Jones-Harrison infection preventionist: Despite the pandemic ‘my heart is telling me that the time for this social justice movement is now’

The Southwest Journal is documenting the coronavirus pandemic by recording the personal stories of Minneapolis residents and workers whose daily lives are in a state of flux. As the outbreak evolves, we will be checking in with the participants regularly. Read all of the stories here.

All interviews are conducted over the phone, and conversations are edited for length and clarity.

Barb Joyce, infection preventionist, Jones-Harrison senior living 

I am in a good place. We have no new cases of residents in our skilled or assisted living. We did a conservative celebratory dance yesterday.

We still have a week left of incubation, but it means that the testing is working. Since it can be spread through people who don’t even know they’re sick, it’s impossible to control without testing.

The tide was turned last week, on May 26. The National Guard came out and we tested all of our residents. In the beginning they weren’t going to test our assisted living, but it’s under the same roof as us, in the same airspace, and we pushed for it.

On May 27, we found nine residents in skilled who had absolutely no symptoms but tested positive. We were able to isolate them in our 22-bed COVID-only unit.

It is not easy to physically move somebody to a whole new unit. You have to have their physician’s orders and their medications and their care plan. The new unit has to understand what the old unit was doing and, on top of that, how the illness is changing the patient. Everybody was literally on razor’s edge. We kept saying, “This is the right thing to do, this is the right thing to do, we’ve got to keep going.”

It was the right thing to do because this week no further transmission occurred. Out of the nine, four or five of them became symptomatic and the others were fine — they would have continued to transmit it. We also identified four asymptomatic employees, who were like, “Wow, we did not know.”

It often feels like the elder care sector is being painted as incompetent, and yet the lack of resources, equipment and testing — and the lack of pay to get enough quality employees — makes us a ripe setting for COVID to explode. With this virus in this environment, no matter what scientific data and guidelines we had from the Minnesota Department of Health, without testing we would have been in the very same shoes we’ve been in for the past eight weeks.

Isolation has taken its toll on our residents with the number of people who have passed from our realm — from COVID and otherwise. Our last census was at 103 residents and we’re a 157-bed facility. I understand the feelings people are going through not being able to see, advocate for or effectively console their moms and dads.

It has been very traumatic. It’s been very exhaustive and very unhealthy. The caregivers are in a status of unhealth. Some cope better than others, but fear has a huge impact on our health. I’m OK in a sense that I don’t have at-risk people in my household, though nobody knows how this virus will affect each individual.

My goal was for it not to come into our facility but it did.

For a time we were successful in containing the disease on the third floor, where residents have some cognitive impairment but can follow directions and have some sort of understanding about the isolative procedures we’ve implemented. They’re able to say, “I don’t feel good.”

Once it came to our second floor, the slope got slippier. It’s a 79-bed moderate-to-severe dementia unit, and they are the most vulnerable because their understanding of communication has been greatly diminished and their needs are more. On the third floor, it was one or two cases at a time. On the second floor, it was like a runaway train.

Our staff are in the airspace of the residents. When they wash a resident’s face, they have to be right there doing every stroke to their body. The residents have to be fed, they have to be bathed, they have to be clothed, they have to have their teeth brushed. Every aspect of their care is involved with another human being, who may be an asymptomatic carrier.

We don’t have enough trained staff to feed residents on the second floor in their rooms one-on-one. We still have to take some individuals into the common area, sharing airspace with others. We don’t have enough skilled workers, though we’re training non-health care workers to be feeding assistants.

Some residents are in shared rooms, which is risky. If one identifies as having symptoms, we break them apart and take the ill resident to a private room while they’re being tested. We have empty rooms we can play musical beds with now. In the beginning we didn’t have that luxury.

Our nursing home has received personal protective equipment that has helped us tremendously. But the equipment, I believe, is still insufficient. I believe everyone in long-term care should be in an FDA-regulated, fit-tested filter mask. But I only have enough FDA-regulated masks for my COVID floor.

I’m still having to ration out other masks on non-COVID floors. There are a lot of counterfeit KN95s that have infiltrated our stockpiles. We get a lot of masks without any identifying markers — they’re not even coming in a box — and we have to figure out if we can use them.

