN C-AL

jallen@allenflores.com

Dan Haimowitz MD FACP CMD

geridoc1@comcast.net