COVID in Long Term Care: Podcast with Jim Wright and David Grabowski

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GeriPal - A Geriatrics and Palliative Medicine Podcast 54 min 4 speakers 8 chapters transcribed 3 days ago

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What is the overall focus of this episode and who are the guests?

Eric Widera 0:01

The Jerry Powell Podcast is brought to you by Archstone Foundation, preparing society and meeting the needs of an aging population. And now, here

Lynn Flint 0:11

are your hosts.

Eric Widera 0:12

Welcome to the Jerry Powell Podcast. This is Eric Guadera. This

Alex Smith 0:16

is Alex

Eric Widera 0:17

Smith. And Alex, this is, I think, number six now in our COVID-specific Jerry Powell Podcast.

Alex Smith 0:23

It is. And we have another host joining us today. Lynn, you want to introduce yourself?

Lynn Flint 0:27

Hi, I'm Lynn Flint, and I'm an associate professor in the Division of Geriatrics, and I work in the nursing home and on palliative care at the San Francisco VA.

Eric Widera 0:36

And Alex, who else is with us today?

Alex Smith 0:38

And today we have Jim Wright, who's a physician medical director of the Canterbury Rehab and Healthcare Center in Richmond, Virginia, and is part of the SNF Long-Term Care Partners of Virginia group. Welcome to the Jerry Pal podcast, Jim. Thanks, Alex. Good to be here. And we also have David Grabowski joining us from Boston, who is professor of healthcare policy at Harvard Medical School. Welcome to the Jerry Pal podcast, David.

David Grabowski 1:00

Great. Thanks for having me on.

Eric Widera 1:02

We're going to be talking about COVID in the setting of nursing homes, skilled nursing facilities, people's lived experiences with that right now, and also things that we should be thinking about going forward with this group. Before we get into that heavy subject, we always start off with a song request. David, you got a song request for Alex.

David Grabowski 1:22

I absolutely do. So, Alex, one of my all-time favorite songs and one I've been playing recently, originally by the Talking Heads, This Must Be the Place.

Alex Smith 1:31

Yeah, terrific song. I'm just going to play a snippet of it.

Unknown 1:40

Home is where I want to be Pick me up and turn me around I'll go numb Born with a weak heart, I guess I must be having fun. The less we say about it, the better. Make it up as we go along.

How did the COVID‑19 outbreak begin at Canterbury Rehabilitation and what are the current statistics?

Unknown 2:10

Feet on the ground, head in the sky. It's alright, I know nothing's wrong.

David Grabowski 2:23

Wow. That

Eric Widera 2:23

was

David Grabowski 2:24

awesome. That was great.

Eric Widera 2:26

Why'd you choose that song?

David Grabowski 2:28

I've been thinking a lot about home. Uh, obviously my, my home here with my family, but also just, uh, thinking more generally about the concept, uh, my, uh, friends, my academic home. And then I think most importantly, the home I grew up in. And I think we're all, uh, thinking about our parents right now. And, uh, I I've, found my mind wandering a lot to my childhood home and where I grew up in Chapel Hill, North Carolina and spending time with them. So I talking to them every day and it's become a very, very important concept right now.

Jim Wright 3:05

Agreed. You should listen to the Lumineers version of that. They've got a great.

Alex Smith 3:10

Oh yeah. I listened to every version last night. Cause I knew I love Sean Colvin. I saw her play this 25 years ago in Ann Arbor, Michigan, part of her cover girl albums. And as David and I were emailing about this terrific album, but I cannot imitate Sean Colvin's voice. I kind of stole the chord progression from the Lumineers. Yeah.

3:31

Yeah.

Eric Widera 3:31

Well, another home that we're going to be talking about is nursing homes. And I want to, again, very big thank you to Jim for joining us today because he is right now in the front lines of this pandemic in Virginia. Jim, can you just describe right now what's the state of affairs that you're dealing with right now?

3:54

Sure.

