Sustaining exceptional memory care in a time of crisis: the lessons of Covid-19

It seems like forever ago that news stories started to circulate about the novel, highly contagious coronavirus we’d come to know as Covid-19. By spring of 2019, though, the scale of the pandemic was growing clearer with every day. For the first time since 1918, the world was facing a pandemic, life was about to change, and The Mooring’s long and carefully considered emergency protocols would be put to the test. .

At The Mooring, where our residential living environment involves unique risks to a vulnerable population, emergency planning had long been a priority. Long before Covid-19 was first identified in Washington State – where residential care facilities were particularly hard hit – we had already begun the process of modifying our emergency plan to anticipate the known and potential risks the virus might pose to our housemates and care partners.

Like scientists, lawmakers, and healthcare professionals throughout the world, we were forced to learn about Covid-19 as its impact grew. During the early months of the pandemic, unknowns far outnumbered knowns – and our response strategy continued to evolve as new information became available. At every step of the pandemic, we embraced the most conservative measures possible, often going beyond CDC recommendations .

During the earliest months of the pandemic, we took particular pains to stock up on PPE, closed our doors to outside visitors, and took the extraordinary measure of forming quarantined care partner teams. For several weeks, these teams committed to multi-day residential shifts, relying on curbside delivery of groceries and other essentials to minimize the risk of virus exposure. During their off-duty hours, care partners maintained their commitment to quarantine conditions, virtually eliminating contact with family members and friends – and housing in place to avoid public interaction.

As our knowledge of the virus grew, we modified our efforts to keep The Mooring Covid-free. Recognizing the commitment of our care partners, we gradually returned to more normalized work schedules – and we were fortunate to maintain a dedicated crew. Throughout the pandemic, care partners committed to routine Covid screenings, to regular self-reporting, and to strict home quarantine measures.

As time passed, the pandemic’s impact grew rapidly, dispelling any notion that it would end quickly. Given the nature and health status of our residential population, we were faced with the challenge of maintaining essential third-party professional care. Our regular practice of transporting housemates for physician visits and physical therapy – and of welcoming those practitioners for on-site visits – was no longer practical. So, wherever possible, we transitioned to virtual appointments, where care providers could provide care without the risk of exposing housemates to Covid infection.

In some cases, however, virtual care couldn’t substitute for in-person consultations. In particular, specialized hospice care could only take place on-site. Accordingly, we worked with third party care providers to ensure their commitment to regular Covid testing, and to strict masking and social distancing protocols. In every case, we worked to minimize contact with uninvolved housemates and care partners – while encouraging efficient visits to reduce on-site time.

As the pandemic – and our knowledge of the virus – grew, we doubled down on our response plan and held our course. Then, beginning in January of 2021, we welcomed the opportunity to immunize the entire Mooring population – including both housemates and care partners. After completing the required second round of inoculations, our entire population now enjoys the highest level of Covid protection available. Despite that fact, we continue to follow CDC guidelines, and remain committed to preserving the health and well-being of our housemates and care partners.

Science, however, wasn’t the only thing on our mind. As we made changes to preserve health and safety, were every bit as concerned with the impact those changes would have on the everyday lives of The Mooring family. Fortunately, we never lost sight of those concerns – and we adjusted accordingly. And now we’re in the position to reflect on those efforts.

Our philosophy held strong.

With the attention of The Mooring’s management team focused squarely on the evolution and implementation of pandemic response measures, we knew the strength of our operational and care philosophy would be put to the test. Despite the fact that concerns about Covid-19 were always on our minds, we never lost sight of our ultimate responsibility to our housemates’ well-being.

Naturally, well-being is a big umbrella – and while we were thoroughly committed to our efforts to prevent Covid infection, we couldn’t simply press “pause” on the need to nurture the mental, emotional, and physical health of our housemates until after the pandemic.

For our housemates, The Mooring is home – and for the duration of the pandemic, we knew we’d need to adjust our routines. Many of our pre-pandemic practices involved lots of outside interaction. Housemate family and friends were regular fixtures on-site, taking part in meals, celebrations and activities. Daily schedules often featured day trips to local stores, restaurants, and events, including plays, live music, and picnics. Frequently, housemates were even able to attend family gatherings, and sporting and cultural events featuring friends and relatives. Almost without exception, the risk of Covid exposure made those freedoms and pastimes impossible.

The difficulty, of course, is that consistency, contact, and engagement play a crucial role in slowing dementia’s progress. Life without interaction simply isn’t normal. So we decided to make the absolute most of the tools we had to create a new normal that provided many of the same benefits – while keeping our housemates and care partners safe. So we shifted gears. We brainstormed new ideas. And we created alternatives to our regular routines that filled the gap – finding a new flow that leveraged our philosophy, and preserved the highest possible quality of life at both our homes.

