|April 14, 2020 | Monica E. Oss
Source: Open Minds
Where are all the supplies? Shortages of ventilators, sanitizing agents, personal protective equipment (PPE), and testing are widespread and frequently reported (see Critical Supply Shortages—The Need For Ventilators and Personal Protective Equipment During The COVID-19 Pandemic).
For staff members of health and human service organizations whose work with consumers cannot be done virtually, the situation is hazardous. Lack of testing leaves staff and consumers operating without knowledge of who has an infection and who may be immune. And, with the very necessary focus on supplies in emergency rooms and acute care facilities, the supply of PPE—masks, gowns, gloves, goggles, shoe covers, etc.—hasn’t made its way to other care settings. An April 3-6 COVID-19 survey of more than 4,000 primary care practices showed that 58% of respondents cite PPE as an “obstacle” to providing care and are using homemade or reused PPE (see Primary Care & COVID-19 Week 4 Survey).
The shortage of testing and PPE is widespread among high-needs populations. Managers of nursing homes, assisted living facilities, group homes, residential facilities, prisons and jails, and detention centers are all reporting PPE shortages—creating anxiety for residents and staff and their families (see Nursing Home Deaths Soar Past 3,600 In Alarming Surge, Death Toll Climbs Inside Group Homes For The Developmentally Delayed, and Unsanitized: COVID-19 In Our Jails, Prisons, And ICE Detention Centers).
American manufacturers are “repurposing” their capacity—with liquor distillers making hand sanitizer, clothing manufacturers making PPE, and car manufacturers turning to ventilator production. But until that production ramps up, the supply gap is right here and now for health and human service organization staff working directly with consumers. Managers of these organizations are developing creative approaches to “filling the gap” and protecting staff and consumers.
Volunteer mask production The crisis has prompted new partnerships for the team at North Range Behavioral Health, which operates a crisis center, outpatient treatment—that’s been transitioned to telehealth—and detox services. When executives learned that a mask order wouldn’t be fulfilled until May, they launched the Sew For Hope campaign March 19. In three weeks, it’s attracted 36 volunteers, who produced more than 300 masks plus gowns and headbands. The non-profit also received donated fabric and elastic from the local chamber of commerce and organic filters from a local company that fit into a pocket sewn into handmade masks that can be washed and reused. “It’s adding a layer of hope right now,” says Micaela Sanchez, marketing and public relations director. “The main thing we’ve found with PPE is that we needed to be willing to think outside the box,” such as opting for soap and water instead of non-alcohol-based hand sanitizer. The upshot, she said is that some of those efforts to engage the community has served a dual purpose. “It’s raised morale for our staff and does something positive for the community,” she added. “It helps keep people connected during a time of social distancing.”
Curbside blood testing At Centerstone, a multi-state health and human service organization, the care team found an option for consumers in a group home who take antipsychotic meds that require blood tests for refills: curbside testing. It enables consumers to get refills without being exposed to different clinical settings. “People are scared. Nobody’s dealt with a pandemic before but we’re getting creative and trying to research what other people are doing to get these things done,” said Becky Hudzik, PCPC, clinical services director. And it’s working. Residents at the group home in Alton, Illinois, have been sheltering in place for weeks and while folks are getting restless, no one has tested positive for COVID-19. The team has restrictions on who comes in and out of the building—maintenance crews are not even allowed unless there’s a major issue—and everyone has their temperatures checked before being admitted.
Take-home methadone Some addiction treatment centers are packaging two weeks of methadone treatment for consumers to avoid daily visits to the clinic. At Remedies Renewing Lives, which offers addiction treatment services and runs a 62-bed domestic violence shelter in Rockford, Illinois, a registered nurse dispenses the medication (individually bottled for 14 days) to ensure consumers get the care they need without exposure, explained Gary Halbach, chief executive officer. This is not appropriate for all individuals, he noted, which is why the organization still offers walk-in methadone treatment as well for about 350 people, whose temperatures are checked before they’re treated. The Substance Abuse and Mental Health Services Administration issued Opioid Treatment Program Guidance March 19 for state-requested exceptions for “stable patients” to receive take-home doses of medication for opioid use disorders (see Opioid Treatment Program (OTP) Guidance). See sample guidance issued for the state of Ohio (see COVID-19 And Opioid Treatment Programs).
Improving telehealth access and planning At Mental Health Partners, a non-profit organization that offers comprehensive mental health care and addiction treatment, the team is buying cell phones for telehealth visits and revamping the way it approaches supplies. That doesn’t mean stockpiling toilet paper, clarified Per Schenk, safety manager for Mental Health Partners, during a recent call, but it does mean ensuring the organization has at least one month of supplies ready for those who need it. All staff members are required to wear masks, but only consumer-facing clinical professionals must wear N95 masks (see Strategies To Optimize the Supply Of PPE And Equipment). Executives need to identify staff members who require masks—for face-to-face services and ensure at least a month of supplies. COVID-19 sets a new standard, but it is not the first pandemic in the U.S., nor will it be the last. “These are all events that show us we should be planning ahead,” said Mr. Schenck, who follows the six Ps he learned in the Navy—Prior Planning & Preparation Prevents Poor Performance. “Organizations should be ready for when this happens again—and it will. A little bit of prepping is good.”
While executives grapple with supply shortages, and test new ways to deliver care safely during the COVID-19 crisis, some are talking about recovery plans (see Later Is Too Late: Why A Crisis Is The Time For The Long-Term View). “It’s not too soon to start thinking about that,” Mr. Schenck believes. “Some people are working from home and maybe that’s a good model to offer services online instead of bringing everybody in. We’re going to have a new normal that’s more innovative in terms of health care in general and how we deliver behavioral health care. Two weeks ago, we were burning the candle at all ends, now we are hitting the midpoint and it’s time to start thinking about how we get back to normal. Money needs to come in, patients need to be cared for.”
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