In the early months of the COVID-19 pandemic, Maplewood Nursing Home sent a message to the local agencies it draws on for staff: Their employees would need either to work at Maplewood full time or not at all.
The county-owned facility in Westmoreland implemented that policy, upon guidance from the state, in an effort to prevent staff from contracting the coronavirus elsewhere and bringing it on-site, according to Maplewood Administrator Kathryn Kindopp.
“In the past … an agency person could’ve worked a day here and then gone to another place the next day,” she said Jan. 22.
In fact, agency workers make up a small fraction of the more than 200 people on Maplewood’s staff, most of whom are employed by the county and hold nursing roles, Kindopp said. And while the facility cannot regulate its employees’ behavior outside of work, she said, it has encouraged them to avoid unnecessary exposure to COVID-19.
“I can’t make them not go to the grocery store, so they’ve got crossover when they go [there]” she said. “I’ve got staff that have kids that are in school, or staff that have kids that are in day cares.”
Like Maplewood, other health-care providers in the Monadnock Region working with elderly populations have similar concerns and are making an effort to mitigate the risk of transmission.
Dr. Richard Feifer, chief medical officer at Genesis HealthCare — which owns senior-living facilities in Keene, Peterborough and Winchester — said earlier this month that nursing-home outbreaks are often caused by infected, asymptomatic workers bringing the virus to work. As a result, Genesis has stressed to its staff the importance of behaving safely outside of work, Feifer told The Sentinel in a Jan. 18 interview.
“Early in the pandemic, we made it a priority to make sure everyone who works at Genesis knows that the decisions they make on their personal time affect them, their peers and the residents under their care at work,” he said.
The most effective way to prevent outbreaks in nursing homes, Feifer added, is to reduce the spread of COVID-19 in the communities around them so that staff face less risk of contracting the virus outside of work.
D&S Elder Services, a Walpole-based company with about 60 employees, provides in-home help for seniors — often cleaning, cooking or doing errands — with the intention of keeping them in a family setting rather than a nursing home.
Before the pandemic, D&S workers also helped clients in senior-living facilities with basic tasks, like taking them to doctors’ appointments and doing laundry, according to co-owner Debbie Miller. Now, she said, the agency is letting the nursing homes decide whether to let their residents receive that assistance and risk exposure to COVID-19.
Genesis, for example, which has recently had outbreaks at three local facilities, is not working with D&S during the pandemic, Miller said. (A Genesis spokeswoman had not responded as of Thursday to a question about whether any of the company’s Monadnock Region care staff also work at other facilities or are employed by independent agencies.)
D&S workers providing in-home services have been restricted to assisting only one or two clients at a time, according to Miller. Anyone working with two clients was already with one of them before the pandemic, she explained, and clients can request to be their caregiver’s only patient.
So far, just one D&S employee has been diagnosed with COVID-19, Miller said.
“We’re very, very careful because all these people are already compromised,” she said.
Another local agency, Trusted Choice Eldercare, provides similar in-home services as well as nursing care.
With some of its employees working full time and others part time, Trusted Choice owner Emily Mitchell, a Spofford resident, said she has kept a “real close check” on their behavior outside of work, though she added that her staff has remained largely vigilant in their free time.
Like D&S, Trusted Choice has accommodated any clients’ requests that their caregivers work in only one home, which Mitchell said has made scheduling “like putting a big puzzle together.”
When one Trusted Choice client contracted the virus, Mitchell said, her caregivers agreed to continue working in the home — their only assignment at the time — and then received multiple tests and before working with other clients. The only Trusted Choice employee to contract the virus, to date, worked with that client, she said.
“I think it’s just been because everyone’s really cognizant of their own private practices,” she said.
If anything, Mitchell added, the pandemic has increased demand for in-home elderly care, as seniors hope to avoid group-living settings that have been devastated by the virus. She believes that trend has intensified a growing interest in the services offered by Trusted Choice, which she founded in 2019.
“I just think people are more comfortable keeping their loved ones home and sending a caregiver in,” she said. “… It’s been wonderful to see the growth in the middle of the pandemic, and I’ve been very grateful because I know there’s been so many business owners that have been not so fortunate.”
Sentinel health writer Olivia Belanger contributed reporting to this article.