Jim Wright 3:54

Sure. So I am medical director of Canterbury Rehab in Richmond, Virginia. Central Virginia, we're in the west end of the city. And we are a long-term care and skilled rehab facility. We have a total capacity of about 190 beds. We have about a 60-bed skilled rehab unit. And we have a 48-bed memory unit, a secure memory unit, and otherwise long-term care, about 130 long-term care beds outside of those 48. So about 190. Our COVID crisis began on the 13th. That was our first suspected patient. And it's been certainly a wild, devastating ride since that time. So currently, our numbers of COVID patients, we have... Let's see. I have to keep updating. We have 108 positive tests in our facility. We have had 18 deaths now as of this morning.

Jim Wright 5:20

We have had a remarkable number of asymptomatic positive tests, about 50 of our total positive tests have been asymptomatic.

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Chapters

8 chapters

1 What is the overall focus of this episode and who are the guests? 0:01–2:10 2 How did the COVID‑19 outbreak begin at Canterbury Rehabilitation and what are the current statistics? 2:10–7:19 3 What clinical courses are being observed among COVID‑positive residents? 7:19–14:56 4 How is advanced care planning being adapted for COVID‑19 in a nursing home? 14:56–21:00 5 What are the biggest staffing and PPE challenges and how is the facility coping? 21:00–27:11 6 Why should post‑acute care be a priority in the pandemic response? 27:11–33:01 7 What policy and care‑model solutions are proposed for long‑term care (specialized COVID wings, home health, hospital‑at‑home)? 33:01–40:03 8 What actions can be taken immediately to protect the long‑term‑care workforce and improve preparedness? 40:03–54:47

Speakers

4 identified

Jim Wright 22 min Eric Widera 4 min Alex Smith 3 min Lynn Flint 3 min

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Topics in this episode

Alex Smith 1 LA Times 1 CMS 1 JAMA 1 Archstone Foundation 1 Jerry Powell podcast 1 Eric Guadera 1 Lynn Flint 1 Jim Wright 2 David Grabowski 2 Mike Wasserman 1 Amda 1

Source

Recorded06 Apr 2020

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524746

Show notes

Imagine that you are the medical director of a large (150 bed) nursing home. Two-thirds of the patients in the home now have COVID-19. Seventeen of your patients are dead. The other physicians who previously saw patients in the nursing home are no longer coming to your facility because you have COVID positive patients. You're short on gowns and facemasks. You're short on nurses and nurse aids so now you have to help deliver meals. This is what Dr. Jim Wright, the medical director at Canterbury Rehabilitation and Healthcare Center in suburban Richmond is living through right now. I felt overwhelmed just listening to Jim talk about his experience since mid-March, and am so grateful that he joined to talk about COVID in the long term care setting, along with David Grabowski, author of the JAMA piece titled "Postacute Care Preparedness for COVID-19 - Thinking Ahead." A couple key points that I learned from Jim's experience. The first point is that half of patients who tested positive were asymptomatic, so you really don't know who has it or who doesn't unless you test everyone. The only thing you really know is that if you have 5 symptomatic patients who test positive for COVID, assume there are at least 5 asymptomic patients. The second point is that there seems to be different clinical courses for those who are symptomatic that David summarized as the following: - Indolent course, deadly: Initial 24-28 hours of fever and severe respiratory symptoms. Then Stabilization for 3-5 days. Then decompensation on days 5-7 with death within 24 hours - Indolent course, convalescence 1. Fortunately, the majority of our patients. Same course as indolent to death although continued improvement over 7-10 days. - Acute respiratory failure: Symptoms begin with fever and acute respiratory failure with death within 6-12 hours. - Sepsis-like picture: Sudden onset of AMS, hypoxia and hypotension without fever. A small subset of patients in our experience. All have tested positive for COVID (may simply have been asymptomatic carriers who developed sepsis independently In the second half of the podcast David Grabowski walks us through the challenges facing nursing facilities and potential solutions to the looming crisis in long term care, including - creating COVID only specialized post acute care settings - increasing the level of home health care and hospital-at-home model - whether nursing homes that don't yet have COVID should be forced to take COVID+ patients form hospitals. So listen up and comment below. Also, check out some of our past COVID podcasts and new resources on our new COVID page at https://www.geripal.org/p/covid.html.

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