PINEDALE – The novel coronavirus swept the world last spring, taking a heavy toll on older adults and people with underlying health conditions.
According to a report released by the Centers for Disease Control and Prevention in August last year, people aged 65 to 74 suffered a hospitalization rate four times higher than those in the 18 to 29 cohort. The death rate was 90 times higher for those over 65 than people in their 20s.
The Sublette Center, an assisted-living care facility populated by those most vulnerable to COVID-19, immediately went into lockdown, said Lara Hayward, CNA and housekeeping manager.
The CDC and Centers for Medicare and Medicaid Services (CMS) established infection control guidelines put in place by the Sublette Center once the first COVID-19 cases struck in the U.S., Hayward explained.
Staff members were tested each shift and wore full PPE, leaving their street clothes in separate spaces and using showers that were installed. Quarantine orders were strictly enforced to protect residents, Hayward said. Employees filled out extensive screening forms on a daily basis and had their temperatures taken throughout their shifts.
The Sublette Center’s measures kept the new coronavirus at bay longer than many other facilities across the state. The disease killed six residents at an assisted-care community in Worland, the Casper Star-Tribune reported in early October.
Despite the protocols followed by the Sublette Center, when COVID-19 spiked in Wyoming and Sublette County in November and December, the disease inevitably found its way into every corner of the community.
Residents at the Sublette Center came down with COVID-19 and out of 60 staff members, 23 tested positive.
“It was a huge hit at one time, and it was a big hit on direct care staff because the facility runs 24 hours a day, seven days a week,” Hayward said. “For at least two weeks, we were having to revamp the schedule, find coverage here, change that, move residents. It definitely has been the most challenging time of my career.”
Due in large part to extraordinary efforts by Sublette Center staff and administration and community support, the residents and employees pulled through the crisis. The center suffered only one COVID-19 related death early in the pandemic, Hayward said. Otherwise, the residents that fell ill during the outbreak survived and recovered, even in cases that required hospitalization.
“I felt like we had some grace in the situation and some extraordinary things happened,” Hayward said. “We were able to get everyone well considering the high volume of people who go sick so suddenly. It was definitely beyond any of our imaginations.”
Hayward credited the team – from dietary staff to housekeeping and the CNAs – for “compromising and sacrificing in giving precious time” to care for the residents and each other as a family.
Answering the call
Hayward made the decision to become a certified nursing assistant early in life while caring for an elderly family member.
“That was a pivotal moment for me,” she said. “Every single thing I gave to him, he gave back in appreciation.”
Working as a CNA is difficult, involves long hours and is “not for everybody,” said Hayward. She believes that her career is a calling, a chance to care for the community’s “most precious resources,” the “matriarchs and patriarchs who built and formed this community.”
Hayward joined the Sublette Center team 25 years ago and worked her way up to CNA and housekeeping supervisor. Other CNAs and staff members Hayward came into contact with over the years also believed in the importance of their work, a fact made apparent during the unprecedented, yearlong pandemic.
“I have staff members who chose to come to work and care for others even though they were in a high-risk category themselves,” she said. “They did not abandon their (Sublette Center) family. They stood by us and what we do.”
When the first isolated COVID-19 cases broke out in the facility, Hayward’s team set up what she called “cohorting sections.” These are spaces that separated residents with COVID-19 from the healthy population and allowed nurses to provide “communal care,” where equipment like hydration systems is shared.
Cases continued to rise and staff eventually had to “move heaven and earth” to create an entire unit for COVID-19 patients.
“We were basically running two facilities,” Hayward said. “You cannot really put your head around what it means to move 18 people and reallocate everyone else – to find them new homes and make them comfortable.”
The COVID-19 unit provided each resident fighting the disease “personalized care” and was “focused on recovery,” Hayward said. This required additional adjustments to a schedule already strained by quarantine and isolation mandates.
“It was nothing short of boots on the ground for everybody,” Hayward said. “I had committed, loyal nurses who were picking up extra shifts, covering and supporting each other.”
Public Health Officer Dr. Brendan Fitzsimmons and the Wyoming Department of Health approved a variance allowing asymptomatic COVID-19 positive employees to staff the COVID-19 unit.
Scheduling remained a challenge, and CNAs frequently stepped in to do housekeeping or dietary duties.
“There were moments where every single one of my housekeepers was positive at one moment and couldn’t work,” Hayward said. “I got to be the laundry person for a few days, and that was okay.”
Hayward made the ultimate commitment and moved into the Sublette Center, living in a small room with a hospital bed typically used for CNA training. She was on call, for any situation, 24 hours a day for 32 days.
Hayward’s management philosophy – a desire to support and foster her team – contributed to her decision to live at the center.
“I felt like I could not ask anyone to show up more than I was willing to show up,” she said.
Under lockdown, Hayward was unable to leave the facility or take visitors even for day-to-day things like a haircut.
“I had made a commitment to the ladies whose hair was getting kind of wild that I would not get my hair done until they did,” she said. “I literally walked up and down the halls with my hair in foil.”
Several other staff members, in order to protect their families living outside in the community and continue their work, stayed for periods at the Sublette Center.
During months of lockdown, Hayward and the staff at the Sublette Center witnessed families physically separated by the pandemic. The facility came up with creative ways to keep residents connected with family members using technology, but it was not the same as an in-person visit.
“It was a difficult thing to watch families and residents go without each other, because they can have such a limited amount of time,” Hayward said.
She emphasized that the Sublette Center, and even the COVID-19 unit, was about life rather than doom and gloom all the time – stereotypes that can accompany assisted-living facilities.
“People who think long-term care facilities don’t have life have never walked the halls,” she said. “I’m telling you, we laugh we joke, we cry. Residents will tell you things that will change your life.”
Residents decorated the COVID-19 unit and people were able to leave their rooms to socialize, watch movies or play games with others temporarily living in the separate wing.
“The COVID unit had a lot of laughter and joy in it,” Hayward said.
It takes a village
The community stepped up and people across the county chipped in to help the Sublette Center through the crisis. Public Health supplied nurses to cover shifts, Hayward said. Jim Mitchell, Sublette County’s emergency management coordinator, and Deputy County Fire Warden Wil Gay helped supply the center with N95 masks and teach staff how to use them, she added.
Employees at Ridley’s and church choirs gathered outside in the cold to sing Christmas carols, Hayward said. A constant stream of care packages, pizza and other goodies arrived for staff members.
Family members frequently brought “their babies and grandbabies over to look in the window and wish, ‘Merry Christmas!’” to loved ones, Hayward added. Child-care centers brought children over to play tic-tac-toe through the windows.
A family member of a former resident called up to inquire whether the coffee machine was working. When she heard the machine was struggling too, she sent staff a new Keurig machine to “keep the nectar of life” flowing, Hayward said.
Families continued to support the facility and staff during the crisis, “even those (families) who felt some angst about when they would get to see their family, or were frustrated with protocols or what CMS was asking.”
The Sublette Center is a nonprofit organization, and the governing board of directors “advocated for us and did some beautiful things for the direct-care staff who sacrificed so much time and energy,” Hayward said.
Working through the crisis at the Sublette Center took its toll at times. “Little moments of saving grace” from the community, residents’ families, the board and staff members helping each other made a difference, Hayward said, and she shared her deep gratitude.
“As difficult as the time was, we got to watch something miraculous transpire.”