Vaccinated Seniors 94% Less Likely to be Hospitalized for Covid

Vaccinated Seniors 94% Less Likely to be Hospitalized for Covid

Both mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) authorized and recommended in the United States protect against COVID-19-related hospitalization among adults 65 years and older, according to a new CDC assessment that finds fully vaccinated adults 65 years and older were 94% less likely to be hospitalized with COVID-19 than people of the same age who were not vaccinated. People 65 and older who were partially vaccinated were 64% less likely to be hospitalized with COVID-19 than people who were not vaccinated. People were considered “partially vaccinated” two weeks after their first dose of mRNA vaccine and “fully vaccinated” two weeks after their second dose.

These are the first real-world findings in the United States confirming clinical trial data showing mRNA vaccines prevent severe COVID-19 illness. The findings provide additional support for CDC’s recommendation for COVID-19 vaccination among people 65 and older in the U.S. population under the Emergency Use Authorization (EUA) for the applicable COVID-19 vaccine as the risk for severe illness with COVID-19 increases with age, with older adults at highest risk.

“These findings are encouraging and welcome news for the two-thirds of people aged 65 and up who are already fully vaccinated,” said CDC Director Rochelle P. Walensky, MD, MPH. “COVID-19 vaccines are highly effective and these real-world findings confirm the benefits seen in clinical trials, preventing hospitalizations among those most vulnerable. The results are promising for our communities and hospitals. As our vaccination efforts continue to expand, COVID-19 patients will not overwhelm health care systems – leaving hospital staff, beds, and services available for people who need them for other medical conditions.”

The assessment looked at hospitalizations in two U.S. hospital networks covering 24 hospitals in 14 states. Vaccine effectiveness was assessed by comparing the odds of COVID-19 vaccination among hospitalized people who tested positive for the virus that causes COVID-19 (these were case-patients) versus those who tested negative (these were controls). Among 417 participants in the assessment, there were 187 case-patients and 230 controls. Close to half of the patients were more than 75 years old.

Also noteworthy, while early reports from Israel also documented the real-world effectiveness of COVID-19 vaccination, including among older adults, those reports only looked at vaccination with Pfizer-BioNTech vaccine. In this CDC assessment, both Pfizer-BioNTech and Moderna vaccine products were equally represented.

As expected, the assessment confirmed that vaccination provided no protection to people who had received their first dose fewer than two weeks earlier. It takes two weeks for the body to form an immune response after vaccination.

Two networks previously established to conduct surveillance for serious influenza disease provided the data for this assessment: Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN)  and Influenza Vaccine Effectiveness in the Critically Ill (IVY).

This assessment is one of many planned COVID-19 vaccine effectiveness assessments to evaluate the real-world benefits of COVID-19 vaccines. Results from these assessments will help inform vaccine policy decisions aimed at saving lives and decreasing serious COVID-19 disease as much as possible.

CDC recommends everyone 16 years of age and older in the U.S. population under the EUA get the applicable COVID-19 vaccine as soon as possible.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Palliative Care Interventions Place Nurses “In a Unique and Privileged” Position to Treat Suffering

Palliative Care Interventions Place Nurses “In a Unique and Privileged” Position to Treat Suffering

This is the second part of a two-part article on the aims and practice of palliative care and its essential philosophy and concepts. Originally published by the Vermont Nurse Connection, DailyNurse thanks the ANA-VT and the authors for graciously allowing us to re-post this. Click here to read Part One

Originally published in Vermont Nurse Connection (the official newsletter of ANA-VT), July 2020

There is a growing body of evidence showing that palliative care results in an improved quality of life for people with serious illnesses. It’s also been shown to result in higher levels of patient satisfaction and improved outcomes at the end of life. While it’s not hard to understand why a palliative approach might improve someone’s quality of life or lead to greater satisfaction with care, it’s also been found that the costs associated with someone’s care usually decrease as a result of palliative involvement. This is likely due to palliative care’s emphasis on uncovering a person’s goals and values and then building a care plan to which these goals are central.

For example, the standard treatment offered by our healthcare system is aggressive, disease-directed care right up until the moment of death, which is fine, but is not what everyone wants. Collaborating with patients and offering care based on their values (instead of the system’s), especially when those values mean something other than intensive hospital-based care, inevitably results in lower costs. But one of the more unexpected benefits of palliative care turns out to be longer life: which has been found in a few studies in both the cancer and heart failure populations.  

