Rising to the Call
July 24, 2020
Komara
When about one-third of the residents and staff of the Benedictine Health Center at Innsbruck in New Brighton, Minnesota, tested positive for COVID-19 in March, staff quickly converted the long-term care facility's transitional care unit into a COVID-19 isolation unit.
Since the onset of the pandemic, a total of 81 residents and 26 employees of the facility have tested positive. Of that count, 67 residents and all affected staff have fully recovered. Fourteen residents have died.
As of July 20, the facility was COVID-19-free.
Throughout the pandemic, Ishmael Komara, the facility's director of nursing, rallied staff to care for vulnerable patients who were COVID-positive. He spoke with Catholic Health World Associate Editor Julie Minda about what it's been like for this campus — which includes long-term care, memory care and short-term rehab — to respond to this pandemic.
When the news broke (of an outbreak at a Washington state nursing home) we started to plan for what it would mean for us. And the first thing we identified was where we were going to place patients if we have COVID. We talked about logistics — staffing and supply management and how are we going to manage information — that's key. We also talked about which staff we were going to use in that unit because we're not looking to place just any staff in that unit. We were looking for staff who were the most competent, who we know would follow every instruction and who were willing to do that.
Immediately after we began planning, we learned that one of our residents was positive. A week later, we began to see a few cases spring up in a specific pocket of one of our long-term care units. We really didn't know the extent to which the virus had spread and later, we learned that one-third of our patients and our staff had already been exposed. Into week two, we had this mass amount of patients that started showing symptoms and we tested them all and they all had symptoms and so we had to come in on a weekend and move all the affected patients to the isolation unit on a really short notice.
The first COVID-19 case that came out of long-term care, I personally went and took care of that patient. In my mind what I was thinking is that people were afraid and there was a lot of uncertainty, and I wanted people to know that, yes, you can care for COVID patients. Being a leader and as a nurse I felt like, well, maybe I can set the example. As we did that, we got staff to start volunteering and saying, "I can do it."
I personally was affected by COVID. I was home sick for 12 days and then came back to work. I had gotten the virus because I was working so intimately close to these patients.
The staff are willing to work, but there was so much uncertainty. For me the difficulty was balancing what the staff were actually watching on TV and on the media versus what we were telling them. And so that was a big challenge. All of my staff — I know every single one of our staff and their kids and we have a lot of single parents who work here — all of my staff were telling me: "Ishmael, I want to work, but I am afraid. I have my family at home, and I don't want to take this thing home to my 5-year-old." And I have to be the one reassuring them and saying I completely get it. I have a 4-year-old at home and when I get home, she runs to me, she innocently runs to me and she doesn't even know what her daddy has just been through.
But I tell staff, here's what I can assure you: I will give you full PPE. I want you to wash your hands. And if you do those things you will be safe.
One of the things I did — I opened up a GroupMe forum on an app for all of our staff. I informed them that this is a forum for us to share ideas and support each other and we even started celebrating folks' birthdays on there in the middle of it to add a little fun to it. And up to this day I've used this forum as one of the primary ways of communicating with staff and it allowed them to express themselves and to express their fear about how they are feeling and about some of the decisions we were making. And it truly allowed them to even criticize some of the things we were doing.
And then the second thing we did: we have been having a weekly virtual staff meeting and that has been extremely helpful in just trying to control the narrative of what's happening in our building compared to what may be happening elsewhere.
And at the end of the day I go to the units every day in person and just say, "I just want you to know you're doing a great job, you're working hard, and if you need me I'm here for you." And they actually see me working — moving beds, moving patients — and so that kind of helps. They see I am not just saying it is OK to treat these patients — staff see I am actually participating, and actually being here.
After the initial outbreak, we started to see patients from the COVID unit starting to recover. The first day we had an informal graduation ceremony — it was just reassuring. It is reassuring to our staff and to other patients that, yes, that person got out of here and I can get out of here too. And it's reassuring for families.
For me, what makes me truly passionate about this is that I just recall the first night we had a family meeting and informed families — "You can no longer come in our building, unfortunately you can no longer come in and see your loved one." That was the most difficult thing for me and I felt that we had a responsibility to keep everyone safe. And that obligation, for me, it was a source of strength.
We are very much a values-driven facility. Everything we do. And personally, every action that I take, I think about it, and I ask am I being just? Is it peaceful? Am I being hospitable? Not just to my patients and their family members but also to all of our staff and all of the people we interact with. Are we actually being a good steward to our patients and their families? And when we make a decision, we take all of those values into account.
One unique example of that for me, and when I say this I tear up, because I had a family member, it was our first patient, who we knew would not make it because she had not been eating. And in my years of experience I know that when you're 90 years old and you've lost your appetite, we know what the outcome is. So I personally talked to the family, and I got an iPad and I dialed the family up on the iPad. The patient couldn't say much but I just tried to give the family an opportunity to talk to her and I just brought the iPad closer to her ear so they could talk about how much they love her. And she was our first COVID patient who actually passed. So it's been really tough.
My main takeaway from this time has been about the importance of having relationships as a team, and with our patients and with their families, and that is very key in all of this. It goes directly back to those same values again because at the end of the day how we see each other, how we treat each other and what it means to be in the same space is so significant.
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