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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