We hope that the two case studies presented below will illustrate a few palliative care interventions as well as highlight the role that RNs and LNAs can have in treating suffering.  We hope this article has given you a better sense of what palliative care has to offer, and also how RNs and LNAs, because of their scope of practice, are in a unique and privileged place to provide this care.   

Case 1, “Charlie”: Discussing the Future with a Heart Failure Patient 

Charlie calls the heart failure clinic with a question about his symptoms. As the clinic nurse you have seen Charlie get all the best possible treatment over the past three years, including a biventricular pacemaker with a defibrillator. You are worried now because despite everyone’s best efforts he is beginning to have more shortness of breath. You talk to his cardiologist to determine next steps, and then phone Charlie back with instructions to increase his torsemide and monitor his symptoms over the next few days. He shares that he’s worried: does this mean that his heart failure is getting worse? You resist the urge to “fix his feelings,” and instead say, “I am worried too, we are going to do our best to help support you and try to improve your symptoms.” 

Charlie calls back two days later to say how much better he feels. This is good news, but you decide to deepen the conversation, saying, “I would really like to learn more about you so that we have a better sense of how to care for you going forward. Could I ask you a few questions?“ Charlie welcomes the chance to talk, so you continue: “At this time in your life, what things are most important to you? When you think about your future, what are you hoping for? And what are you most worried about?” Charlie gives you a wealth of information, and you document your conversation in the chart.  

The next week Charlie comes in for his routine clinic appointment. He lets you know that the conversation you had with him was very helpful and relieved some of his stress and worry. He asks if there are other things he should be thinking about? You steer the conversation to what’s known as “advance planning”: “Have you completed an advance directive? If you were so sick that you couldn’t make your own medical decisions who would make them for you? Finally, you offer to help him complete his advance directive (this is a document identifying a health care agent as well as what forms of treatment you would/would not want).  

Case 2, “Alison”: Providing Comfort and Support for a Stage IV Cancer Patient 

Alison is being admitted to the cancer floor with abdominal pain related to stage IV ovarian cancer. Sarah is her nurse for the evening shift.  Alison’s pain requires regular use of her PRN dose just to keep it under control. She also shares that she is not sure that she wants to continue chemotherapy. Sarah calls the attending and recommends a palliative care consult. “Alison is using frequent PRN doses and I feel her symptoms could be better controlled. She is struggling with what her care should look like going forward.” The attending physician is convinced and orders a palliative care consultation.  

Later that evening Alison’s LNA, Beth, finds her sitting up in the chair crying. Alison shares that she just got off the phone with her teenage son, and she is worried about him. Beth asks Alison if it would be OK if she just sat with her. Alison agrees and they sit in silence for a while until Alison starts sharing about how hard this has been. Beth offers a supportive statement, “I cannot imagine how hard this must be for you.” Beth listens as Alison describes how wonderful her son is and how he has been caring for her. Beth says, “You must be very proud of him… How do you hope he’ll remember you?” 

 Over the course of Alison’s hospitalization, she is started on scheduled doses of long-acting morphine, and her pain decreases. She rarely requires PRN doses. However, then at a family meeting her oncologist shares that there are no more cancer treatments available. Alison asks Sarah’s opinion about whether or not she should go home on hospice. Sarah assesses Alison’s understanding, asking her what she knows about hospice. Alison answers that she is not sure, but that her doctors said since there are no more cancer treatments she should “consider hospice.” Sarah describes hospice as an extra layer of support to help people make the most of the time they have left, and when they are closer to dying, to ensure they have a peaceful death. Alison starts to tear up and asks, “Does this mean I am dying now?”  

In response, Sarah gently asks Alison to say more about what she is feeling. Alison goes on to share that she hopes she has more time to spend with her son, and to be able to see a few more of his tennis matches. Sarah responds, “I hope that you are able to do this too.”  Alison goes on to tell you more about her son and her attempts to ask him about her illness. Sarah shares that hospice can also provide support for having these conversations and will also be there to provide bereavement support for Alison’s family after her death. After Sarah spends time addressing Alison’s concerns while also responding to her emotions, Alison seems more at peace. 

