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Proactive Communication and Collaboration With Families During COVID-19

      Graphical abstract

      These are frightening, insecure times. More than likely, families are reading multiple stories about coronavirus infectious disease 2019 (COVID-19), some of which conflict and may cause even more fear and alarm. Proactive and transparent communication with families can help minimize some of the fear and counter misinformation. A trauma-informed organization demonstrates trustworthiness and transparency, which is reinforced by clear, timely, and accurate communication.
      As nursing home health care leaders, we can collaborate with families to let them know what steps the facility is taking to make the environment as safe as possible and provide the best possible care for residents and staff.
      Regular communication has always been a hallmark of great health care, and right now it is even more crucial. Here are a few suggestions for information to share with your families.
      • Explain why it is so critical to limit visitors and visitation of residents to prevent viral spread, even if no residents have been infected with COVID 19 yet.
      • Inform families if anyone has tested positive for COVID-19 in your facility. The fear of not knowing can be worse than knowing the truth. We tend to conjure up horrid stories in our minds that get repeated and augmented, exacerbating the fear. Share with the families, even those who do not demonstrate any interest, what the facility is doing in terms of screening, especially when residents leave and re-enter the PALTC facility. Let them know what precautions are in place for the residents who share rooms and what would happen if a roommate tested positive.
      • Ensure that families know whom to call if they have questions, and that the phone will be answered or the call returned.
      • Teach families about personal protective equipment (PPE), and let them know how those items are being used to keep residents and staff safe. Let families know about the training that staff has received to properly use the PPE. If PPE is not available, tell families what the facility is doing to obtain it. And tell them what processes are in place in the meantime to keep everyone as safe as possible.
      • Be honest about how this is a fluid situation that requires daily — sometimes multiple times a day — updates and renegotiations. Let families know how the staff are communicating with each other and how the leadership is staying abreast of staff and resident needs.
      • Establish a communication plan that includes regular updates. Don’t make families ask for information — offer it willingly. Be proactive. Be honest.
      • Acknowledge that nursing home staffing can be a tricky subject. The reality is that your facility may experience staff shortages, whether due to illness or staff making the difficult choice to stay home. Let families know how the facility plans to handle these situations, including how the residents’ needs will be met for personal care, meals, medication administration, and social engagement.
      • For family members who are a resident’s surrogate decision-maker or power of attorney, inform them that they will be asked to clarify their treatment wishes in the event that their loved one becomes ill, either with COVID-19 or another condition. Update advance directive documents, especially code status. Consider discussing temporary Do Not Resuscitate status. “Prioritizing Advance Care Planning in the Time of COVID-19” is a free webinar offered by Johns Hopkins Medicine that offers valuable considerations for those conversations (https://www.hopkinsmedicine.org/gec/index.html).
      • Ask families for their input. When people are invited to collaborate, especially during times of crisis, they will be more invested in the outcome and success of combined efforts. Families can be a wonderful support, and they may even welcome the opportunity to do what they can to help the facility and staff.
      AMDA – The Society for Post-Acute and Long-Term Care Medicine has a webpage dedicated to resources to help providers and facilities. Go to https://paltc.org/COVID-19 to obtain information on the Society’s guidance, resources, and tools; COVID-19 daily email updates; podcasts and webinars; press coverage; and updates from the Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services.
      Be prepared to repeat information. When people are stressed, their ability to retain information and recall it accurately diminishes. Exude compassion, expertise, and confidence, but also humility as we all learn how to function in this extraordinary time.
      Ms. Hector is a clinical educator and public speaker. She is passionate about nursing homes and supporting staff to care for the most vulnerable people in their communities. She is an associate editor of Caring for the Ages.