Taking care of frail or gently infirm older adults, even in “good” times, is a challenging job. For many of us in senior care it is also a satisfying way to serve, and offers rewarding engagement.
But how does one rally to protect and defend older adults living in senior communities from COVID-19, the newest corona respiratory virus with multiple symptoms and possibly an unmerciful death, perhaps alone?
Medical experts and tragic statistics share that older adults are more vulnerable than others to this borderless virus. A recent New York Times article reports an estimated one-fifth of U.S. deaths are linked to nursing facilities often due to inadequate protection and/or compensation for staff who sometimes work in more than one building to financially survive.
COVID-19 is now in Mexico. It flowed from Asia to Europe and the U.S. first. As of April 18, 958 Mexicans over age 60 have been hospitalized and 160 have required intensive care, representing 37% of the population. (No number is known from senior homes if any, but most patients had underlying health conditions).
Inspired by the response of healthcare workers around the world and despite distressing international and local news, all hands are on deck at approximately 25 assisted living/”nursing” homes at Lake Chapala, Mexico, one hour south of Mexico’s second largest city Guadalajara. Residents are ex-pat and Mexican retirees and do not represent typical populations in other parts of the country.
Important note: In Mexico, there are no nursing homes as they are defined north of the border. Acute care is in hospitals only. Assisted living homes offer some nursing care and rehab. There is more or less a one size fits all approach to senior care in Jalisco state and the rest of Mexico, with exceptions.
Shelter-in-place began March 19, the date of the first confirmed case in Guadalajara. Since then I’ve been engaged by phone and e-mail with home owners and staff where I have found appropriate care for “gringos”. I am also in touch with precious residents via phone, e-mail, and sometimes Skype.
The virus has probably been present at Lake Chapala far longer than April 22, the date of the first reported but yet to be confirmed COVID-19 case locally. Why? Because the lake is a major destination for American, Canadian, and European retirees and/or residents who travel extensively.
What protocols have been in place at assisting living/”nursing homes” since mid-March?
First, no visitors allowed, until further notice.
Each lakeside home (4 to 20 residents, owned by Mexicans or ex-pats) is doing what it can to adhere to guidelines from Jalisco Governor Enrique Alfaro and his Ministry of Health, as well as to those of the World Health Organization (WHO). In a land not known for high health standards and cleanliness, and where compliance for the greater good is not the norm, it is impressive what this virus has prompted at assisted living/”nursing homes”.
Hand washing for all, several times. Hand sanitizers at all entry ways.
Hand sanitizer on mini-tables outside every room for doctors, nurses, caregivers, and residents.
Personal Protective Equipment (PPE) such as masks and gloves are provided for staff and residents, including masks for sitting in outside garden areas. These items are in regular supply. This is unusual as hospitals countrywide do not have enough PPE. Outside China, Mexico is the largest manufacturer of PPE. Mexico, ironically, sent a majority of its supplies to help China months ago. There is a cottage industry in every lakeside village making cotton double fabric washable masks at reasonable cost. Not the same as N-95 masks which are intended to be disposed after each use in clinical settings and are a challenge to clean. Home-made masks are, however, a helpful alternative.
Staff has stopped wearing scrubs on their way to work.
Rooms for staff to change from street clothes to scrubs have been created. Some places had these areas before with private lockers included.
Washing machines are going all day with resident clothing and staff clothing.
Staff stopped wearing scrubs to work based on hospital doctors and nurses being assaulted with bleach, hot coffee, eggs, or beatings because scrubs identify them with the virus. From Guadalajara to Merida healthcare worker abuse incidents have been markedly on the rise. Some essential workers have been prevented from entering their apartments or evicted by landlords who fear contagion. In one city, hospital workers now live in a hotel. See The Guardian article at end for more details.
Daily disinfection multiple times of door handles, railings, ground walkways
Double the work keeping dementia care residents safe
Food for kitchens now delivered to entry gates, fewer trips out
Meals served in rooms. Disposable utensils instead of flatware.
So far, no staff shortages and no cases as of this writing. Staff is showing up, fear or not. This could change if the infection takes hold. The majority of healthcare workers are young and have families.
