Date: 09/23/2020 COVID-19 Update #25

Subject: COVID-19 Update #25, Status.

Good afternoon,

I thought this would be a good time to re-send to families the reopening guidance for Phase III. The word “guidance” is misleading. This guidance has been issued by the CDC and CMS and endorsed by the Virginia Department of Health. We are expected to follow it without deviation. The guidance falls under eight categories. Some of the information does not apply to current residents, i.e., the admission of new residents and so I will list only that which does.

Visitation – Visitation is allowed with screening and additional precautions including social distancing and hand hygiene (e.g. use alcohol-based hand rub upon entry). All visitors must wear a cloth face covering or facemask for the duration of their visit. Physical contact is not permitted. We are working on procedures that will allow for face to face visitation while still observing social distancing.

Dining – Communal dining is limited to COVID-19 negative or asymptomatic residents or residents who meet criteria for discontinuation of transmission-based precautions. Residents may eat in the same room with social distancing (limited number of people at tables and spaced by at least 6 feet). We were allowed to implement this during Phase II and did so.

Social and group activities – Group activities including outings allowed (for asymptomatic or COVID-19 negative residents, or residents who meet criteria for discontinuation of transmission-based precautions with no more than the number of people where social distancing among residents can be maintained , appropriate hand hygiene, and use of a cloth face covering or facemask. We were able to resume group activities on a limited basis during Phase II. We will be allowed to increase the number of participating residents and activities during Phase III.

Non-essential staff – Allow entry of non-essential healthcare personnel/contractors as determined necessary by the facility, with screening and additional precautions including social distancing, hand hygiene, and cloth face covering or facemask. Allow entry of volunteers with screening and additional precautions including social distancing, hand hygiene and cloth face covering or facemask. The return of volunteers will likely occur at a later date. The City of Richmond and surrounding counties remain in the “caution zone” with percent positive cases from testing well above 5% and in the City of Richmond 9.2% Because of these numbers, The Virginia Home is required to test all of our employees on a weekly basis. We do so every Wednesday. Should the percent positive in Richmond exceed 10% we will have to begin twice weekly testing.

Resident trips outside the facility for non-medical necessary reasonsMight be allowed to asymptomatic or COVID-19 negative residents who meet criteria for discontinuation of transmission-based precautions* only in addition to social distancing, appropriate hand hygiene, and use of a cloth face covering or facemask. We will not resume non-medical necessary trips outside the facility until the City of Richmond and surrounding counties experience a significant reduction in percent positive tests.

Salons – Salons may open so long as the beautician or barber is properly screened when entering the facility and must wear a mask for the duration of time in the facility. The beautician or barber must remain in the salon area and avoid common areas of the facility. Salons must limit the number of residents in the salon at one time to accommodate ongoing social distancing. Staged appointments should be utilized to maintain distancing and allow for infection control. Salons must properly sanitize equipment and salon chair between each resident; and the beautician or barber must perform proper hand hygiene. No hand-held dryers may be used. Salons must routinely sanitize high-touch areas. Residents must wear a face mask during their salon visit. We were allowed the discretion to reopen our salon during Phase II with the above precautions. We did so last week. Our beautician Claudine Smith is now seeing residents each Wednesday and Friday.

Onsite Physical Therapy – During Phases II and III, access to an onsite physical therapy room should be limited to COVID-19 negative or asymptomatic residents or residents who meet criteria for discontinuation of transmission –based precautions but residents may use physical therapy equipment with social distancing (limited number of people in the room and spaced by at least 10 feet), hand hygiene, and cloth face covering or facemask. Staff should wear a face mask as well as a gown and gloves while conducting physical therapy. Gown and gloves must be changed between residents. Equipment should be properly cleaned and disinfected between each use. We have been providing in-room therapy to residents throughout the pandemic. The return to therapy provided in the PT/OT department will be done gradually according to the guidelines.

This has been a long and difficult process for residents, families and staff. But, the precautions we have taken have been successful in keeping our population safe. We have had only one resident test positive in the past six months. Unfortunately, our neighbors in the community aren’t doing as well. Many states that have experienced outbreaks have gotten a handle on their situation and brought their percent positive numbers down. Though Virginia didn’t have the extreme outbreak experienced in other states we haven’t made a lot of progress bringing the number of percent positive test results down. Before we expose residents to the community, we’d like to see improved testing results.

