Preventing Covid-19 Infection in Care Homes: Is It Possible?

Covid-19 has been devastating in Care Homes in countries like Italy, the UK and the USA. The media has featured horror stories of Care Homes devastated by the virus, such as the one where the bodies of the deceased were left in their rooms while staff deserted the facility, overwhelmed by the sudden and overwhelming devastation of the disease on especially older people. With the death rate due to Covid-19 especially high among the older generation, there has been great concern about similar scenarios playing out in South African Care Homes.

The question that arises is whether it is possible to prevent Covid-19 infection in a Care Home for the Elderly or must we simply accept that infection is inevitable?

This is a question that has given us endless sleepless nights here at Resthill Memory Care. Taking care of our 26 residents who suffer from Alzheimer’s disease and other dementias is a big responsibility at the best of times. Add the spectre of Covid-19 and the effect it could have on the health and wellbeing of our residents, their families, the staff and ultimately the business, and it became clear quite early that e had to take drastic action. Our Director Esmarie Venier was quick to lock down the facility even before the official lockdown in South Africa was announced. This has subsequently resulted in a major change in the way the facility operates and has major implications for operations in the future. 

Resthill Memory Care is situated on a smallholding in Laezonia, which is in the far west of Centurion, Pretoria. In fact, it is just a stone’s throw away from Lanseria Airport. There are two houses for residents on the large property, one for those in the middle stages of dementia and a second for late-stage dementia residents. The directors/owners and the foreman live on the property as well, each in a house of their own. 

Being a little out the way has counted in Resthill Memory Care’s favour, as has the fact that the farm-like atmosphere provides numerous opportunities for physical distancing, working separately and having loads of fresh air. The fact that the residents are in two houses is also an advantage, as is the fact that there are only 28 residents. Two Care Worker rotations of 11 people each work in shifts, with gardeners and housekeepers a part of the mix. Management consists of the two directors, the foreman, registered nurse and Administrator.

If the Coronavirus is to enter the facility, it will have to come from outside. To reduce this risk all family visits were immediately cancelled, while staff started working on a two-week shift rotation. During this time they stay on the property for the fortnight so as to reduce the risk of infection. The nurse and Administrator also stay in, with weekends off every second week. Every member of staff signs a commitment letter in which they pledge to stay home while off duty and take extra precaution should they need to go out. The staff both on and off duty are required to do daily temperature checks and they keep a lookout (and report) any possible symptoms of Covid-19 infection.

Staff staying in on the property for two weeks at a time brought with it its own challenges. Providing suitable sleeping arrangements, catering for one main meal a day and keeping morale high has required a big effort by the management team. The staff must be commended for the way in which they have responded to the challenge. They understand the value of their work and the responsibility thrust upon them to ensure they themselves and the residents stay safe from infection.

This is partly due to the strict operating protocols which have been put in place. These include how to deal with deliveries, access control and disinfecting procedures. Other protocols cover a variety of issues including staff washing hands at least once every hour and disinfecting regularly in-between. Gloves, face masks and other personal protection equipment (PPE) have become standard and are in all probability here to stay. The staff are continually trained in hygiene and mask usage, while pertinent information  and articles regarding Covid-19 are shared and discussed.

This has been informed in large part by official information and legislation for Alert Levels 5 and 4. Going forward to Levels 3 and beyond these protocols will be gradually adjusted in keeping with legislation and advisories from the National Department of Health. Changes that may come are for example to move to one-week shifts until normal shifts can resume, allowing select visitors under strict conditions, restarting existing maintenance and building projects, and so on

Well before Covid-19 hit our shores, Resthill Memory Care switched their cleaning product provider to EcoZyme which specialises in enzyme-based products. Both houses were deep-cleaned and an anti-virus product introduced as part of the daily cleaning routine. Doing this meant we had a head-start on the Coronavirus and it has served us well so far, resulting in a continually clean environment for our residents and staff.

Complimented by strategically placed alcohol-based sanitisers and basins for hand hygiene, the team at Resthill is covering as many bases as possible to avoid a slip-up. Staff rotations are managed with the strictest protocols in place. The incoming team is pre-screened for symptoms and exposure risk before they arrive. As they report for their two-week shift, their temperatures are checked and their shoes and luggage sanitised. They get a refill of soap and sanitiser for personal use too. They then go to shower before they change into their work uniforms. and report to their posts. Care is taken so the incoming shift does not have contact with the outgoing team so as to prevent any cross-contamination.

There have been many changes in the way staff interact and care for the residents, too. Usually, residents of the two houses shared tea-times and a weekly braai, as well as having combined activities such as singalongs at the piano. Once lockdown was introduced, contact between residents of the two houses have stopped and each house now keeps separate from the other. This was done in order to reduce the chance of virus transmission between the two houses in the event of an infection occurring in one of them. 

Complacency is probably the biggest threat to preventing infection. Because Rsethill Memory Care exists in a kind of a bubble, things may appear safer than they might actually be, therefore vigilance is an essential quality to keep using. Staff need to be evaluated and gaps filled with training and improving protocols to suit the evolving situation. This can only be done if the whole team stays vigilant and honestly self-report for the benefit of improving the chances of preventing an infection.

Official projections show that the number of infection, and by implication the risk, will increase as the lockdown is relaxed. The peak rate of infections is only expected by September of 2020, with the second wave of infection expected in the new year. Our preparations therefore also take into account what to do in the event of a suspected Covid-19 infection. Creating a quarantine area for either staff or residents, quarantine procedures and planning for deep-cleaning are all part of the planning for such an eventuality, which of course we are striving our utmost to avoid in the first place.

There are so many unknowns about Covid-19 that nobody can say with any certainty that completely preventing it from spreading in Care Homes can be guaranteed with any certainty. We are learning as we go along and doing our best. Staying vigilant and consistent in our approach could be the difference between life and death.