One building picks up all staff for work so they do not travel by bus. The ideal situation, though not possible in most places, is having staff live on campus for the duration of the outbreak. Hogar Miguel Leon, a senior home housing 30 residents in Cuenca, Ecuador, for example, has outside staff living with the nurse nuns who are in charge.
Most homes, despite the added work load for prevention and preparation, are addressing isolation and possible loneliness issues of their residents. Volunteer visitors, outside entertainment, and chair yoga teachers on campus are no longer present. There is instead accelerated collaboration with faith communities, the Lake Chapala Society, other service groups, and individuals providing phone trees and Zoom chats. Adopt-a-Senior is happening. Facebook provides various resource guides for COVID-19 and delivery services on lakeside group pages. Example: one home orders to-go lunches which are delivered by a restaurant every Friday.
Technology. There is a sudden rise in Facetime and Skype use. Zoom conferencing has been implemented and used for daily or weekly news and events. For those who are cogent, this technology is happily received. For the most part, there are not so many innovations for dementia residents. No one has mentioned the use of telemedicine which is on the rise in the U.S.
Culture. In Mexico, life works depending on who you know. Owners and staff network for support with family, friends, and colleagues for solutions – Facebook reigns.
As mentioned, the majority of homes at Lake Chapala implemented public health advice promptly and with uncommon vigor.
But will the rest of the community outside these homes rally for COVID-19 and honor quarantine and face mask measures?
Is there a way to prevent unprecedented loss of life in assisted living at Lake Chapala?
Senior living homes may not be able to prevent outbreaks, but they are working on delaying them. They are taking known measures to protect vulnerable populations and staff. But the variables are many and luck is required. As in the U.S., testing is slow to arrive.
And, the virus is invisible, so prevention may be an impossible task. Staff could unwittingly be silent carriers. Local quarantines are suggested and are not enforced. Mexicans enjoy gathering in large groups, no matter what, even when they’ve been asked not to.
The song Ay Yay, Yay Yay… Canta, No Llores comes to mind for Mexico in the time of COVID-19. Sing, Don’t Cry, continue on. The words represent a mindset for suffering and profoundly sad situations which the majority of the population has endured for five centuries. The country is rich in resources. Few are well-to-do. The rest struggle to put food on the table. Singing is a way to continue every day.
In closing, gratitude to all Mexican healthcare and essential workers, unsung heroes and heroines. Thank you for your presence. You demonstrate tremendous strength and courage. May you and those you care for be protected in the days ahead.
Final note: The majority of older adults in Mexico cannot afford healthcare, let alone assisted living or in-home care. The majority of assisted living/”nursing home” residents at Lake Chapala are ex-pats, even though there are a number of Mexican residents. Each home has private rooms and baths, few have shared rooms, What’s available at the lake is not typical of the rest of Mexico where almost 900 senior homes are generally more crowded and contagion more likely.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
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© Wendy Jane Carrel, 2020
https://www.theguardian.com/world/2020/apr/23/mexico-health-workers-attacked-covid-19-fears Mexican healthcare workers being attacked throughout the country
https://medium.com/@richardensor_50805/a-chat-with-mexicos-coronavirus-czar-e2117a3a4757 Economist reporter interviews Mexican Deputy Minister of Health Hugo López-Gatell April 5, 2020, excellent overview of the public health situation
https://mexiconewsdaily.com/news/coronavirus/40-of-seniors-have-survived-covid-19-without-hospitalization/ Mexican seniors who have survived
https://www.seniorlivingforesight.net/life-after-covid-19-technologys-starring-role-in-affordable-senior-housing/ technology is making a positive difference for quality of life and care in places where it is affordable and can be implemented
www.reuters.com/article/us-health-coronavirus-canada-seniors/we-are-failing-our-grandparents-canadas-trudeau-says-as-covid-19-hammers-nursing-homes-idUSKCN2253I6 Canadian nursing home situation
https://www.nytimes.com/2020/04/17/us/coronavirus-nursing-homes.html about a fifth of U.S. virus deaths are linked to nursing facilities
https://ktla.com/news/california/socal-nursing-homes-among-hardest-hit-in-covid-19-outbreak/ list of CA nursing homes affected by virus…. 70%% of deaths in Long Beach. April 20, 2020
https://www.helpage.org/guidelines-for-care-homes-for-older-people-in-the-context-of-coronavirus-covid19/ Help Age International guidelines for care homes