INDIANAPOLIS (WISH) — Long-term care facilities are epicenters for COVID-19 outbreaks. To date, more than 2,300 Hoosiers have died in nursing homes, accounting for 56% of total coronavirus deaths in Indiana.
To address this, Dr. Kathleen Unroe, geriatrician and research scientist at Regenstrief Institute, is spearheading a new project, ECHO, to help stop the outbreak. ECHO (Extension for Community Healthcare Outcomes) is designed to help nursing homes and similar facilities connect with each other as well as outside physicians. Through education and a series of weekly calls, Unroe hopes that open discussions among staff members and invited outsiders will help nursing homes and long-term care centers gain control of the coronavirus spread within their communities. Here is the complete interview:
Gillis: We’re going to be talking about a program that you’re involved in…a very important issue that’s been going on for so long during this COVID-19 outbreak…the spread in nursing homes and long-term care facilities. So, we’ll be talking about that, but I also want to circle back to yesterday’s announcement. Governor Holcomb said the National Guard will be deployed to all 534 long-term care facilities in Indiana by mid-November. This is a serious issue. Your thoughts on it?
Unroe: The situation in nursing homes has been very serious for many months now. As a provider, I worked in a facility that experienced a major outbreak and can really bear witness to the intensity of that experience for everyone involved.
The deployment of the National Guard…the shipments of PPE and multiple other initiatives and programs that the state and federal government have been putting out there are recognition of how strained and stressed nursing homes staff are. The deployment of the national guard…the national guard members and facilities will be doing tasks that off-load the front-line staff and help free them up to do more resident care.
There are so many new jobs that have been added into the workflow of nursing homes during the pandemic. From data entry and recording for all that data that we need to track in the setting to cleaning all of these surfaces or just think about when the dining room shuts down and everyone needs meals in their rooms. So, the whole strain on the staff has really increased over these last months and the national guard will provide human resources into facilities to support that day-to-day care. So I really look forward to seeing how the national guard is going to be able to assist in the setting.
Gillis: Let’s talk about your program specifically. What is it about and how do you anticipate it helping to stop the spread?
Unroe: ECHO is a national program that is designed to connect medical specialists with primary care providers. And it has been an existing program that’s been used with different populations, different specialties and areas of medicine across the country for many years. AHRQ (Agency for Healthcare Research and Quality) has given a large grant–the national ECHO institute–to stand up hubs to support nursing homes across the country. At IU Health, at the IU Fairbanks School of Public Health and IU School of Medicine we are leading the Indiana statewide effort to stand up an ECHO program specifically to nursing homes in our state.
Gillis: I want to circle back for a moment to what you were saying about the additional tasks workers have to do in long-term care facilities–additional things prior to COVID-19. Collecting data, tracking things. How is this program going to help ease that burden on employees?
Unroe: Well, with the pandemic….just in terms of the clinical treatment of residents with COVID-19…there has been an evolution over time of best practices for clinical care. There’s also best practices for how to do all of these new tasks and processes in nursing facilities. Creating hubs and networks to share best practices among each other? This is why this program is exciting.
So with the ECHO program in Indiana…we will be taking all nursing homes who are interested in participating and creating hubs of about 30 facilities. Each of these hubs will participate in a weekly call for 16 weeks. And there will be infectious disease and geriatric experts on the line during these hub calls, but it’s really about the nursing facilities themselves being able to interact and collaborate and share best practices. The ECHO format program includes both presentations from experts on key topics, but also spaced learning and so that’s where we get to these additional tasks and additional challenges related to COVID-19.
Nursing homes facilities will be able to bring those forward on these calls and we’ll problem solve and talk about how different facilities should handle things in certain settings and how to do it together.
Gillis: You mentioned these facilities have to volunteer or opt into the program. Going back to being forward about what’s going on, it seems as if there has been a lot of hush-hush around in terms of what’s going on in nursing and care facilities. We’ve heard reports here in Indiana here and in different newsrooms about them not wanting to report certain COVID cases, not being transparent with families, not quarantining individuals if someone has been diagnosed with the virus.
So, given there is this sort of hesitancy to comply with certain rules and mandates how do you expect these facilities to voluntarily opt in? What are you hoping for?
Unroe: First of all, I would push back on that characterization. Nursing facilities are required to report data on COVID-19 testing and positive numbers for both staff and residents and they absolutely are doing so. They are mandated to do so. Infection control surveys are happening. I mean, nursing homes are working very hard to follow the rules, right?
And communication around families…how those processes have been set up now. Families used to be able to walk in a nursing facility and scribble their name on a visitor’s log and spend time with their mom in the afternoon. And now–even though Indiana has been one of the most progressive states in our country in terms of opening up to visitation–it’s still very limited.
So, I know it has been incredibly difficult for families to be less connected to the residents even though I think we’re doing a better job in Indiana than just about anywhere…it does create issues around communication.
In terms of the overall environment and whether or not nursing homes will be interested in participating? I think that if they don’t, it’s truly just because there are so many things going on. But what our job is is to create as much value in these educational sessions as possible. I have seen nursing homes freely sharing amongst each other’s best practices and I think this creates a formal way to do this and to capture these learnings and to share more broadly and share nationally across the ECHO network.
Gillis: And final thoughts about your program and what you hope to accomplish and any comments about research moving forward as you learn things?
Unroe: I’m excited about the statewide network that we are working to create here. So, we have partnered with Parkview Health in Fort Wayne, University of Southern Indiana in Evansville and are taking on other partners as we need to create capacity. Any nursing facility in the state who wants to participate in this supportive program–we are hoping will be able to participate and we’ll create the capacity to support them.
News 8’s medical reporter, Dr. Mary Elizabeth Gillis, D.Ed., is a classically trained medical physiologist and biobehavioral research scientist. She has been a health, medical and science reporter for over 5 years. Her work has been featured in national media outlets. You can follow her on Instagram @reportergillis and Facebook @DrMaryGillis.