Resources 

Palliative Care Fast Facts     

Serious Illness Conversation Guide 

CAPC (Center to Advance Palliative Care)

National Consensus Guidelines  

Hospice & Palliative Nurses Association HPNA

American Academy of Hospice and Palliative Medicine (AAHPM) 

Vital Talk: National organization committed to building clinicians’ serious illness conversation skills.  Vermont has its own version called TalkVermont.

Five Wishes: “To help start and guide family conversations about care in times of serious illness” 

The Conversation Project: A “starter kit” to “provide a shared understanding of what matters most to you and your loved ones” 

Understanding Palliative Care: A Nursing Perspective

Understanding Palliative Care: A Nursing Perspective

This is the first part of a two-part article on the aims and practice of palliative care and its essential philosophy and concepts. Originally published by the Vermont Nurse Connection, DailyNurse thanks the ANA-VT and the authors for graciously allowing us to re-post this.

Originally published in Vermont Nurse Connection (the official newsletter of ANA-VT), July 2020

Palliative care is essentially an interdisciplinary endeavor, requiring the special skills and knowledge of physicians, nurses, social workers, and countless others in order to effectively care for patients with serious illnesses. In fact, Dame Cicely Saunders, whose pioneering work is the basis of modern palliative care, was herself a sort of interdisciplinary team, having trained as not only a nurse, but also a social worker and physician. 

Dame Cicely Saunders, OM DBE FRCS FRCP FRCN, founder of the first modern hospice.

The American Academy of Hospice and Palliative Medicine (AAHPM) describes palliative care as “patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering,” which feels very closely aligned both with nursing’s traditional focus on holistic, person-centered care, and with the American Nurses Association’s philosophy of nursing (ANA website, 2015), which emphasizes the relief of suffering and the care of both patients and families. We have always been struck by the strong resonance between nursing and palliative care, and it’s part of what inspired us to write this article on palliative care specifically for RNs and LNAs. 

When Dame Saunders started the first modern hospice in 1967, her goal was to provide patients nearing the end of their lives with compassionate care that focused on their fears and concerns, as well as medical treatment for their symptoms.

We find it kind of astonishing that caring for the suffering and dying was so chronically overlooked that a specialty had to be created to address these needs. Up until that time, medicine concerned itself with curing or preventing disease, and there was no room for a methodical, evidence-based approach to the treatment of suffering or the care of the dying. Even today, it’s not uncommon for patients at the end of life to continue receiving aggressive and often unhelpful treatment focused purely on their diseases, and to eventually die in the hospital. 

Given the alignment between nursing and palliative care philosophy, it’s not surprising that RNs and LNAs are central to palliative care. Some of you may have helped care for patients and families at the end of life; most of you have likely cared for patients with serious or life-limiting illnesses, and all of you have seen how your patients and their families can suffer. As such, you are uniquely positioned to help relieve that suffering, whether it’s through the swift identification of symptoms, the timely delivery of appropriate medication, the willingness to offer therapeutic presence to someone in psychological or emotional distress, or the courage to advocate for patients or families in distress. 

Is “Palliative Care the same thing as Hospice Care?” 

Before we go further, it may be helpful to define some of the terms you’re likely to encounter. Many of you may have heard the words “palliative care,” “hospice care,” or “comfort care” being used somewhat interchangeably, though in truth there are important differences. For example, while both palliative care and hospice focus on identifying patient goals and values, treating burdensome symptoms, and optimizing quality of life, palliative care can be delivered at any stage of illness (from the time of diagnosis onward), and can be offered alongside disease-directed treatment.  Hospice, on the other hand, while essentially identical to palliative care in terms of treatment, focuses on patients with an expected prognosis of six months or less who have elected to forgo further curative treatment.  

“Many of you may have heard the words
‘palliative care,’ ‘hospice care,’ or ‘comfort care’
being used somewhat interchangeably, though in truth there are important differences.”

So, given that all hospice is palliative care, but not all palliative care is hospice, you could be forgiven for asking why hospice exists at all. The short answer is that hospice’s specific “six months or less” prognostic criteria is what is used to qualify patients for Medicare’s hospice benefit, which picks up the tab for medications, equipment for the home (which is where many hospice patients spend their final days), as well as home visits from physicians, nurses and other providers. The longer answer is that hospice got there first (recall that Dame Saunders opened her hospice in 1967, whereas palliative care only became a defined medical specialty in 2006).  

