Since returning from a vacation in early March, my job has rapidly shifted in my role, responsibilities, and ability to interact with my patients in person. I had no idea that I would return from my 5 day vacation and that my job would be completely changed.
Here’s a Timeline of the Changes I have experience as a Medical Social Worker working in Hospice in East Texas. (Nacogdoches and Lufkin surrounding areas to be exact.) I think it will be important to note changes in our roles as we continue to experience this unprecedented Pandemic and the every shifting reactions my Company and our Government has implemented to help reduce the spread and curb the infection. Each day, my coworkers and I, are on the frontlines of this pandemic, working our hardest to continue to serve our patients and families despite ever changing restrictions, national updates, and supply shortages.
Timeline of Changes:
Wednesday, March 11th:
- Company-wide email recieved mandating that all employees must contact our Business Manager or Patient Care Manager before going to work to report the presence or absence of symptoms (monitoring for fever, shortness of breath, cough, respiratory illness.) Anyone with these symptoms would need a Physicain’s note to return to work.
- Badges that display we are “Covid 19 Screened and Trained” are delivered, and all employees are directed to wear these at ALL times.
- All staff will receive a review of handwashing, bag technique, universal and droplet precautions, as well as the Coronavirus in service, Mandated and Must be completed immediated.
- A letter is sent to our partner facilities, insuring that we are working in collaboration with the Medical Community outlining our new protocols.
- Personal Protective Equipment is ordered and on the way to assist with isolation precautions.
- We are encouraged to continue to go to work, respecting facilities protocols when nessecary. (at this point many facilities are implementing their own Covid19 protocols and this is an ever shifting change that eventually results in all most facilities on complete lock down within the next month)
Thursday, March 12th:
- Facilities including Hospitals, Long Term Care Facilities, Assisted Living Facilities, and residential communities begin to lock down and restrict assess to outside service providers. Hospice Nurses and Aides are still allowed to visit, Social Workers and Chaplains services are restricted at many facilities at this time.
- Instructions for how to document Pandemic/Covid19 protocol is provided.
Friday, March 13th:
- Administrators share information with the company from the CDC, requesting that all employees stay educated and informed about the Coronavirus signs and symptoms, hand hygiene is reviewed, and the use of PPE.
Monday, March 16th:
- Company wide letter is issued explaining the reasoning behind the Facilities Covid19 protocols:
From the STATE and CMS:“At the direction of Governor Greg Abbott and effective immediately, we are now requiring nursing facilities to prevent non-essential visitors from access given the significant health and safety risk to residents posed by COVID-19… Nursing facilities must also implement screening protocols for anyone entering their facility. They must screen staff, medical professionals, and other essential visitors for COVID-19 using guidelines issued by the Centers for Medicare and Medicaid Services. Only under certain compassionate care situations, such as a resident’s end-of-life, can non-essential visitors be allowed in a nursing facility, and the facility must follow all CMS protocols. “
Tuesday, March 17th:
- Virtual Meetings become a requirement in lieu of in person meetings. Weekly IDGs (Interdiscplinary Groups) will be restricted to essential personnel only and all other team member will be expected to interact and complete all documentation for the meeting remotely.
- Hospice physicians are updated and trained with the new meeting format and encouraged to check their emails daily to stay updated on changes in the meeting formats and Covid protocols with partnered facilities.
Wednesday, March 18th:
- Covid19 inservices are completed by all staff and documented. (during this time other inservices are required/repeated including infection control, proper use of PPE, emergency response protocols, Bag and hand washing technigues.)
- All employees are required to complete new inservices and encouraged to finish inservices for the remainder of the year to stay updated and informed.
Friday, March 20th:
- Travel Letters are provided by the home office, all employees who drive company vehicles are required to sign a letter and display it in their vehicle to insure the ability to continue to drive and serve patients should travel restrictions be implemeted by the state. (this was a proactive move on our company, and it became officially nessecary in my county on March 29th)
Wednday, March 25th:
- Nacogdoches reports first Covid19 Case. Coronavirus Call Center and Testing sites are set up in the area. (The press release said while no shelter-in-place orders exist at this time, people are strongly advised to stay home and to leave their residence only essential errands or to perform essential work. The release asks people to continue practicing social distancing protocols, including maintaining six feet apart and proper hygiene.)