We accept every donation we can get our hands on. The community has jumped through hoops to get me anything I need. When I needed shirts, I had 500 shirts. A company that usually makes boat seats made us isolation gowns out of a water-resistant upholstery material. The community of Breck high school asked us if we wanted their graduation gowns. I was able to alter 200 graduation gowns into uniform protectors.

I did a supervised compassionate visit between a tenant in our assisted living facility and her husband, who was dying of COVID.

I observed her from the doorway, through plastic sheeting. I stayed for two reasons. She’s an elderly, vulnerable person and I was worried about her stamina being emotional with her husband. I also wanted to make sure her personal protective equipment was staying in place and she didn’t expose her community.

She wore a surgical mask and a full plastic facial shield. During her visit, the shield came off three different times because she wanted to kiss her husband and forgot she had it on. She wanted to hug her husband and forgot she had it on. She was crying, so she needed to blow her nose, and forgot she had it on.

I went back into the room each time, got her back set up, changed her gloves and then left the room again. These compassionate visits they want us to do — it’s the right thing to do and I totally believe it, but they have no clue in the guidance as to what is actually needed. We don’t have enough caregivers. Our staff are sick and we’re having to move our staff all around the facility because we’re at our last resort.

According to the guidance, the woman doesn’t have to quarantine after this visit, but according to me, the answer is yes. Our facility is attempting to balance tenants’ rights in an independent assisted living community with infection control protocols. And it’s not always easy to do the right thing. People want to visit their loved ones, so we need to think of creative ways to do it safely.

I went to the protest [over George Floyd’s killing] last Sunday and the truck almost hit two of my daughters on I-35W. I have a horrific picture of my kids running out of the way of the trucks.

As a health care worker, I made the decision to go — as a person, as a human, as a humanitarian. I am appalled that we’re living with this systemic racism in this day and age. I am flabbergasted that this is being allowed to continue. So I am standing with my brothers and sisters in standing against systemic racism.

But on my way to the protest, I put my health care brain on and said, “I shouldn’t, I can’t.”

I stayed on the periphery. We participated in the kneeling and moment of silence on the bridge. It was one of the most amazing sights I’ve ever seen. There had to have been at least 3,000 to 5,000 people packed in on that bridge. Because I’m a health care worker, I looked and noticed that at least 50% to 75% had on masks, which made me feel good.

There is a march for health care professionals this Sunday at the Capitol that I’ve signed up to attend. We will be socially distancing and I will have my mask on. In the midst of the COVID pandemic and at the risk of ongoing transmission, my heart is telling me that the time for this social justice movement is now. The time is now for us to stand up, to speak up, to show up so our state and our country and our world can be transformed.

Right now the rights of all people are not being acknowledged and that must stop. Not just for me, who, by the way, is brown-skinned, but for my children and their children to live in a better world. My faith says this is the right thing to do.

It’s been difficult to see the crowds. Everybody has their own lens they look at the world from. The first push to open the state up made me very sad and very angry, and I was very tired. I didn’t fully understand the crowds that were demonstrating. I judged those crowds with my health care worker heart. I thought, “You don’t care about us. You don’t care about the people who are dying being isolated from their family members. You don’t care that you’re putting a set of people at risk for hospitalization and death. You don’t see us. You don’t care. You don’t care.”

I was really, really distraught. I feel the stress of this has taken the toll on all of our health. The cortisone levels we get when we’re stressed is playing havoc to the inside of our organs. Stress prematurely ages and kills us.

But I did not see the devastation [the stay-at-home order] was doing to my brothers and sisters whose incomes had been lost and whose businesses had gone away. From that standpoint I understand that people need to have their voice heard. We have to listen to every peaceful demonstration.

Yet the hardest things to hear were, “I need to get a tattoo” and “I need to get my hair done.” That was the hardest pill to swallow. Non-essential stuff that we can give up for another month, we should give up.

I didn’t like how the first group marching through Michigan with AK-47 rifles was allowed, and yet these peaceful marches in Minneapolis were getting tear gas and rubber bullets. I think there’s an inequality there.

I don’t think the intent of the protests are to spread COVID. It’s just that the time is now. They have an opportunity to make change, and they’re not going to let it pass them by. They’re not screaming for their rights over the rights of others.

Through my lens, it’s the haves and the have nots. I see the first group fighting for quality of life. I’m more willing to work the long hours for the second group, because they’re fighting for survival.


VOICES FROM THE PANDEMIC

 You can read all of the stories here.