Since the COVID-19 pandemic began, 40% of all deaths have been residents of nursing homes. Although the vaccine roll-out is now well underway, long-term care facilities continue to be high risk environments disproportionately affected by the virus. To help administrators and nursing leadership fight the spread of COVID-19, the UNC Center for Aging and Health is training and supporting skilled nursing homes in North Carolina, working through the North Carolina COVID Action Network (NC CAN), sponsored by the Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement and the Project ECHO telementoring program (Extension for Community Healthcare Outcomes), developed at the University of New Mexico.
UNC’s NC CAN, kicked off November 13, 2020, led by Cristine Henage, EdD, principal investigator. Other Geriatrics expert mentors leading sessions affiliated with the UNC Division of Geriatric Medicine and Center for Aging and Health include: Marvin McBride, MD, MBA; Claire Larson, MD; Ben Blomberg, MD; Rosanne Tiller, MD; Jan Busby-Whitehead, MD; Carissa Lau, MD; Andrew De la Paz, MD; Delethia Lloyd, RN, MSN, AGNP; Amy Denham, MD, MPH; John A. Batsis, MD; Bryan Godfrey, LCSW; Meredith Gilliam, MD, MPH; and Lindsay Wilson, MD, MPH.
Other mentor participants include Tanya Zinner, MD, and Paul Thananopavarn, MD, from the UNC Department of Physical Medicine and Rehabilitation, and Evelyn Cook, RN, CIC, the associate director of UNC Statewide Program for Infection Control and Epidemiology (SPICE).
A Flipped Classroom
Weekly Zoom meetings offer educational content, starting with a 15-minute didactic that kicks off a telementoring session. Questions and answers follow, with the bulk of time spent on case discussions. The forum develops community with other nursing home providers, but more importantly, it offers a place for nursing homes to apply what they are learning about COVID-19 through quality improvement discussions with faculty, including IHI experts, geriatricians, nurse practitioners and educators.
Using an “all-teach, all-learn” format, tough cases and systems improvements are discussed and shared.
“This is truly an example of a ‘flipped classroom,’” said Henage, who is the Assistant Director for the Carolina Geriatric Workforce Enhancement Program, a training center partner for ECHO.
Solving Issues
Session topics have ranged from how to prevent COVID-19 from entering facilities and how to stop the spread when it occurs, to how to help reintegrate visitors safely.
Rosanne Tiller, MD, has participated in sessions on COVID-19 prevention, diagnostic testing and PPE. She says the sessions have provided a collaborative environment for tackling the many challenges in long-term care facilities.
“Part of our goal has been to learn about specific cases and challenges that individual facilities are having across the state. As a group, we brainstorm ways to address the issues together.”
Issues related to vaccine hesitation were recently discussed, recognizing a national report that estimates 72% of certified nursing assistants are reluctant to take the vaccine.
“The weekly sessions provide a place for representatives from 91 nursing homes to share best practices, discuss the legal issues around mandating the vaccine and make plans for educating and supporting their staff,” said Henage.
Learning and Sharing
Lisa Leatherwood, an administrator at Silver Bluff Village in Canton, NC, a five-star, family-owned facility, since 1962, faced an outbreak in July, 2020, and then again in November, despite highly proactive efforts to addressing infectious diseases way before the pandemic started. Emotionally frustrated after doing everything right, Leatherwood said the weekly sessions provide value, and she is present on every call.
“Being able to have people to talk to weekly has helped me understand the guidance that keeps changing, and verify that we haven’t missed anything,” Leatherwood said.
A recent session focused on facility processes and how administrators and nursing leadership can determine if their processes are reliable and working successfully. It concluded with a discussion about vaccine deployment and testing compliance.
“I had questions about vaccine distribution that Marvin McBride helped with. I’ve been able to ask how other facilities are getting their staff to sign up for the vaccine. It’s an opportunity to say ‘this is what I do’ and ‘this is what I’ve done.’ Is there anything else I could be doing?”
Other NC-CAN ECHOs
Two other training groups are running NC CAN ECHOs, UNC Family Medicine and the Mountain Area Health Education Center. These combined telementoring efforts are estimated to be reaching 58% of the 432 nursing homes in the state, and some in South Carolina.
Other ECHOs at UNC
UNC is an ECHO partner hub for other telementoring initiatives, including medication-assisted therapy, cardiology, and geriatric medicine (focused on geriatrics, diabetes, serious illness and comorbid conditions), either directly or through AHEC partners.
History of ECHO (Extension for Community Healthcare Outcomes)
Sanjeev Arora, MD, of the University of New Mexico created ECHO in 2003 to increase specialty access for rural patients in NM who had hepatitis and were literally dying waiting for an appointment with the academic medical center. He reasoned that he could teach primary care providers to treat hepatitis C patients in their own communities if he supported them through the tough cases, and so the first of more than 860 ECHO videoconferencing networks began, used in 40 countries to push specialty knowledge to support frontline healthcare providers.