Thursday, March 26th:
- Clinical Guidance and Covid19 protocol information is pushed out to all clincial staff including: Nurses, Aides, Social Workers, and Chaplains
- updates to documentation reflect new Covid19 precautions to explain “missed” visits to facilities that prohibit outside staff.
Friday, March 27th:
- Telehealth trainings are provided, new consents are created, the company continues to education staff on ways to continue to service our patients remotely and outlines how to document encounters.
- updated Essential Health Care Workers travel letter is issued by the company and mandated to be displayed in all company vehicles
- Daily Conference Calls with Updates from the Executive Direction begin, allowing all employees to be on the same page and ask questions about our ever changing roles.
- All employees are still employed and maintaining their hours, creative ways to serve the community are created including: Aides helping with food organization and distribution at the Salvation army, Social Workers to deliver fresh produce donated by a local funeral home and farmers market, Volunteers to make signs and letters for patients who are unable to recieve visitors.
Sunday, March 29th:
Monday, March 30th:
- Stay at home order effective in Nacogdoches county allowing for only essential travel to occur. Order to expire on April 7th.
Tuesday, March 31st:
- Additional Covid19 Trainings are updated online and required for all employees. A YouTube Video by a Doctor on the FrontLines in NY, “How easy it is to not get infected.”is used to educate employees, families, and patients. (I shared this video in my own social circle among colleagues, family, and friends with a positive reception, my own questions are answered in this video and I have a better understanding of how to protect myself from Covid19 infection and spread to others as a result.)
Wednesday, April 2nd:
- New protocols for documenting Covid19 positive patients are implemented, PPE use is reviewed in detail. Employees are cautioned to continue to implement Covid19 protocol as Covid19 positive patients will most likely be served by our organization to assist local hospitals in keeping nessecary bed and equipment available during this time. (an influx in home patients is expected)
- Lufkin area announces new restrictions, urging the city and residents to stay home. A Curfew is instated from 10pm-6am.
Friday, April 4th:
- Access to the office is restricted to essential employees only and all others are asked to work from home. Supplies, paperwork, and PPE can be picked up on a case by case basis by calling the office and setting up a pick up time to reduce physical contact and to maintain social distancing.
- Any employee who visits the office and has been with a patient is instructed to go home and shower before approaching the office. Employees are asked to prioritize patients and see the sickest patients last to reduce spread of infection throughout the day.
Tuesday, April 7th:
- Nacogdoches “Stay-at-Home” order extended indefinitly. Press release is amendedand includes updated accounts of Covid19 progression in Texas outlining Texas Government and Department of Health recommendations and outlining consequence of not following the order.
- Local Nursing Facilities and Long Term Care Facilities continue to adjust their Covid19 Protocol, many are no longer allowing any outside staff to enter, including Hospice Nurses.
Wednesday, April 8th:
- any employee entering the office must maintain social distancing as previously declared and must also wear a mask.
- I work in the field, wearing a mask and gloves, assisting with admissions for home patients. I assist with two DNRs and visit 6 locations to have them completed, a task that used to be completed through various staff roles and in person meetings.
Thursday, April 9th:
- Bereavement and Family support groups provided by our Bereavement Coordinator are now scheduled as virtual group using Zoom. New documentation for using technology is used in all disciplines to ensure HIPPA Compliance and the safety of PHI.
- Daily Conference calls with updates on Company protocol hosted by the Executive Director are reduced to every other day.
Friday, April 10th:
- On-call staff remains on call during although calls for Social Workers and Chaplain are low during this time of COVID19 due to restrticted access to facilities.
- IDT continues to be on the phone and remotely accessed.
- Mental Health of Patients are reviewed and their are increased signs and symptoms observed in our patient population. Medication regimes are reviewed, mental health is a priority, our team works together to address the needs with medication, psych education and adjustments to POC including increasing frequency of phone contact.
Monday, April 13th:
- Database updates are pushed out to tablets and remote devices that include updated assessment to be used during COVID19 precautions. Documentation is updated to reflect assessments of COVID19 and outline how to report active/suspected cases of COVID19 are updated and reviewed company wide.
Tuesday, April 14th:
- As confirmed numbers of COVID19 cases continue to rise in Nacogdoches County and Surrounding Counties, testing and information is shared with employees and families to help education the family on what do to should COVID19 symptoms appear.