Perhaps the most compelling argument I can provide for a cautious approach to reopening is that any positive COVID-19 test of a resident will force us to regress to Phase I. We’ve come too far to allow that to happen.

As soon as we are able to advance to Phase III and plans are in place to implement in-person visitation, I will correspond again with procedures for scheduling.

*discontinuation of transmission –based precautions

Transmission-Based Precautions are for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens, which require additional control measures to effectively prevent transmission.

Thank you,

Bob Crouse, President & C.E.O.
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Date: 09/11/2020 COVID-19 Update #24

Subject: COVID-19 Update #24, Status.

Good afternoon,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic.

1. Good news! Testing of all staff and residents was conducted on Wednesday and all results are negative. That is two consecutive weeks that we have produced 100% negative results and so we anticipate an advance, once again, into Phase II of re-opening on Monday. In Phase II, we will increase small group activities and small group dining. We are also making plans for the return of our Hair Stylist, Claudine to offer hair cutting services.

2. We are required to continue weekly testing of all employees as long as the City of Richmond remains above the 5 percent positive level. Should the City exceed 10 percent positive we will have to test employees twice per week. Currently, Richmond has an 8.2% positive rate.

3. Our hope is that we will be able to advance to Phase III in approximately two weeks. In Phase III we will be able to allow additional visitation, still with social distancing.

I’m pleased to be able to share this good news with you and hope for more to follow soon. Have a nice weekend!

Bob Crouse, President & C.E.O.
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Date: 09/04/2020 COVID-19 Update #23

Subject: COVID-19 Update #23, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic.

1. I’m pleased to report that we have received the results of our facility-wide testing of residents and staff conducted on Wednesday, September 2nd. We were 100% negative!

2. We will have to conduct repeat testing next Wednesday, September 9th. Should we achieve a similar 100% negative result, we will be able to advance to Phase II of re-opening.

3. New CDC regulations require that we continue to conduct weekly testing of all employees as long as the percentage of positive tests in the Richmond community exceed 5%. Should the percent positive exceed 10% we will have to test employees twice per week. Currently, Richmond has a 9.9 percent positive rate. Previously, this was a recommendation. Now it is mandated.

4. All efforts to keep residents engaged socially continue. Fresh air time, “through window” visits and one-on-one visits are but a few of the ways we seek to provide socialization and stimulation. We’re very hopeful that we will be able to offer more with an advance to Phase II.

5. With the holiday weekend approaching we are doing all we can to remind staff members of the need for vigilance. Holiday weekends are normally a time for large social gatherings and relaxation of the precautions that help to prevent COVID-19. We trust in our staff to remain mindful of this and to be cautious.

Have a safe weekend!

Bob Crouse, President & C.E.O.
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Date: 08/28/2020 COVID-19 Update #22

Subject: COVID-19 Update #22, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 pandemic.

On Wednesday of this week, we tested all staff and residents who live or work on the floor where we had a positive test result last week. All tests were negative. The resident who tested positive is recovering at TVH and will hopefully be released from isolation late next week.

Next Wednesday, we will again test all staff and residents. If all results are negative we will repeat the testing. Two rounds of 100% negative testing are required in order to return to Phase II of reopening. Next Monday, we will resume outside time for residents, and of course “through the window” visits continue as scheduled.

Finally, I know many of you are frustrated by the precautions that have been in place for going on six months. I understand and share your frustration. While it is important to do all that we can to keep residents from getting COVID-19, the precautions come at the expense of the resident’s complete well-being. We’re doing everything we can within the guidelines we must follow to keep residents engaged and provide some socialization and respite from the isolation. I promise you that we will never impose restrictions out of convenience or make residents stay isolated for one day longer than necessary. We all want the same thing, and that is to return to a normal level of operation as soon as possible. I encourage all of you to continue with your calls and “through window” visits whenever you have the opportunity. They mean an awful lot to the residents.

Stay safe. Additional updates will follow as our situation changes.

Bob Crouse, President & C.E.O.
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Date: 08/20/2020 COVID-19 Update #21

Subject: COVID-19 Update #21, Status.

Good afternoon,

Unfortunately, after several months of no new COVID-19 cases among our resident population, one resident has tested positive with a new case. Yesterday, we tested nearly all residents and employees and the one resident did test positive. While we don’t yet have 100% of the results, I can tell you that all other residents on the same floor tested negative. I’m also happy to report that the resident who tested positive is asymptomatic.