In addition to being an insurance benefit, the term “hospice” can also refer to a facility where patients receive end-of-life care, as well as a philosophy of caring for the dying that emphasizes the relief of not only physical suffering, but also emotional, spiritual, psychological, and social pain (together referred to as “total pain”). This innovative approach to end-of-life care eventually gave rise to palliative care, which broadened the concept of hospice to encompass the entire trajectory of serious disease. 

Terms such as “comfort care” or “comfort measures” are also commonly used, particularly in the form of “shop talk” between providers (during change-of-shift report, for example), but use of “comfort measures only” or “CMO” is discouraged as it implies a limited form of care, as in “you’re only getting this limited form of treatment, as opposed to the whole enchilada”. Unfortunately, many providers, patients, and families have this idea that palliative care means a failure (either a failure of the patient to “fight,” or a failure of the provider to “cure”), and is therefore a consolation prize, a second-hand form of medical care. You may sometimes see this attitude among providers who vaguely refer to palliative care as simply “loading them up with morphine.”  

But the fact is, palliative care is not some watered-down, inferior form of treatment, nor is it intended to hasten death. Rather, just as oncology or cardiology are medical specialties that aggressively treat cancers or diseases of the cardiovascular system, so palliative care is a medical specialty that aggressively treats and seeks to remove sources of suffering. 

Treating Patients for Pain and Suffering 

We’ve talked a lot about relieving suffering, but what does that actually look like at the bedside? How do you go about treating something that you can’t really test for or objectively measure (even the pain scales, for instance, are simply ways to track a subjective experience over time)?  

It may be helpful to think for a moment about what we mean by the word “suffering.” Suffering is not just experiencing pain or misfortune. Take the muscle pain you may experience a day after some strenuous exercise; it’s not uncommon to hear people describe this as “good pain.” Interpreted as a sign of accomplishment or muscle development, the pain is seen as a good thing: yes, there is pain, but there is no suffering. And then contrast this with the pain experienced as a result of illness. There may be no difference, physiologically, between these two instances of pain. Both are the result of a complex neurohormonal cascade of stimuli and response. But because the pain from illness is very likely to be interpreted as a sign of decline and even death, it typically leads to what we would describe as suffering. So to summarize, pain is simply a physiological phenomenon, while suffering is what that pain means to us. 

Treating suffering, therefore, means first understanding how that person is suffering; understanding the significance of what they are going through, and organizing our treatment around their experience. This might sound mysterious, but it’s usually straightforward: for example, pain medication for a patient who is writhing and grimacing.  

Medical management of symptoms is a significant part of palliative treatment. Pain is often the most distressing symptom for patients, but dyspnea, nausea and vomiting, constipation, depression, and anxiety can also significantly diminish someone’s quality of life. We use familiar medications such as opioids and NSAIDs, laxatives, anticonvulsants, SSRIs, and benzodiazepines, but we sometimes use them in unfamiliar ways (using haloperidol to treat nausea, for example). By treating the symptoms we do often manage to treat the suffering (for example, a patient may be suffering from the fear that they will always be in pain, and by relieving their pain, we also relieve this fear). But sometimes merely treating symptoms is not enough to also relieve suffering, and this is why much of palliative care takes place in the form of conversations with the patient and their family, in which we try to explore with the patient and/or family how things are for them, and the ways in which they’re suffering as a result of their situation. 

“Sometimes merely treating symptoms is not enough
to also relieve suffering, and this is why much of palliative care takes place in the form of conversations
with the patient and their family.”

In addition to more broadly therapeutic conversations, where you may simply be offering a comforting presence as a patient talks about their fears, anxieties, regrets, and hopes, there are also more focused types of interactions where you are trying to help the patient come to terms with the nature of their illness and, with that in mind, support them as they decide how they want to be cared for. Essentially, this means working with the patient to help them understand the nature of their illness, as well as where they are with relation to the illness trajectory (for example, gently helping someone understand that their cancer will cause their life to end at some point, but that for them that is likely still a few years away).

In this example, with death still somewhat remote, the patient may feel safe engaging in a conversation about what sort of care would make sense for them as they get sicker, or about who should speak for them if they can’t speak for themselves (eg, designating a health care agent). People’s values and priorities do change, however, and a more intense version of this conversation often takes place when the patient’s disease is more advanced and they are nearing the end of their life.  

