Once again, the holiday season is upon us. However, due to the pandemic, the way people celebrate will be different this year. Holiday traditions that normally call for large gatherings of people—such as family dinners, religious ceremonies, and company holiday parties—will be planned keeping in mind the Centers for Disease Control and Prevention’s (CDC) recommendations for reducing disease transmission. Social distancing is critical because anytime people gather, especially those who do not live together, the risk of spreading the COVID-19 infection increases for everyone. The higher the level of community transmission in the area where the gathering is held, the higher the risk of spreading COVID-19 at the gathering. The frail elderly living in skilled nursing facilities (SNFs) are particularly susceptible to the spread of COVID-19, and it has been found that as the spread of the virus increases in the community, the risk for an outbreak in an SNF increases dramatically (AHCA, 2020).
Facility leaders, in addition to making personal holiday decisions, also need to be proactive and start making plans for how their facility will approach the holidays. This plan should not only include procedures for residents and staff but also address physical plant issues that may occur.
Getting the Facility Prepared
The facility may see an increase in visitors during the holidays, and leaders should make sure they are prepared. When developing its plan, the facility should consider:
- Encouraging outdoor visits, if weather permits – The facility may need to acquire outdoor heaters, if allowed per regulations, for cooler temperatures. Due to inclement weather, indoor visits, if allowed, may be the only option. Designate areas both indoor and outside for visitation.
- Space for visitation – Ensure there is adequate room, both inside and outside, for visitation. Ensure there are enough physical barriers to prevent the spread of infection.
- Cleaning procedures – Increase cleaning procedures, especially for communal areas, hallways, and restrooms, at a minimum. Ensure there are adequate cleaning supplies to handle the increased needs.
- Screening procedures for visitors – Confirm staff understand the screening process and assign them to screen visitors daily.
- Visitation regulations – Review the most recent local and state visitation regulations to ensure the facility is in compliance.
- Signs – Post signs reminding visitors of guidelines including social distancing, masks, and handwashing.
- Personal Protective Equipment (PPE) – Ensure the facility has an adequate supply of PPE, especially if you will be offering supplies to visitors.
- Visitation times – Ensure there are adequate visitation time slots. Or, if the facility is not assigning time slots, ensure time allotted each day for visitation is adequate enough to allow for safe visitation for all visitors wishing to see their loved ones. Determine how many visitors at a time the facility can safely handle and establish limitations accordingly. Consider how many visitors will be allowed per resident.
- Policies and Protocols – Implement policies and protocols for both residents and staff members who leave the facility to attend family gatherings. These policies should include considerations such as increased monitoring, quarantining, use of transmission-based precautions, and return to work criteria.
Residents and Families
For residents and their families, communication is key. Reminding residents and families of the risks and informing them of the procedures the facility will follow during the holidays will assure them that the facility is doing everything it can to keep their loved ones safe. Hopefully, this will eliminate any harsh feelings or difficulties families may have about facility procedures they may need to follow to visit or take their loved one out for the holiday.
Leaders should also compose a letter to residents and families highlighting the risks of large family gatherings during the holidays. Communicate the CDC guidelines, which explain:
- Lowest risk: Virtual-only activities, events, and gatherings.
- More risk: Smaller outdoor gatherings in which individuals from different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., a community, town, city, or county)
- Higher risk: Medium-sized, in-person gatherings that are organized/laid out to allow individuals to remain spaced at least 6 feet apart, in which only some wear cloth face coverings and some participants come from outside the local area (e.g., a community, town, city, or county).
- Highest risk: Large, in-person gatherings in which it is difficult for individuals to remain spaced at least 6 feet apart, participants do not wear cloth face coverings, and some travel from outside the local area.
SNF leaders should also reinforce to residents and families the visitation policy the facility will follow and what will occur if that policy is not followed. Make sure to highlight the following:
- Any PPE visitors will need to wear, and whether they need to provide it or if the facility will provide it for them
- The type of visitation the facility is making available (indoor vs. outdoor)
- The number of visitors that are permitted per visit
- An explanation of the process to schedule a visit
- Location of the visit and the protocol to follow to gain access
- The requirement for social distancing during visits
- An explanation of screenings that will be done and what those screenings entail
- The requirements for COVID-19 testing prior to visiting the facility and sharing results, if required by the facility
- The restrictions for visitation that include not feeling well, exposure to COVID-19, or a positive test for COVID-19 or influenza
- Visitors may be asked to leave if procedures are not followed
Facilities might consider discouraging leaves of absence from the SNF because of the risk that residents acquire COVID-19 outside the facility and spread the virus upon return to the SNF. Yet leaders should anticipate that some residents will nevertheless decide to join their families to celebrate the holidays outside the facility. It is imperative that residents and their loved ones know the procedure for a leave of absence during this time so they can discuss the risks, make informed decisions about holiday celebrations, and plan accordingly. Leaders may wish to:
- Communicate that if residents are leaving the facility to attend a family gathering, they should practice behaviors that prevent the spread of COVID-19, such as social distancing, mask wearing, frequent hand washing, limiting use of shared items, and practicing respiratory etiquette (covering mouth with tissue or inside of elbow when coughing and sneezing, then washing their hands)
- Inform them what will occur upon return to the facility, including if the resident will need to quarantine for 14 days, have increased monitoring, etc.
- Encourage virtual visits or other alternatives to a leave of absence, such as sending gifts, cards, etc.
Communicate to families what the facility is doing to celebrate the holidays. Include activities that will be occurring, such as special dinners, parades, or similar. Ask residents and families what activities they would like to see at the facility this holiday season. Families may feel more included if they are contributing to the holiday fun at the facility.
Staff Members
Holiday time is also stressful for staff members. Stressors at work may be compounded by the hard decisions staff may need to make in their personal lives related to the holidays. Therefore, communication to staff members is just as important as it is for residents. Facility leaders should remind staff that get-togethers outside of the facility with friends and family are discouraged. As with residents, highlight the risks of gatherings, per the CDC. Along with this education, the facility may want to do the following:
- Educate staff on holiday procedures.
- Ensure the facility policy for staff flu vaccines is followed.
- Plan ahead for call-offs.
- Remind staff of screening procedures and any return to work policies related to travel.
Finally, don’t forget to show facility staff how much they are appreciated. Support their commitment to caring for the residents and each other this holiday season. The following are some ideas facility leaders may wish to implement to boost staff morale during the holidays:
- Company gifts – Large gifts such as turkeys or hams may not be possible this year, but something small—such as gift bags with hand sanitizer, holiday masks, etc.—may be a good alternative.
- Thank-you board – This is a great way for leaders, residents, and families to recognize staff and thank them. It could also be a nice way for staff to state what they are thankful for.
- Dress up days – Designate certain days staff can dress up in holiday attire, such as ugly sweater day or holiday pin day.
- Holiday time-out room – Convert an unused room or closet into a room filled with holiday items that appeal to the senses, where staff can take short breaks to recharge. Items could include holiday scented oils like peppermint, cinnamon, and pine. Supply the room with holiday snacks, such as cookies, hot chocolate, or a seasonal blend of coffee. Lastly, provide some soothing music.
Although this holiday season may be more challenging for everyone than in past years, the facility that is prepared should be able to weather these stressors much better. Happy Holidays!
Resources
American Health Care Association. (2020). Report: Nursing homes see spike in new COVID cases due to community spread This slideshow could not be started. Try refreshing the page or viewing it in another browser.