The precautions that were put in place during our last resident outbreak have been reinstituted, though it is hoped that they will only be necessary for a short time. The small group activities that we resumed on Monday have been temporarily suspended until all of the results are in. We do not plan to stop “through the window” visits at this time but will reevaluate should additional positive results be received.

I will continue to keep you posted with updates as the situation changes.

Bob Crouse, President & C.E.O.
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Date: 08/11/2020 COVID-19 Update #20

Subject: COVID-19 Update #20, Status.

Good afternoon,

The following is an update regarding The Virginia Home’s response to the COVID-19 pandemic.

In previous updates I have reported several employees testing positive for COVID-19, likely from community based exposure. Numerous residents have now been tested twice for this exposure and I am happy to report that all tests have been negative. We have not had any residents test positive in more than four months.

We remain in Phase I of our re-opening. I am hopeful for an advance to Phase II in the near future. We are in doubt at this point regarding the necessity of further testing prior to the advance and are awaiting guidance from health officials. Beginning next Monday, we plan to implement additional small group activities under the leadership of Jody Young our Director of Recreation Therapy. The activities will be conducted in groups of five, likely on the first floor and outside.

Additionally, keep an eye out for an email from Jody regarding September and October “through the glass visits.” Her email will contain a link to the sign-up application. Should we advance to a level of re-opening for closer contact visits we will let you know as soon as possible.

I hope that all of you are remaining safe and healthy during this difficult summer. We all thank you for your continued support and understanding.

Bob Crouse, President & C.E.O.
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Date: 07/23/2020 COVID-19 Update #19

Subject: COVID-19 Update #19, Status.

Good morning,

I apologize for not providing any updates last week. We had several issues and test results pending and I wanted to be able to report the results.

Last Friday, (7/17/20) we conducted a second round of Point Prevalence testing on nearly all residents and staff. Since then, the results have trickled in, but I am happy to report that once again all tests produced negative results. That means that we have not had a resident or staff member test positive in more than three months.

As you know, we are in Phase I of re-opening. We have met nearly all of the criteria to enter into Phase II. We’re prevented from doing so by a technicality that we are trying to clarify. One of the criteria to enter Phase II is that the nursing home must have adequate PPE, used in the conventional manner to care for two or three COVID positive residents for a week. The word “conventional” is the issue. Conventional use means what we would do under normal operating circumstances. That means every time a nurse or CNA enters the room of a COVID patient, they would put on all fresh PPE and then dispose of it when finished. That has been an impossible standard throughout the pandemic. Of particular concern is that normal PPE for caring for someone with COVID includes the use of an N95 mask that has been fit tested. Again, every time a staff member enters the resident room they would need to put on a fresh mask and dispose of it when finished. We have conducted two rounds of fit-testing, but can’t get the masks our staff have been fit tested for. No one can!

Throughout the pandemic we have implemented what’s called “contingency” and sometimes “crisis” use of PPE. We’ve had to reuse masks, use cloth/non-disposable gowns, etc. This has been the practice throughout the healthcare community because of PPE shortages. Some items are more available now, but there is still a tremendous shortage of the type masks we need. We have brought this issue to the attention of policy makers, industry advocates and even one member of Congress. I’m confident we’ll be able to get some resolution on this, because it is unlikely that any provider can meet this standard and that means that our residents remain quarantined. That’s not in anyone’s best interest.

I will advise you as soon as we get an answer and hopefully some relief. For now, we will take pride in the fact that we’ve been able to keep COVID at bay for the past three months.

Thanks for your patience and support,

Bob Crouse, President & C.E.O.
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Date: 07/08/2020 COVID-19 Update #18

Subject: COVID-19 Update #18, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic.

I am pleased to report that yesterday, we received the results of Point Prevalence testing of all residents and staff for COVID-19 conducted on June 26th. We had no residents or staff test positive!

The successful completion of this testing allows us to move into Phase I of reopening. Little changes with our advance to Phase I, except we can now allow small groups of residents to leave their rooms for meals in the day room on each floor. Residents will have to remain at least 6 feet from others. We cannot conduct group activities or provide other social events yet. The greater significance of our move to Phase I is that it brings us closer to Phase III when we can begin to operate in a significantly more normal fashion including face to face family visitation. For more specific information regarding the phased guidelines for reopening, please refer to my June 25th update. It is also available on our website under the COVID-19 button.

This is a small but important step for us made possible by the patience and understanding of residents and family members and the diligence of our employees to do everything possible to remain COVID free.