In this case, the conversation is about supporting the patient as they grapple with the fact that their time is short, and then helping them identify what’s most important to them at this point and how their medical care should reflect that. An example of this would be a patient who only has a short time to live, and for whom the most important thing is being comfortable and being at home with her family (as opposed to being in the hospital and continuing to receive treatment directed at controlling the underlying disease). In this case, given that the patient’s goals are to be comfortable and to be at home, the most appropriate treatment would be a comfort-directed plan of care focused on symptom management, and discharge home to be cared for by her family as well as the community hospice team. 

Goals of Care Conversations 

We call these conversations “goals of care conversations” because we hope through them to identify what a particular person wants in terms of their treatment outcomes (eg, “I want to be pain-free,” or “I want to live at all costs”). Once we’ve worked with the patient to identify these goals, we can use them to create a plan of care that is “goal concordant,” or that aligns to their wishes. Some patients’ goals are to be comfortable and to die at home, while others want “everything done,” and accept that this means they may die in the ICU. In reality, most people want something in between, navigating some trade-off between quality of life and length of life. These goals of care conversations may seem unique in some ways (the specifics of each patient’s lived experience) and in the dynamics, the back-and-forth or the “dance” of the conversation itself, but the deeper truth is that all of these conversations begin and end in the place where a human being confronts and attempts to reconcile themselves to their mortality, to the fact that they (that each of us) is going to die.  

The value of palliative care at these moments is creating a space that allows the exploration of hopes and priorities that can then be used as guideposts when creating an actionable plan of care. As part of a complete “goals of care conversation” we must also signal a willingness to uncover fears and worries, such as the fear of dying, fear of the unknown, of having uncontrolled symptoms at the end of life, or being a burden on families. Knowledge of these fears help us stay one step ahead of their suffering and further informs the plan going forward.  

See Part Two in Monday’s DailyNurse! 

Covid Cases Drop 83% Among Nursing Home Staffers

Covid Cases Drop 83% Among Nursing Home Staffers

Joan Phillips, a certified nursing assistant in a Florida nursing home, loved her job but dreaded the danger of going to work in the pandemic. When vaccines became available in December, she jumped at the chance to get one.

Months later, it appears that danger has faded. After the rollout of covid vaccines, the number of new covid cases among nursing home staff members fell 83% — from 28,802 for the week ending Dec. 20 to 4,764 for the week ending Feb. 14, data from the Centers for Medicare & Medicaid Services shows.

New covid-19 infections among nursing home residents fell even more steeply, by 89%, in that period, compared with 58% in the general public, CMS and Johns Hopkins University data shows.

These numbers suggest that “the vaccine appears to be having a dramatic effect on reducing cases, which is extremely encouraging,” said Beth Martino, spokesperson for the American Health Care Association and National Center for Assisted Living, an industry group.

“It’s a big relief for me,” said Phillips, who works at the North Beach Rehabilitation Center outside Miami. Now, she said, she’s urging hesitant co-workers and anyone else who can to “go out and take the vaccination.”

After a brutal year in which the pandemic killed half a million Americans, despite unprecedented measures to curb its spread — including mask-wearing, physical distancing, school closures and economic shutdowns — the vaccines are giving hope that an end is in sight.

Noting that more than 3 million doses of vaccine have been doled out in nursing homes, CMS issued new guidelines  Wednesday allowing indoor visits in the facilities, even among unvaccinated residents and visitors, under most circumstances.

National figures on health care worker infections in other settings are hard to come by, but some statewide trends look promising. In California and Arkansas, health care worker covid cases have dropped faster than for the general public since December, and in Virginia the number of hospital staffers out of work for covid-related reasons has fallen dramatically.

Research in other countries suggests that vaccines have led to big drops in infection. A study of publicly funded hospitals in England indicated that a first dose was 72% effective at preventing covid among workers after 21 days and 86% effective seven days after the second shot. At Sheba Medical Center — Israel’s largest hospital, with over 9,600 workers — 170 staff members tested positive from Dec. 19, the first day the vaccine was offered, through Jan. 24. Of those who tested positive, only three had already received both doses of the vaccine, according to The Lancet.

Lost on the Frontline, a yearlong data and reporting project by KHN and The Guardian, is investigating over 3,500 covid deaths of U.S. health care workers. The monthly number has been declining since December, but deaths often lag weeks or months behind infections.

