Retirement community staff should prepare themselves for norovirus outbreaks, which can shut down dining halls, damage public relations, and strain residents’ physical and mental health, according to staff members of a Portland, Ore., facility who learned the hard way last year.
"Knowing what we know now, there are a lot of things we would have done differently," said Mjere Simantel, director of social services at Willamette View, a continuing care residential community in Portland, at the annual conference of the American Society on Aging.
Norovirus, which causes diarrhea, vomiting, and fever, is seldom deadly and most patients recover in 48 hours, but it can spread quickly in the tight quarters of a retirement community. And victims can continue shedding the virus for weeks after symptoms fade.
The virus had visited Willamette View before, but without doing much harm. "Previous outbursts were taken care of very quickly," said Rikki Schoenthal, community counselor for the 500-bed facility.
She first became aware of last year’s outbreak in March of 2010 when some residents complained of food poisoning. That was on a Friday, and the local health department was closed because of furloughs. Over the weekend, the number of residents with symptoms began mushrooming. The health department ordered the community to close the dining room and stop cross-traffic between the community’s buildings.
"Our dining service had to figure out how to feed our residents," recalled Ms. Schoenthal. "How were we going to deal with the hair salon, the computer lab, the laundry room, the health center, the pool, the bank, the cleaning room, the library?" Eventually, almost all social activities were canceled.
And the staff found themselves on a sharp learning curve. One hard lesson was that the virus can live on ordinary surfaces indefinitely. "We actually had staff wiping down books," said Ms. Schoenthal.
Another lesson: Hand sanitizers don’t kill the virus. It has to be physically removed from skin with soap, water, and scrubbing. Likewise, vacuuming carpets can send the virus airborne. The community invested in a large stock of chlorine wipes, only to find them ineffective. Some chemicals that were used to sterilize surfaces proved so potent they took the paint off walls, corroded doorknobs, and damaged elevator buttons.
With such confusion, communication proved very important. The management slipped newsletters under each resident’s door every day. Still, residents felt isolated; the only human contact for some was the staff who delivered their meals.
"Some of the residents felt like it was room service," said Ms. Schoenthal. "Others reacted with dismay. They felt like they were being ‘quarantined.’ That word started to be used and we did not want it to be used."
Staff was strained to the breaking point. Those whose work was involved with social activities had to be reassigned. Dining hall staff had to work extra hours. Even the CEO began delivering meals.
The meal deliveries became the community’s main means of checking on the daily health of each resident. The management created a database to track who had fallen sick and who had recovered. Eventually, 96 residents got sick and 2 were hospitalized with dehydration.
Some 50 staff members fell ill as well. "Some of the older adults had accidents, and the environmental staff had to go in there and clean up, and most of them got sick," said Ms. Schoenthal.
She saluted their sacrifice. "The way the staff protected the dignity of the residents in an undignified situation was just stellar," she said. Although the management recognized this effort with a $50 bill for each staff member, many staff members suffered financially because they were forced to take time off after falling ill with the virus. Those who didn’t have enough paid days in their account had to take the time off unpaid. "That was something we still want to explore," said Ms. Schoenthal.
As the outbreak stretched on, the strains increased. The health department insisted that the dining hall be kept closed for 4 weeks, and no visitors or social activities were allowed.
"We had residents who didn’t leave their rooms for 4 weeks," said Ms. Simantel. "Our residents were used to being extremely social. They went from all to nothing. It felt to them like a lockdown, and we still have residents report that they have not recovered."
The staff piped brain teasers into the residents’ rooms through closed-circuit television and began making phone calls to them, but many residents suffered from the isolation. One man had to be referred to hospice care when the restrictions were ended.
The Willamette presenters recommended the following issues for similar communities to consider before they’re hit by norovirus:
• When to activate an emergency plan.
• How to collect data.
• With whom to share the data.
• What role state agencies will play.
• Whether staff has to use paid time off if they get sick from their work.
• What your business insurance will cover.
• How to clean infected rooms.
• How to communicate with state agencies and the news media.
• Whether to use the "Q word" (quarantine).
The presenters also listed the following measures that they would do differently:
• Broadcast a closed-circuit television program of physical exercises.
• Ask health department experts to visit and make recommendations tailored to the community’s circumstances.
• Allow visitors to go to residents’ rooms while wearing gowns, masks, and gloves, which they would discard after each visit.
And audience members who have experienced norovirus outbreaks offered the following additional suggestions:
• Keep a box of supplies on hand for such an emergency.
• Put magnets on the doors of sick residents so that staff can tell which is which.
• Create a system of phone friends to help break the isolation.
Whatever else they do, staff members should be prepared for a longer haul than they expect, said Ms. Schoenthal. "We just kept thinking it would end tomorrow."
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