Thank you

Bob Crouse, President & C.E.O.
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Date: 06/25/2020 COVID-19 Update #17

Subject: COVID-19 Update #17, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. We have no residents or staff members who have tested positive for COVID-19 in more than two months.

2. Quarantine of our residents continues as advised by VDH, CDC and CMS. Our staff our doing their best to provide activity, therapy and stimulation to residents. Fresh air time continues daily as well as through window visits with family. If you haven’t signed up for a window visit I would encourage you to do so. Those who have, express a level of relief that their loved one looks good and is in a good state of mental and physical health.

3. Tomorrow is a big day for us as all staff and residents will be COVID-19 tested by the Virginia Army National Guard. The specimens will be processed by the Virginia Dept. of Health and we hope to have results by early next week. The importance of this testing is that it is a requirement for advancing our state of re-opening to the next phase. The frequency and scope of the testing will depend on the results of the testing that takes place tomorrow. At this moment we have no residents or staff with symptoms of COVID-19. But, as you know, it is not unusual for someone to test positive who has had no symptoms.

4. I continue to receive questions regarding the level of discretion that management has over our decisions to relax visitation restrictions, etc. The answer is that we have none. We are bound by the process that regulators have put in place. The below attachment describes the path we must follow to re-opening. Other than the testing, we are ready to progress to phase II.

Nursing Home Guidance for Phased Reopening

Stay well and thank you again for your support and understanding.

Bob Crouse, President & C.E.O.
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Date: 06/19/2020 COVID-19 Update #16

Subject: COVID-19 Update #16, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic.

1. We do not currently have any staff or residents with active COVID-19. All who have previously tested positive have recovered and we have had no positive test results in eight weeks.

2. One of the necessary steps for progression to our eventual return to normal operations is to have all residents and staff tested for COVID-19. This testing will occur next Friday, June 26th. It will be conducted by the Virginia Army National Guard and paid for by the Virginia Department of Health. This test is mandatory as a condition of employment for our employees. I’ve attached information pertaining to the testing here:

Resident & Family COVID-19 Testing Information

For those of you who are legal guardians for your family member, please read this information carefully. Depending on the results of this testing we may have to repeat it one additional time or on a regular basis. All of the testing is a prelude to advancing to the next phase of re-opening, so the results are very important.

3. All other aspects of our quarantine remain in place. We continue with drive-up visits. You should have received an invitation to sign up for the next round of visits. Staff members are doing their best to keep residents engaged and healthy. Residents continue to show a great deal of resilience to these unfortunate circumstances.

4. I will provide additional information as it becomes available. If you have questions, please email them to me and I will answer them in my next update.

Thank you,

Bob Crouse, President & C.E.O.
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Date: 06/12/2020 COVID-19 Update #15

Subject: COVID-19 Update #15, Status.

Good morning,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. There has been no change to our numbers of positive tests since my last update a week ago. Our last positive test was more than seven weeks ago and all residents and staff testing positive have recovered.

2. We remain in quarantine with all residents in their rooms and no visitation. One to one interaction with Recreation Therapy staff, OT, PT, Chaplain and others continues as well as the scheduled “through glass” visits which seem to be going very well. Be on the lookout: we will soon send out the next invitation for visitation on Sign-up Genius. This will be for the period July 7 – August 29. Please do not sign up for more than one time slot.

3. We still await formal word on Virginia’s requirements for re-opening nursing facilities. As I’ve said previously, there is a disconnect between the federal government’s recommendations and an individual nursing home’s ability both to conduct and pay for the frequency and magnitude of testing that CDC and CMS recommend for advancing to the next stage of opening. I will let you know when we receive more definite information.

4. Protests continue in and around the City of Richmond. On Tuesday evening a group of around 1,000 assembled near the Columbus Status just across Byrd Park from TVH. Later that evening the statue was pulled down, set on fire and dumped in Fountain Lake. I’ve expressed my concern through our City Councilman Stephanie Lynch that police are being instructed to stand down and allow this type of activity to continue. I asked her to consider the safety of our residents not far from the protests and pass that concern along to Mayor Stoney. We have increased the hours of our own Security detail, all current or retired members of RPD. Fortunately, there are no statues, monuments or other potential targets of vandalism nearer to The Home than the Columbus statue.