Along with other health care workers, nursing home staffers and residents were first in line to get vaccines in December because elderly people in congregate settings are among the most vulnerable to infection: More than 125,000 residents have died of covid, CMS data shows, while over 550,000 nursing home staff members have tested positive and more than 1,600 have died.

Yet the vaccination rate among staffers is far lower than that of residents. When the first clinics ran from mid-December to mid-January, a median of 78% of nursing home residents took a dose, while the median for staff was only 38%, according to the Centers for Disease Control and Prevention. Now several nursing home associations say the rate of staff vaccination has been climbing, based on informal surveys.

While vaccines are “contributing to the observed declines in COVID-19 cases in nursing homes, other factors, like effective infection prevention and control programs/practices,” are also at play, CDC spokesperson Jade Fulce said.

Vaccine uptake by nursing home residents has been “very promising,” said Dr. Morgan Katz, a specialist in infectious diseases at Johns Hopkins University who is advising covid responses in nursing homes. “I do think this is a huge contributing factor” to the drop in staff cases.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Caring for Incontinent Patients: A Brief Guide

Caring for Incontinent Patients: A Brief Guide

Roughly 13 million Americans are affected by incontinence, with elderly patients as the leading demographic. Also known as the loss of bladder control, urinary incontinence can be stressful and embarrassing for patients. November is National Caregiver Awareness month, but it is important at all times to properly advise patients to ensure they’re physically and mentally well. There are several steps and preventative measures that can be taken to lessen stress and uncertainty.

Understand the Basics

Oftentimes, seniors feel overwhelmed with anxiety and embarrassment surrounding incontinence, and try to hide the signs. Approximately 54% of seniors suggest if they suffered from incontinence, they would be ashamed and hesitant to discuss with their loved ones. When caring for an incontinent patient, be sure to monitor for any and all symptoms, while being as helpful and empathetic as possible. To ensure you’re equipped to spot the signs, first, you need to be able to identify the three most common types of incontinence.

  • Urge incontinence: As the most prevalent type, urge incontinence is the involuntary loss of urine due to an intense urge of urination.
  • Stress incontinence: Bladder muscles often weaken as individuals get older and sudden physical movements (such as laughing, sneezing, getting up or carrying a heavy item) could contribute to involuntary loss of control.
  • Functional incontinence:A patient has the urge to urinate but can’t easily make it to the bathroom quickly due to mental or physical disabilities – examples include arthritis, Alzheimer’s, and neurological disorders.

The “Do’s” for Incontinence Care

Implement Structure

As habits and routines have drastically shifted compared to pre-pandemic, be mindful that seniors have experienced great change and their typical schedules have been heavily disrupted. With that in mind, try to provide consistency and structure, and implement healthy habits across the board.

A consistent schedule can help alleviate discomfort and anxiety for both the patient and the caregiver. This can include scheduled bathroom breaks, organizing medication weekly, and setting up reminder systems for ordering necessary incontinence products. To help alleviate anxiety around incontinence episodes, be sure to keep backstock of necessary products when applicable. Ensure the size and absorbency of all products are appropriate so that patients know they always have access to the products they need. 

Encourage Healthy Eating

A healthy diet goes a long way in helping to manage incontinence. Increasing intake of fiber enriched foods and healthy carbs (ie: whole grains and brown rice), adding more vegetables and certain fruits that are also high in fiber, such as berries, bananas, apples, and pears can help overall bowel function and urinary health. This also means avoiding dairy, caffeine, and spicy foods to prevent a potential increase in accidents.

Closely Monitor Fluid Intake

This step is crucial, but unfortunately often overlooked. Individuals with incontinence tend to drink less water, in hopes of reducing the risk of leaks or accidents. Meanwhile, low water intake can actually irritate the bladder and increase the risk of other infections, such as urinary tract infections (UTIs) which in turn causes more frequent, painful urination that can lead to more accidents. Encourage the intake of fluids throughout the day and add more hydrating foods in patients to help keep their bladders healthy.

It’s also important to try to limit fluid intake in the evenings. Many accidents happen at night when a patient either doesn’t wake up to use the restroom or can’t make it there in time. Stopping fluid intake around 6pm can help minimize the chances of nighttime incontinence. Waking up to a wet bed can be very embarrassing for patients. On top of monitoring fluid intake in the evenings, patients may also benefit from wearing an overnight bladder control product as well as using a protective bed covering such as a chux pad or mattress cover.

