An Inside Look at Hospitals and Nursing Homes

Mike Ellison:

For months now, doctors, nurses, hospital staff and first responders around the world have been on the front lines, working long hours with limited supplies to treat those stricken with COVID-19. We’ve heard stories about their heroism, but it can be hard to get a good look at what their daily lives are like. Today, we hear directly from those on the frontline.

Matt Heinz:

I’ve seen really impressive things from our healthcare community. Everyone’s showing up. No one’s quitting and running away. They’re coming into the hospital just like any other day.>

Hi, I’m Mike Ellison with an AARP Take on Today.

We’ve all heard how the pandemic has strained our health care system like never before. Doctors and nurses are up against a brand-new, fast-moving disease that has a long recovery time. They are working tirelessly -- despite isolation, exhaustion and risks to their own health -- in order to care for COVID-19 patients.

In your 35 years of nursing, have you ever seen anything like this pandemic?

Donna Russo:

I've been through a lot including the HIV crisis when that started, MRSA, the methicillin resistant Staph aureus, and other diseases that we didn't know a lot about in the beginning. But I've never encountered anything like this.>

Mike Ellison:

That’s Donna Russo. She’s the Director of Nursing of an assisted living facility for former first responders in New Jersey.

Donna Russo:

It was like a tsunami just patients started getting sick, staff started getting sick. And we had to take care of the patients. Thankfully, many survived and are doing very well, but we lost 23 residents to this disease. Yeah, 23 deaths in that short of a period of time and I've never been through anything like that in my life, so we go through all the stages of grief and death and dying when we lose a resident to any disease. But to have to go through it 23 times in a five week period has been, just awfully grueling.

Mike Ellison:

Not only has the pandemic been emotionally challenging for Donna’s facility, but they’ve also struggled with shortages of PPE, or Personal Protective Equipment. Today they have adequate supplies, but struggled to get there.

Donna Russo:

So for us here at the nursing home, it started on Friday the 13th of March and which I got a call that this COVID-19 was in the state of New Jersey and that we needed to start to be prepared. So that night, at midnight, I met our county operation emergency management team in the parking lot with our first delivery of PPE supplies. They brought us N95 masks which those of us that work in nursing homes are not familiar with having had experience for a long time in acute care, I did know what an N95 mask was, but nurses in nursing homes don't, to the best of my knowledge, ever have to wear them. They're more for people with like tuberculosis and diseases of that type. So we got our first delivery that night which was not enough to last us for very long because within three days we were hit with our first staff member and resident that lives here with COVID-19. The unknown was the most frightening part of it because especially back in the beginning, there was so muchs that we didn't know- And we were searching for PPE that nursing homes don't traditionally have and I had a telethon going in my office every single day, trying to get PPE from anywhere that we could beg, borrow or steal it to be honest, not steal but to be honest with you. And then nurses started coming down with COVID and patients very fast very rapidly, getting very sick and transporting those patients out to the hospital, dealing with EMT crews getting here to take the patient to the hospital and they were frightened and scared, and not very comfortable dealing with the patient.

Mike Ellison:

PPE shortages in the US have left many health care professionals exposed to the virus. But even still, doctors and nurses everywhere continue to show up to work, day in and day out.

Matt Heinz:

when I came out of the hospital this morning, I took off my external surgical mask, I took off the N95 I wear underneath that because I'm admitting people to the hospital, where we don't know their COVID status, we don't have any idea.

Mike Ellison:

That’s Dr. Matt Heinz - a physician at a hospital in Arizona.

