In mid-March, as San Francisco mayor London Breed issued a citywide stay-at-home order, Peggy Cmiel started getting prepared. Cmiel is the director of clinical operations at the San Francisco Center for Jewish Living, or SFCJL, a 9-acre senior housing complex in the Excelsior neighborhood that includes long-term care facilities, short-term rehab housing, and a memory care wing. The campus houses over 300 elderly residents, members of one of the populations most vulnerable to the deadly and highly infectious coronavirus that has spread across the globe.
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Cmiel’s staff stocked up on personal protective equipment and masks for workers and residents; screened everyone who walked in the door for symptoms; hired more staff to clean bathrooms and common areas; and started educating everyone on best practices for containing the virus, like washing hands, avoiding close contact, and keeping an eye out for symptoms like fevers or coughs. And while nursing homes account for nearly half of California’s coronavirus fatalities, at the SFCJL not a single resident has tested positive for the virus. “Getting an early start was really the most helpful thing we did,” says Cmiel. “The doorknobs in this facility have never been more clean before.”
Not every home was so lucky and so well prepared. Nursing homes across the US have been devastated by Covid-19. In many states including Colorado, Massachusetts, and Virginia, nursing home resident deaths account for 50 percent or more of coronavirus deaths. But the success of a handful of homes, like SFCJL, might offer their colleagues some clues about how to keep residents safe as the nation braces for a potential second wave of infections.
Geriatricians and nursing home operators understand why these spaces are so vulnerable. Long-term care facilities are, in many ways, perfect virus incubators. Residents, who are older, frail, and often have comorbidities like heart disease or diabetes, are more susceptible to severe Covid-19 infections. Many need help performing basic tasks like eating, dressing, or bathing—care that can’t be delivered through a video appointment, making it more likely they could get an infection from the aides who help them, or pass the virus along to their caretakers. Those aides may work at several different facilities, and unknowingly carry it from one home to another.
The layout of these facilities also furthers contact in various areas. Most residents share bedrooms, bathrooms, activity rooms, and dining rooms—and staffers share a break room. Those group spaces are designed partly to cut costs, and also to encourage socializing. But shared spaces have also helped spread the virus. Senior facilities do have protocols to handle outbreaks like the flu, but the pandemic arrived so quickly and the SARS-CoV-2 virus is so contagious that many facilities were caught unprepared. “There’s an extent to which this virus just had the upper hand,” says Anna Chodos, a geriatrician at the UCSF. Unlike hospitals, most nursing homes aren’t ordinarily well stocked with gear like masks and gowns, which aren’t necessary when containing the flu.
Now, as states slowly start to reopen, senior care facilities are facing a more complicated endeavor: figuring out how to keep residents safe and maintain their quality of life as the Covid-19 pandemic stretches on. Even for facilities like SFCJL, the path forward is far from clear. “How do we safely and slowly introduce visitation and group activities? It’s going to be very car