Redesigning the nursing home system: health & design experts study COVID-19 spread, and how to stop it

AUSTIN (KXAN) — It’s not a group you’d expect to find working together, but some of the state’s top health care professionals and designers are searching for solutions to the coronavirus crisis in nursing homes.

“Design is a very creative process that considers the human needs of whoever you are designing it for, first and foremost,” Design Institute for Health Executive Director Stacey Chang told KXAN in May.

Chang leads the partnership between Dell Medical School and the College of Fine Arts at The University of Texas at Austin, breaking ground at the intersection of health care and design.

After the Austin City Council approved a resolution dedicating resources to long-term care facilities, Chang said they would begin looking at the root problems contributing to the spread of the virus and how to redesign the system to prevent it.

MORE: ‘We’re not moving fast enough’: Austin City Council to consider nursing home resolution

Chang’s team from the Design Institute for Health has been working on the “Nursing Home System Study” alongside experts from the UT School of Nursing, the Steve Hicks School of Social Work, Austin Public Health and the Texas Health and Human Services Commission.

On Tuesday these researchers will present Phase 1 of their study to city council.

According to a city memo outlining their results so far, they identified ways to “simplify workflows and reduce staff burden, keep residents connected to their loved ones, ensure sustained financial viability for operators, and address employee retention.”

  • Read the full results here.

According to the study, around 3,000 people live in the 31 skilled nursing facilities in Travis County, but there are as many as 5,000 staff working inside. The researchers toured four different local nursing homes, interviewing management, certified nurse aides, social workers, and housekeeping staff on-site.

They looked at how dining rooms were being utilized, how PPE was being accessed or stored, and how communal spaces — like nursing stations — were still allowing for person-to-person contact.

Much of their research focused on the pandemic’s effects on the workforce. The study concluded “staff workload (physically and mentally) is disproportionate to hourly wage.” They also noted that the competition is “fierce” for employees with the same skill set.

“They can make more at Buc-ee’s over the weekend, than they can here in a week,” one staffer reported.

A Director of Nursing at another facility reported to the researchers, “Why would you do this job for 13 dollars an hour? All that manual labor, and then you’re exposing yourself to COVID, when you could be working at HEB.”

They also noted that staff turnover rates were high — 85% for certified nurse aides.

One CNA told the researchers, their work often goes “unappreciated.”

Chang told council on Tuesday, he didn’t speak with a single CNA who could do their job from 6 feet away — one of the biggest challenges the industry is facing.

“There wasn’t a single facility we visited where there weren’t a half-dozen ‘hero’ stories,” he said.

Lori Porter, Founder and CEO of , said not much has changed in the industry since she first started a job as a CNA 30 years ago.

“There was a pandemic in nursing homes long before there was a virus pandemic. There was a pandemic of too low of pay, horrible image — no one wants to live in a nursing home, therefore no one wants to work in a nursing home,” she said.

She noted that for a while during the pandemic, unemployment and federal assistance paid more than many facilities.

“The average CNA doesn’t make 600 dollars a week, holding lives in the palms of their hands,” she said.

Porter also described the grueling nature of the job, losing residents who become like family, while risking their own health. She co-authored a piece for the Washington Post, calling it the “most dangerous job in America” right now. The story indicates that the death rate for nursing home staff is on pace to double that of last year’s most dangerous jobs — logging and commercial fishing.

“There wasn’t a facility we visited, where there weren’t a half-dozen hero stories of staff making really incredible sacrifices in their own personal lives, to ensure safety of residents,” Chang said.

They recommended things like “‘commitment’ pay for staff for choosing to stay at one facility: an additional $2/hour for day shift and $4/hour for night shift” and “free employee meals during shifts.”

Chang also cited a disconnect between infection prevention procedures and the realities of the job.

“I didn’t meet a single certified nursing assistant aide who said, ‘I can practice what I need to do at a safe distance. If I am going to dress, bathe, feed a patient, I am going to be in contact with them,’” he said.

They hope that a creative approach from a design perspective will bring about other solutions to the problems they discovered in Phase One of the study.

They focused on skilled nursing facilities, but plan to expand their research to other long-term care options, like assisted living and state hospitals in the next four phases. They also hope to evaluate nursing homes in more geographically diverse parts of the city, and Chang mentioned South and East Austin.

According to Chang’s presentation, Phase Two begins this week. The full study is expected to be completed by the end of this year.

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