Finally, and as always, thank you for your support and understanding as we continue to operate under these difficult circumstances. Please continue to exercise an abundance of caution as our economy opens up. I’m sure you’ve heard that a number of states further along in the re-opening phase have seen a spike in new positive cases. We’re doing everything we can to avoid that kind of recurrence at The Home. I hope you are doing the same.

Bob Crouse, President & C.E.O.
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Date: 06/5/2020 COVID-19 Update #14

Subject: COVID-19 Update #14, Status.

Good afternoon,

The following is an update regarding The Home’s response to the COVID-19 Pandemic.

There has been no change to our “numbers” of positive tests since my last update a week ago. Our last positive test was more than six weeks ago and all residents and staff testing positive have recovered. We remain in quarantine with all residents in their rooms and no visitation. One to one interaction with Recreation Therapy staff, OT, PT, Chaplain and others continues as well as the scheduled “through glass” visits which seem to be going very well.

I’d like to address a couple of questions that have been raised over the past week or so.

1. Q. Do we have to follow the CMS and CDC guidelines pertaining to re-opening and visitation? A. Yes, we do. There are both legal and financial ramifications for not following the guidelines, particularly if we were to have a bad outcome. More than 50% of the Medicaid money we receive originates at the federal level and the program is administered by CMS. Their recourse to not following their guidelines and regulations is to fine and penalize providers.

2. Q. What if I get tested for COVID-19 today and get the results tomorrow. If I test negative can I then visit my family member in person? A. No, I’m afraid not. Testing results provide only a snapshot. You can be negative today and positive tomorrow. Again, not allowing visitation during this phase of recovery is a CDC recommendation.

3. Q. Could we bring back some of the OT and PT employees to provide additional services on the weekends? A. We have never furloughed any employees during the Pandemic. All of the CNA’s normally assigned to OT and PT have been working on the floors. We are now also providing therapy in resident rooms. We are currently providing recreation and socialization six days per week and unfortunately, we do not have the manpower to expand this to seven days.

4. Q. Can “compassionate care” be interpreted as anything other than “end of life”? A. Not at this time.

5. Q. Have the protests and demonstrations that have occurred in Richmond impacted The Home in any way and is there a plan of action should they get close and threaten The Home? A. So far, most of the demonstrations have remained far enough from The Home to not be deemed a threat. Monument Avenue has been the hot spot over the past few nights. Unfortunately, the “Fallen Officer” memorial in Byrd Park was vandalized earlier this week, but nothing else near us. We have a very detailed disaster plan that includes provisions for civil unrest. Many of those provisions are already in place because of the COVID-19 Pandemic. Our Director of Security Peter Jackson maintains daily contact with the Richmond Police Department and knows each day where the demonstrations are going to take place.

Stay well. I will provide additional updates as the situation warrants.

Bob Crouse, President & C.E.O.
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Date: 05/28/2020 COVID-19 Update #13

Subject: COVID-19 Update #13, Status.

Good afternoon,

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. I am happy to report that we have not had any new positive test results in more than five weeks. All who have previously tested positive for COVID-19 have now recovered.

2. In accordance with CDC guidelines, all residents remain in their rooms and visitation is not allowed. Staff members continue to engage residents on a one to one basis to help them with the isolation. Residents in general have remained in remarkably good spirits. We offer them the opportunity for outside time at regular intervals and yesterday several staff members conducted a garden concert that could be heard by residents on the garden side of the building. They will do the same for residents on the other side of the facility as well.

3. On Tuesday we began “drive thru” visits using the vestibule near the Powhatan Street exit. They seemed to go very well with families and residents happy to see one another even without physical contact. These visits are booked through the month of June. Keep an eye out for an email offering the opportunity to sign up for a July visit. FYI, I think some may have overlooked the previous email as it didn’t come from Jody Young or myself. We are using an app called Sign-up Genius so watch for an email from them in a few weeks.

4. Of course everyone wants to know when we will be open for normal visitation again. The short answer is, I don’t know. The Trump administration through CMS has articulated a three phase approach to re-opening. I’ve included a link below for those of you who want more specific information. The key sticking point is the requirement that all nursing home employees must be COVID-19 tested every week just to enter Phase I. Most providers along with Professional, Medical and Provider associations agree that this is both unattainable and of little value. To give you an idea of what it would take to achieve this, we have approximately 225 employees. The very best testing price we’ve found in Richmond is $100 per test. For us to implement this policy would cost $22,500 per week. Annualized that would be $1,170,000. And that is just to show that we do or don’t have any employees carrying the COVID-19 virus on one given day. If we do have an employee testing positive that would force us to go back to Phase I of reopening, regardless of the Phase we were in. Providers and others are pushing back on this. Point Prevalence testing definitely has an important role in identifying and eradicating the COVID-19 virus, but the directive from CMS is costly and of little value even if we could gain access to that many tests.