The “Don’ts” for Incontinence Care

Try not to be reactive

It’s not easy watching a patient or loved one struggle with incontinence, but it’s imperative to exercise as much patience as possible. Try not to get frustrated and be flexible by altering your care strategy appropriately to best fit the patient’s needs. Having honest conversations and offering extended support when needed the most will go a long way in addressing incontinence with dignity and destigmatizing the condition for those living with it.

Avoid terms that could appear insensitive

Words, such as “diaper,” could come off demeaning and evoke shame in the patient. Think about words carefully and ensure you’re being as sensitive as possible. If a patient feels ashamed or embarrassed, they could further hide their symptoms and avoid being honest with you, which could lead to more serious health complications.

The pandemic has been difficult for a myriad of reasons, especially for seniors struggling with incontinence. When caring for an incontinent patient, be aware of all the signs, get them on a routine, implement tips to ensure a healthy bladder and lastly, avoid coming off as reactive and try to be as patient as possible. Empathy goes a long way and will leave the patient feeling more settled during this uncertain, stressful time.   

Mica Phillips is Director of Urology at Aeroflow Urology, a durable medical equipment supplier that provides individuals across the country with incontinence supplies through insurance. An advocate for those living with incontinence, Mica is committed to helping men, women, and children navigate their insurance benefits to receive high-quality products that they can depend on.

Short on Staff and PPE, Nursing Homes Prepare for a Hard Winter

Short on Staff and PPE, Nursing Homes Prepare for a Hard Winter

COVID-19 hit nursing homes with a situation that they “were not equipped to handle,” according to David Coppins, CEO and co-founder of IntelyCare , a workforce management company specializing in post-acute care. In an interview with DailyNurse, Coppins discussed the battle that nursing homes have had to confront during the pandemic, and Pennsylvania CNA Christine Pepple offered a frontline perspective.

DailyNurse: Can you list the factors that make nursing homes so vulnerable to the pandemic?

“Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital.”

David Coppins, CEO, IntelyCare
David Coppins, CEO, IntelyCare

David Coppins: “Most healthcare workers would tell you that they were not adequately prepared to handle this virus. It has been traumatic across the board. But the nursing home community has experienced incredible loss during the pandemic, and it feels as if they have been wrongfully blamed for that loss. They were thrust into a situation they were not equipped to handle. 

Nursing homes, by nature, are not designed to manage highly infectious diseases like a hospital. Hospitals are designed with the assumption that everyone could have an infectious disease, and their workers also operate under that assumption. Nursing homes take what precautions they can, of course, but they do not have the equipment hospitals do, and their workers typically deal with the management of chronic conditions. 

In the first wave, when there was a desperate need to get healthcare heroes PPE, hospitals had the purchasing power to acquire PPE quickly. Nursing homes simply don’t have that same purchasing power, and were effectively left to scramble for what little PPE remained – often times at 10x the typical price. There was also widespread movement from the public to get all available PPE to hospitals – you had people buying up N95s and donating them to their local hospital. The nursing homes did not benefit from public support in the same way.  

It also is important to note that the nursing home population is the most at risk of all patients. It’s largely geriatric residents, or people living with chronic conditions. These folks have multiple risk factors for COVID-19. The care at nursing homes is also very touch-oriented. There are multiple CNAs in and out of rooms helping residents with teeth brushing, feeding and washing, and those CNAs, as I mentioned, were not afforded proper PPE, and were forced to use their PPE over and over again. 

Finally, it bears saying that nursing homes struggled with staffing prior to the pandemic. The pandemic only exacerbated their short-staffing problem. Hospitals were impacted as well, but in most cases, hospitals canceled elective procedures and were able to re-allocate staffing resources to COVID-19 dedicated floors. Nursing homes did not have this same pool of people to rely on – they’re only fall back was agency staff which was also severely taxed. 

While there was no ideal situation to be in during the pandemic, nursing homes found themselves in a uniquely unfortunate one – they didn’t have the financial resources, the PPE, or the workforce levels to cope.”

DN: What are the key lessons learned from the initial experience during the first wave of COVID-19? What measures are being taken to make nursing homes safer for nurses and residents? 