- Peopole are asked to call this number (936-630-8500) if you have any of the following symptoms: Fever, Cough, Headache, Sore Throat, Ear Ache, Shortness of Breath, Sudden Decrease In Taste or any Flu Like Symptoms.
Friday, April 17th:
- Hospice Employees prohibited to enter any facilities with patients without a N95 mask, covered by a second papermask (when interacting with more than one patient the paper masks must be discarded between patients). At this time Social Workers, Chaplains, and Aides are not allowed in the facilities. Nurses have restricted access. Most support is completed via phone assessments, virtual assessment, or in person with proper PPE in use.
- Hospice employees must wear full PPE when visiting patients in the hospital including, Gown, Google, N95, papermasks, and shoe shields.
- Personally, as a medical Social Worker, I refrain from all face to face contact with patients unless requested by the family to visit, to reduce transmission and spread of Covid19.
- Phone assessments are completed in lieu of in-person assessments, Covid 19 precautions are reviewed with each new and existing patient, hand hygiene is reiewed and social distancing is encouraged. (and practiced with double masks should I visit a home patient at request)
- Diagnostic and Database updates are pushed out to electronic devices company wide, our company continues to adjust its service platform and point of contacts with patients as we adhere to new COVID19 precautions and recommendations shared by the CDC, Corporate, and Executive Directors.
Monday, April 20th:
- All Employees are working from home who are able to do so. All visits are done over the phone if possible and home visits are made at request of the family only. Covid19 precautions are outlined and reviewed daily.
- All Employees continue to check in daily with the BOM or the PCM to ensure no presence of symptoms and that COVID19 protocol is utilized.
Thursday, April 23rd:
- Company wide updates include the suggestion of wearing a face shield, in addition to double masks (a papermask over a N95)
- We are assured as a company that we will have enough PPE to serve all patients and that masks that have been used with a COVID suspected patient should be discarded without doubt each use. 3 versions of N95 masks have been provided by our company, ironically enough they are from China.)
- Administration at Nursing homes base their restricted access on criteria of reporting Covid to the national registry. Most facilities have determined it is best to allow no outside visitors to reduce transmission and spread of the virus.
April 24th-May 12th:
- We continue to treat patients who are Covid19 positive in the hospital and in the home setting. Multiple staff members including Aides and Nurses are self quarantined after multiple aides test positive with Covid19.
- PPE is mandatory in all company settings, in and outside the office, employees are asked to not ride in the same vehicle without proper PPE.
- We continue to have access to PPE including N95s, shields, gloves, gowns, and shoe covers.
- The company provides every employee with an infrared thermometer to help employees access symptoms at home.
- All employees must continue to report to the Business Manager or Patient Care Manager daily whether or not symptoms are present before working each day.
Mid May to Mid June:
- Texas continues to reopen businesses from 50 to 75% capacity for restaurants and bars reopen. (Bars are not requiring face covering or social distancing in many cities and states across the nation including Texas)
- Rise in covid19 confirmed cases continue to grow due to many events including Memorial Day Celebrations, Black Lives Matter Protests, and amticipated July 4th Celebrations that encourage large crowds to gather without proper social distancing and face coverings.
- Our office goes back into lock down: non essential employees are asked to work from home, social distancing and wearing masks is mandated in the office and supplies are carefully unpacked and stored while wearing gloves and masks.
- PPE continues to be provided by our organization without any issues, employees are encouraged to educate families on wearing masks and social distancing and can provide masks when needed to help assist families.
- Harris county mandates mask ordinance for all businesses in the county.
- Houston Hospitals are at 95% capacity and prepare to use surge beds.
- Austin city implements mask ordinance for public spaces.
- Governor Abbott issues a new order to reclose all bars and reduce restaurant capacity back to 50%.
- Nacogdoches residents are encouraged to wear masks and a voluntary mask order is issued for the dates of July 1-8th for the county and city of Nacogdoches.
- All Texans are ordered to wear face coverings for nose and mouths in public settings.
- Groups gatherings are restricted to 10 or less.
- Patients and family are using telemedicine and telephone visits for the majority of interactions to reduce transmission to nursing homes and among families.
- Employees are encouraged to stay home when possible and practice good judgment in the community. I personally work from home as often as possible to reduce transmission.
I will continue to update this list as my organization adapts daily during this time of pandemic.
Keep your heads up, hands clean, and mouths covered.