Matt Heinz:

And it takes the test and we do have a rapid test thank God now that's finally something we can use in my facility that's been fairly new just over the past few days, actually. But usually before that had been sent out. So you have just the masks like a simple mask, the N95 type mask if you're going to be working closely with patients or... and I would say the people that need to be worrying about having masks, especially any sort of public facing role. So like I got some groceries yesterday and the deli workers had masks on, and that makes sense. The grocery store clerks have masks on, that makes a lot of sense. In terms of the medical community, of course, our first responders, in certain cases, police officers and firefighters and of course, our EMS crews, we want them to have all that protective equipment too. And if you're in a hospital doing a procedure, then you're going to see people in the spacesuits, right? If they're having any sort of necessary intubation to help someone breathe, they're going to have kind of a helmet thing on that has its own positive airway pressure in to keep out any sort of infectious droplets and a complete bunny suit so called basically like the Ebola suits, if you've seen those. Where you're completely head to toe, everything is covered from your feet to the top of your head. That is not usually necessary except for procedures in hospital. Oh yeah, for sure. And anyone who's in a role like that would I recommend of course, and I think they're doing this now. They're having at least a surgical mask on, and as a reminder the surgical masks protect others from you and your respiratory secretions. They don't actually necessarily unless you're within six feet for multiple minutes of conversation, they don't generally protect you from others.

Mike Ellison:

Dr. Matt Heinz said PPE isn’t the only thing lacking in hospitals and nursing homes. Several medical facilities don’t have enough tests to properly diagnose patients with COVID-19. And although supplies of tests are increasing in the US, the CDC says it may still be difficult to find a place to get tested.

Matt Heinz:

February 5th, I believe I was trying to... the date when I first experienced a situation where we were desperately trying to get just a test for the virus ordered to see if this person actually had at the time the novel Coronavirus because we didn't have... there was no COVID-19. It was hours talking to the public health officials and finally the CDC approved it, and you can't use three and four hours of multiple physicians and case managers and nurses time to go through this process for one dinky test. I mean, come on, this is usually just you click something on a screen and hit enter or you submit it and it's happening, that's what I'm used to. and that really clued me into the fact that we were just desperately behind in our testing. And that I know we... there's so much talk about testing. We hear about not having enough tests, we still don't have enough tests. I've never been tested, I don't have symptoms, but I think it's probably a good idea for frontline health care workers to probably get tested at some point.

Mike Ellison:

Right now, two kinds of tests are available. The first, a viral test which detects if you are currently infected. The other is an antibody test that determines if you previously had  the infection. Both are important for tracking and maintaining the spread of the virus.

Matt Heinz:

And then on the viral testing side, you have to be able to rapidly and reliably determine if someone or a population let's say, in a nursing home, if there's an outbreak starting somewhere, we need to identify that right away so we can mitigate it and to protect people and to get people out of that situation and to make sure they're safe. So that's helping us locate and address hotspots and where we should direct resources. That's the viral testing side. The antibody testing side is okay, where can we start to ease restrictions? Where does there appear to be enough herd immunity, which... where have enough people been exposed so that the community spread of the virus will be diminished significantly, that kind of thing. Yeah, testing is crucial and we were never really on the ball with that as United States and to this day, I continue to be really surprised.

About one to three patients under Dr. Heinz’s care has COVID-19. His hospital isn’t at capacity, but he says the virus has presented new challenges for health care workers. Now that outside visitations are cancelled, doctors and nurses play a pivotal role in keeping patients connected to their loved ones.

Matt Heinz:

It really is... from the patient experience, it's different because we can't have visitation. And in terms of as a doctor in the hospital, it's very helpful for us to have a daughter, a son, a spouse, someone there to help you to just be present and to be a loving and compassionate... someone who can be there to help people get through this process, this horrible disease. And right now, it's a lot of really amazing healthcare workers and nurses and doctors and respiratory therapists, but it's not their spouse, it's not their loved one. And that's something that like look at kind of the human side of disease and hospitalization. That's one of the things that's different than most other types of diseases we treat is we cannot have the family for very obvious public health reasons, we just can't have those support people around. It changes a bit the healthcare providers role and also it does make things a little bit lonelier for folks. And we're trying to work through that. We do FaceTime, we do of course the various Skypes and whatnot to get people to be able to interact. Something that my facility is able to do, it's the largest hospital in southern Arizona, but it's also the largest single story hospital in the nation, I'm told. So that means you can actually take people and escort them to an outside window and have them interact safely with their loved one at least so they can see them, right? So there's some stuff that my hospital has been able to do that's kind of part of my hospitals charm, I think that it's able to accommodate a little bit of safely distance visitation sometimes through a window.