Here are a few takeaways that highlight the changes we made – and demonstrate the resilience of the housemates in our care, and the care partners who enrich their lives.

Takeaway #1: Practice substitution, not subraction

Each month – at each Mooring home – we schedule an average of 150 activities, which breaks down to roughly five each day. Ordinarily, roughly half of those activities were off-site, providing housemates the opportunity to actively participate in the surrounding community. During the pandemic, we were forced to curtail nearly all of those activities – but we refused to reduce the number of daily opportunities housemates would have to play, to socialize, to create, and to stay engaged and stimulated.

So we improvised. In short order, trips to the grocery store, restaurants, and picnics were replaced with scenic drives, dog walks, and patio meals. We celebrated more, never missing an opportunity to transform an everyday event to something special. We sang together. Weather permitting, we welcomed musicians on our socially-distanced patio. We got crazy good at puzzles. We danced. And while we looked forward to the opportunity to resume our off site adventures, we filled the time by laughing together, creating art, and building deeper friendships with one another.

In effect, we embraced the concept of “substitution – not subraction.” It’s an idea popularized by Teepa Snow, a leading dementia care expert and advocate, and we’ve routinely turned to in our everyday housemate interactions. On the micro level, the concept helps us to move toward our housemates’ perceptions. If, for example, a housemate feels strongly about keeping their soiled napkin in their pocket after a meal, that’s absolutely fine. Later, when the opportunity arises, we can offer to make an exchange for a clean handkerchief. In most cases, the one-for-one exchange resolves the issue without stress.

Throughout the pandemic, we applied the same concept on the macro level – and with great success. While we weren’t able to venture freely into the community, we were fortunate to find safe alternatives. Our activity-accustomed housemates adapted naturally to the shift, living in the moment of their busy schedules.

If you’re interested in learning more about “Substitution – not subtraction,” we promise to do a deeper dive in a later blog. Until then, this post (https://bonniet1.wixsite.com/pacblog/single-post/the-power-of-substitution-not-subtraction) on the Positive Approach to Care web site does a terrific job of explaining the concept in greater detail.

Takeaway #2: There's real value in virtual engagement

We weren’t strangers to virtual technology prior to the pandemic. Often, when family or friends were out of state or otherwise unable to visit, housemates made the most of video calling technologies like FaceTime and Zoom.

Once the pandemic took hold,?virtual communication became a vital part of everyday life at The Mooring. In addition to personal videoconferences, we quickly transitioned traditional in-person activities – including group exercise classes and live music to virtual alternatives. Housemates adjusted quickly to the change, and participation – and enthusiasm remained strong.

In addition to entertainment and connection, video technology also allowed us to significantly reduce on-site visits by medical professionals – including primary care physicians, nurse practitioners, and in many cases, both physical and occupational therapists.

In a perfect world, we still have a strong preference for in-person contact – whether with friends, family, physicians, musicians or otherwise. But under difficult circumstances, virtual technologies gave us the ability to continue nearly all of our social, entertainment and health programming – without exposing our wonderful housemates and care partners to increased infection risk.

Takeaway #3: Our care partners rise to the occasion

While high quality facilities and programming are essential elements in the effort to provide exceptional residential memory care, no single consideration is more crucial than staffing. At memory care facilities throughout the country, the Covid pandemic served as the ultimate stress test – and we couldn’t be more proud of the commitment, dedication, and professionalism of our staff.

From the very earliest days of the pandemic, we recognized the need to rethink our standard staffing practices. Like the rest of the world, our knowledge of the Covid virus was extremely limited. Out of an abundance of caution, we elected to create teams that would work multi-day shifts, with care partners staying on-site for the duration. Our care partners never skipped a beat. Without exception, they embraced the demanding schedule – and committed to maintaining strict quarantine protocols during their off-duty hours.

Our care partners have never been anything other than exceptional. Prior to the pandemic, it was common for off-duty care partners to visit and engage with the housemates they’d come to know and love. Our care partners don’t see their careers as work. They see it as a calling. And when circumstances called on them to go above and beyond their already exceptional commitment, they never skipped a beat.

We are enormously grateful to all our care partners for their roles in adapting to and minimizing the pandemic’s impact on our housemates. We feel the same gratitude toward our housemates and their families for their patience and understanding over the course of the pandemic. Through the support of our community, we’ve been successful in normalizing our housemates’ lives – to the fullest extent possible. Over the coming months, we’ll continue on our path, learning and adapting to changing conditions, and sustaining the warm, engaging, and loving environment we’ve all come to appreciate and expect. ?

When we refer to The Mooring as a family, it’s not hyperbole. We are a family. And without the commitment of our care partners, their families, and the families of our housemates, we couldn’t do what we do.

We’re fortunate. We know it. And we couldn’t be more thankful.