Trump Administration Issues Guidance to Ensure States Have a Plan in Place to Safely Reopen Nursing Homes

5. We continue our efforts to maintain a well sanitized environment, knowing that is our first line of defense.

If you should have any questions about issues I haven’t mentioned, please send them to me via email and I will try to answer them for the benefit of all in a future update.

Thank you again for your support and understanding. Stay well!

Bob Crouse, President & C.E.O.
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Date: 05/22/2020 COVID-19 Update #12

Subject: COVID-19 Update #12, Status.

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. Currently, we have no known active COVID-19 cases among our residents or staff. The last of our 12 residents to test positive was more than a month ago. All positive cases were confined to one resident floor and all of them have now recovered.

2. We continue to employ all recommended precautions as best we can with the PPE that is available to us. At this time we have ample supplies of the items most important to us. Cleaning and disinfecting is continuous and considered our first line of defense.

3. The CDC and CMS have articulated a plan for the future re-opening of nursing homes. It will be a three phase approach. I don’t see this happening soon. Many of the benchmarks and recommendations, such as weekly testing of all employees is not yet possible.

4. We’re increasing the level of social contact that residents have with staff. Those who want to have opportunities for outdoor time with appropriate social distancing precautions.

5. As you know, next Tuesday we will begin “through window” visitation by appointment. The response to this has been very positive by residents and families alike. I know how important it will be to you to see that your family member is well.

I hope all of you have a nice Memorial Day weekend. Stay safe!

Bob Crouse, President & C.E.O.
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Date: 05/13/2020 COVID-19 Update #11

Subject: COVID-19 Update #11, Status.

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic.

Very little has changed since my last update on Friday. At that time we had a total of five staff and residents with upper respiratory symptoms. All were tested for COVID-19 and all tests were negative. So, at this time, we have no residents on isolation precautions for COVID-19.

We continue to work very hard to disinfect and clean all of our facilities to try to prevent the return of the virus. In anticipation that it will, we continue to try to re-supply all of our PPE including gowns, masks, goggles and face shields. Currently, we are implementing the use of face shields for all direct care givers at all times.

Residents are still holding up remarkably well. Many have taken advantage of the opportunity to spend some time outside in a very controlled setting. We will continue to do this as much as possible. Neither the CDC or CMS have given any clue as to when and under what circumstances visitation rules should be modified or lifted. I know that many of you are frustrated by this and that is understandable. We will continue to seek ways to keep the residents busy and engaged in a safe manner. Our hope would be that this current sacrifice will help prevent the return of the virus and that we will reach a point where visitation restrictions are a thing of the past. Don’t forget that we can always facilitate face to face phone conversations. Contact your resident’s social worker to help set this up.

You may have heard that the White House has directed states to conduct COVID-19 testing for all nursing home residents and staff over the next two weeks. We would welcome the opportunity to do this but I find it very unlikely it will happen soon. In Virginia, the National Guard has been tasked with collecting test specimens in long term care facilities. They have six teams that go from place to place each day to do this. But, there are more than 350 nursing homes in Virginia. Here at TVH, it took the Guardsmen the better part of a day just to test one floor. So, we probably shouldn’t expect this testing to occur that quickly. We could conduct our own specimen collection but have no source for 350 test kits.

Finally, thanks for all of the words of encouragement and support both for the residents and the staff too. Your patience and understanding have made this difficult situation easier to bear. Week of the Nurse ends today and we simultaneously celebrate National Nursing Home week. I’ve attached a photo of a banner that our employees will see each day this week when they arrive for work.

Stay well!

Bob Crouse, President & C.E.O.
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Date: 05/7/2020 COVID-19 Update #10

Subject: COVID-19 Update #10, Status.

The following is an update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. As of today, we have no residents testing positive for COVID-19 who have not recovered. The last resident to test positive has been removed from isolation precautions.

2. A total of twelve residents and four employees have tested positive. All live or work on the same floor, and as I said have all recovered.

