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Modern Healthcare - 2021-05-03

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‘My eyes can’t unsee what I have seen this past year’

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One of Dr. Elizabeth Lowe’s nursing home patients was considering going to the hospital as he battled COVID-19. It was last April, the height of the first wave that slammed many nursing home residents and staff. The patient was in the second week of the illness, and Lowe knew that his family wasn’t going to see him again if he went to the hospital. Lowe told the patient’s daughter to give her two hours—enough time to convince an oxygen company to bring a tank and write a morphine order. “We dressed them up in PPE and she got to be with her dad as he passed away,” Lowe, an internist at MarinHealth, said. “Being able to provide those moments made me feel like I was helping make a bleak scenario slightly less dark. I might not have been able to change the outcome, but I could help change the experience—that mattered.” Lowe and Kaiser Permanente caregivers, in collaboration with the Marin County Department of Public Health, have traveled to long-term care facilities throughout the California Bay Area to try to curb the spread of COVID-19. While skilled-nursing facility residents and staff make up less than 1% of the population, they account for around a third of COVID deaths, according to Kaiser Family Foundation data. The daily calls have slowed to twice a week as vaccination efforts reduced COVID cases across longterm care facilities. While COVID grants fueled their mobile van, long-term funding has been hard to come by. Lowe has reached out to University of California at San Francisco, which helped the providers set up an acute-care clinic with drive-through testing last year. The goal is to expand the mobile outreach for the immobile. But it’s hard to measure the impact. Preventing hospital visits and acute care doesn’t translate well to dollars and cents, Lowe said. “My eyes can’t unsee what I have seen this past year,” she said, adding that she cried herself to sleep on Christmas Eve because the facilities didn’t have enough staff, which meant some COVID-positive patients had to lie in their own waste. “Our elderly are very vulnerable. It’s nothing against these facilities, it’s just hard work that is not reimbursed or compensated well. It opened my eyes to how we treat our elders and our communities.” Even without funding for mobile outreach, providers expect the partnership to last. “It’s been one of the silver linings of the pandemic,” said Dr. Karin Shavelson, chief medical officer at MarinHealth Medical Center & Network. Lowe has restarted her primarycare practice, splitting time with the mobile outreach. But she and her peers have not been able to breathe a sigh of relief as variant strains of the virus threaten the progress they’ve made. While there isn’t a silver-bullet solution, long-term care workers need to be rewarded with the respect and compensation they deserve, Lowe said. “I don’t know what the greater fix is. But people who work in long-term care are definitely heroes, because I think a lot of CEOs wouldn’t do that job,” she said. “It’s hard to bear witness to n that and not be changed.”

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