“To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”

David Coppins, IntelyCare CEO

Coppins: “At the start, there was a rationing of supplies. The CDC recommended that nursing home staff refrain from using masks and gowns for every resident, and they also recommended the reuse of the same mask for long periods of time. And, nursing homes are very touch-oriented – which facilitated the spread of the virus from patient to provider. That was the first problem. 

Due to resourcing and staffing issues, some facilities struggled to maintain COVID-19 specific units. While facilities did have COVID-19 specific units, they were not always able to adequately isolate workers and residents to those units. And hospitals were also sending COVID-19 patients to nursing facilities, which, in some instances, introduced COVID-19 to previously unexposed populations. 

When we talk about measures to fix this problem, they’re expensive ones. We’re talking about the high cost to redesign facilities for infection control, and affording a higher capacity of PPE. Ultimately, the biggest takeaway is that the government should have stepped in faster to get necessary PPE to nursing homes. They simply did not have the purchasing power to compete with hospitals.  

To prepare for another wave, there needs to be a prioritization of PPE, and an investment in reusable PPE.”

DN: Have nursing homes started to benefit from the various state and federal funding efforts?

Coppins: “There are various state and federal funding efforts to help out nursing facilities – but those funds were exhausted through PPE price gouging, paying for agency staffing, and the high cost of testing. It was a short-term solution. Those funds are running out, and as far as anyone can tell, there is no second wave stimulus money on the horizon. These facilities are going to be scrambling for PPE and staffing again soon enough.”

DN: What are nursing homes doing to counteract the CNA staffing shortage? Can CNAs expect higher wages or bonuses?

Coppins: “Some pay rates have gone up. Right now, nursing homes simply don’t have the cash flow to put towards recruiting and staffing. And CMS reimbursement rates haven’t changed – they need to be reevaluated and updated to match the current demand. 

Staffing levels are still recovering from the unemployment act. It blew up CNA shortages. The indiscriminate application of the federal bonus had an unintended catastrophic effect on CNA staffing. Many CNAs stayed home and out of the workforce while there was a desperate need for people to work. 

We may see an increase in CNAs working in the coming months. Unfortunately, there have been massive layoffs in the service industry (restaurants, retail, entertainment, etc). So you have a large population of people in need of work. Nursing homes might be an appealing prospect for those populations, and there are plenty of programs out there trying to quickly recruit and train new CNAs. But I think it will be some time before we see if this has any impact on the staffing shortage.”

“Our Residents Need Us” — A CNA’s Perspective on Nursing Homes and Covid

DailyNurse also asked Pennsylvania CNA Christine Pepple for her first-hand view from the nursing home frontlines.

DailyNurse: How has the pandemic changed the working routine of CNAs? How has it changed the way they interact with nursing home residents?

Christine Pepple: “For me, it’s really just wearing the PPE and being aware of new protocols. If I have been working at a facility that has COVID-19 exposure, sometimes I will be restricted from working at other facilities. Now I am just wearing a mask and eyewear. Earlier in the pandemic, I was head-to-toe in PPE, including a plastic gown. It was so uncomfortable.

But as for how I’ve interacted with residents, not much has changed. I have a job to do. And the residents need my care. This has been so hard on them. Luckily, visitations are coming back, and we’re now able to take them to the dining room and they can get their hair done.”

DN: How have CNAs been coping with the hardships of working during the pandemic?

“Luckily, the facilities have our backs.”

Christina Pepple, CNA

Pepple: “The hardest thing for me was the stigma. I wasn’t really able to see friends and family because I was working with COVID-19 on a regular basis. It’s been hard. 

Luckily, the facilities have our backs. They have all gone above and beyond to make sure we were taken care of, and the residents were taken care of. It’s good to see some of the activities opening up and having the residents get to see each other again.”

DN: Do nursing home workers feel better prepared for the next wave of COVID?

“The facilities I have been working with have been so on top of it.”

Christine Pepple, CNA

Pepple: “We know what to expect now. We’re resilient. Nurses and nursing assistants are going to continue to do their jobs because our residents need us.  

We are more prepared now. It feels like we have a lot of PPE and we have more structure now than we did at the beginning. When they bring a resident in from the hospital they quarantine for two weeks on the COVID-19 wing. If you’re working there, you wear a gown, masks, and protective eyewear. And if you’re on a wing where there’s no COVID-19, we’re just wearing eyewear and masks. We’re also getting tested every week – the facilities I have been working with have been so on top of it.”