3. Residents must still remain isolated to their rooms. Please understand that this is a directive that comes from the Centers for Disease Control (CDC) and the Center for Medicare and Medicaid Services (CMS). It is not a local rule that has come from myself or the Medical Director. Their guidelines will also apply to loosening and ultimately eliminating these restrictions. The only exception to this is for end of life visits.

4. Though many facilities have transitioned to a simpler menu served on paper products, we continue to provide full meal service with residents choosing their meals from the regular menus. Recreation staff, social workers and others have been very helpful in marking menus with residents.

5. We continue to take residents outside a few at a time for some “blue sky time.” This is done very carefully with social distancing strictly observed.

6. As you may know, this is Week of the Nurse. Unfortunately, circumstances prevent an appropriate celebration of the contributions made by all of our caregivers, but I want you to know how proud I am of them and the way they, and all of our employees have stepped up in the face of great diversity. I’ve attached a photo of a sign that was placed on the front lawn by the parents of resident Thomas McDermott. Needless to say it was very much appreciated by all of our employees.

Finally, as I’ve stated in the past, I’m a bit fearful of the re-opening of businesses that will bring about increased contact with people who may infect members of our staff and ultimately residents. I urge all of you to continue to follow the kind of social distancing that has helped to get us to the point where we can consider inching toward a more normal existence.

Stay well!

Bob Crouse, President & C.E.O.
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Date: 04/29/2020 COVID-19 Update #9

Subject: COVID-19 Update #9, Status.

Good morning, I hope you are all well. I thought you might like an update regarding The Home’s response to the COVID-19 Pandemic.

It has been something of a “two steps forward, one step back” experience for us. We went more than two weeks without anyone testing positive, but then we were notified last Friday that one of our residents who was at the time hospitalized for an unrelated problem tested positive. He returned to TVH on Saturday and is doing well. He is a resident of the same floor the other positive tests have originated from.

Dr. Simmers made a request to the Health Department to conduct point prevalence testing on all residents and staff members from the infected floor who had not already tested negative. The National Guard was dispatched yesterday to conduct both COVID-19 testing and antibody testing. This morning we have received the results from about half of the residents and they have all been negative. Unfortunately, one nurse did test positive and has been sent home.

We have been able to bring residents down to the garden two or three at a time, of course exercising social distancing. I think it has been good overall for their mental well-being. They have been isolated in their rooms for a month and a half. Most are doing remarkably well. We assist with Facetime and Skype phone calls to family members. They’re still able to eat from the normal selective menu. Recreation staff and social workers are assisting with menu marking. Family members for the most part have been cooperative and understand the need for such stringent precautions.

All staff members are to be commended for the wonderful attitudes and teamwork they’ve displayed throughout this crisis. They take their responsibilities very seriously and I believe have done everything humanly possible to prevent the further spread of the virus.

As you can see by the attached photos from our visit by the National Guard – we’ve definitely seen some unusual things over the past two months! As always, you may share this information with anyone who is interested.

Stay well!

Bob Crouse, President & C.E.O.
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Date: 04/24/2020 COVID-19 Update #8

Subject: COVID-19 Update #8, Status.

New regulations issued by the Center for Medicare and Medicaid Services requires that nursing homes inform their residents, family members and staff members every time an additional resident tests positive for COVID-19 .

The purpose of this letter is to inform you that one additional resident has tested positive for COVID-19. That makes a total of twelve residents who have tested positive. All except this most recent resident to test positive have recovered.

Bob Crouse, President & C.E.O.
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Date: 04/22/2020 COVID-19 Update #7

Subject: COVID-19 Update #7, Status.

The following is a brief update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. We currently have no residents under isolation precautions for COVID-19. The last of the original 11 residents to test positive was removed from precautions yesterday. It has now been more than two weeks since our last resident tested positive. All positive results originated from the same floor.

2. All residents will remain in their rooms for the time being with no visitation. This is in accordance with CDC and Dept. of Health recommendations.

3. We have increased visits by recreation staff, the chaplain, social workers and others to assist with Face Time and Skype phone calls and other forms of safe socialization. It is our goal to gradually and safely provide outdoor respite from resident rooms for residents. Social distancing remains vitally important. Residents have been furnished with masks to wear during care and should they leave the room for any reason.

4. It is clear that our efforts to contain the virus have so far been successful. We will continue those efforts as we know that there is still COVID-19 in the community and we want very much to keep it out of ours.