Mike Ellison:

Donna has faced similar challenges with residents in the nursing home.

Donna Russo:

We can't allow families to come into the building and they can't be with their loved ones if they're dying. And they can't be their patient advocate and they can't spend time with them. And we never want anybody, especially as nursing home nurses to ever die by themselves. But then we were told early on, you have to bundle the care and you can't spend more than 10 minutes time in the patient's face. We do everything with them. And so it's been awfully trying very, very difficult to say the least.

Mike Ellison:

I mean, what you're describing it's got to be heartbreaking. How are you and your co-workers consoling each other? I mean, are there resources for you guys to help you deal with the emotional toll this is taking?

Donna Russo:

Well, we were able to for the first time last week on Tuesday and Wednesday afternoon, for half an hour, we went back to our nurses training and I think all through nursing school, everybody's attended some kind of a support group session, whether it was like Alcoholics Anonymous or something like that as part of our training, we all had to do something like that. So we use those tools and what we could find on the fly on the internet, and we had... we didn't call it a support group, but we just like let's talk it out group. Two days last week. The first day we scheduled a meeting for 02:30. And at 02:30 nobody was in there besides myself and the assistant director and our social worker, and I said, you know what, let's just start talking. Let's talk about our feelings. And within 15 minutes, people from every department in the facility, not just nurses, but all of our departments in trickled 35 employees.

Donna Russo:

And many nurses said that they're just not ready to talk about this yet, that they're just not there yet. They're just not there yet. But some said that they felt like camaraderie just to be able to sit together in a room and kind of like, look at one another and sigh a little bit. Like we've been through this, looks like we all lived to make it through which we were wandering for quite a few days, we had two nurses hospitalized, one nurse intubated. And we didn't know we were all going to make it, or if we were all going to get sick with this.

Mike Ellison:

Hearing about the intense pressure doctors, nurses and all health care professionals are under, it’s hard to know of an adequate way to show our gratitude.

What advice would you have for the rest of us out here on how to help each other how to be more supportive of folks like you and your colleagues?

Tracy Dickerson:

If you know a nurse or know of a nurse, the simple words of thank you for what you're doing, I think mean the world to all of us, and I think all the nurses that work here for me, I definitely think they're heroes. I think the healthcare hero signs and the little pictures of nurses like I think that's all really good. But I'm a big believer, like I said earlier in that personal touch. So if everybody who knows a nurse or physicians or healthcare workers reaches out and says listen... with a phone call, is even nice. Thank you so much for what you're doing. I'm not sure I could do that myself. But thank you so much for risking your life and taking care of people who are very vulnerable. I don't know how comfortable anybody is with being called the hero. But I think it's nice, I think it's wonderful.

You heard Donna. If you know a nurse, doctor or health care professional, be sure to thank them for their service. We’re all in this together.

And, one last thing. We caught up with a VA nursing home’s nurse manager, Tracy Dickerson from Delaware. As a manager, she gives her nurses words of encouragement every day. If any nurses are listening, Tracy wants to tell you something:

Tracy Dickerson:

My advice for other nurses would be “stay the course. Keep your center of gravity low, and know that truly, this is not a sprint, it’s a marathon. Pace yourself. If you need to rest, get down and rest. If you feel like you need to throw in the towel, throw it in the dryer, and then take it out again and keep going.”

For more information on nursing homes, PPE, and updates on the COVID-19 pandemic, visit aarp.org/coronavirus.

Mike Ellison:

Thank you to our guests Donna Russo, Dr. Matt Heinz, Tracy Byrd Dickerson and all nurses, doctors, health care workers and first responders.

If you liked this episode, please let us know by emailing us at newspodcast@aarp.org.

A big thanks to our news team.

Producers Colby Nelson and Danny Alarcon

Production Assistant Brigid Lowney

Engineer Julio Gonzales

Executive Producer Jason Young

And, my co-hosts Wilma Consul and Bob Edwards.

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For An AARP Take on Today, I’m Mike Ellison. Thanks for listening.