5. Cleaning and disinfecting as well as employee screening and numerous other precautions will continue.

We’re very happy with our good results and know we must remain vigilant. I’m very proud of our staff and the residents for taking this threat very seriously and sacrificing for the good of all.

Stay well!

Bob Crouse, President & C.E.O.

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Date: 04/17/2020 COVID-19 Update #6

Subject: COVID-19 Update #6, Status.

The following is a brief update regarding The Virginia Home’s response to the COVID-19 Pandemic:

1. Currently, 11 residents and 3 employees have tested positive for the Coronavirus. As of today, all but three residents have recovered and have been removed from isolation precautions. The remaining three should achieve that milestone within a couple of days. We have had no additional residents test positive in the past ten days.

2. Our efforts to contain the spread of the virus have so far been successful. Those efforts have included cohorting sick residents and their direct care givers, extensive and continuous cleaning and disinfecting, isolation of all residents and proper use of Personal Protective Equipment. While we are happy with the management of the virus, we remain vigilant knowing that it could reemerge at any time.

3. My greatest concern at this time is the premature return to “business as usual” and abandonment of social distancing. The biggest threat our residents face is contact with an infected staff member. As staff members begin to come into contact with the virus in the community it puts residents at risk. I urge all of you to continue to practice social distancing and encourage others to do the same. I understand the need and desire to get the economy rolling again, but there has to be a premium placed on human life and as you know, residents of health care facilities remain the most vulnerable.

4. Just a reminder that should your family member test positive for COVID-19, we will inform you immediately and continuously throughout their recovery. If you haven’t heard from us regarding your family member, you can assume they are well.

Thanks to you all for your support and understanding during this difficult time. As Chaplain Mike Hamilton announces each day, “we will get through this together.”

Bob Crouse, President & C.E.O.

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Date: 04/14/2020 COVID-19 Update #5

Subject: COVID-19 Update #5, Status.

I am happy to provide this update on The Virginia Home’s response to the COVID-19 Pandemic. As of today, we have 11 residents and three employees who have tested positive for the Coronavirus.  You’ll note that this is the same number of residents and one additional employee that we reported in our last update on April 9th. All 11 residents live on the same floor.

Our efforts to contain the virus have been largely successful.  Of the original group of positive tests, most have fully recovered. We continue to clean and disinfect all areas around the clock.  That, along with the use of Personal Protective Equipment, hand washing and universal precautions is our best defense.  We have taken some additional steps such as providing residents with masks that they can wear while receiving care and supplying more protective clothing on the remaining three floors where there have been no positive tests.

Residents continue to be very resilient, tolerating the confinement better than one would expect.  It is our hope that we can gradually increase the level of social interaction including help with phone calls over the next couple of days.  We know the isolation has been very hard on them and we will do whatever we can safely do to combat their feelings of loneliness and boredom.

Our staffing levels have remained very good.  Though we are all anxious for this to come to an end, everyone comes to work each day with the mindset that we have a job to do and the well-being of our residents depend on our doing it well.

Stay safe.  Further updates will follow as the situation warrants.

Bob Crouse, President & C.E.O.

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Date: 04/09/2020 COVID-19 Update #4

Subject: COVID-19 Update #4, Status.

Currently, we have 11 residents and two staff members who have tested positive for the virus.  We do still have some tests pending and results come inconsistently.  Two of the residents for whom we received positive results yesterday were actually tested eight days prior.  So far, all of the residents who have tested positive live on the same floor.  Two residents have been hospitalized but one returned from the hospital on Tuesday.   Approximately seven of the residents who tested positive are nearing the end of the 14 day period when they would be infectious.  Though they may shed the virus after that time it is unlikely they would be contagious.  There have been numerous anomalies with the testing.  I mentioned the group that took eight days for results.  We’ve also had residents we’re sure are positive test negative as well as another who was asymptomatic and tested positive only to test negative on a re-test.  In other words, we don’t have great confidence in test results and have operated under the assumption that everyone on the infected floor is positive and cared for them accordingly with full PPE.

Our staffing levels have remained very good.  We care for our positive testing residents with the same staff each day.  That group has a dedicated entrance/exit separate from the rest.  Each exit is equipped with a bleach foot bath so that employees can disinfect the soles of their shoes when they leave work.  They’re advised to change and launder their clothing immediately upon arriving home.  We’ve offered the use of our locker room showers to anyone who would prefer to do so before leaving.

Many of our non-direct staff are working from home, especially those in a high risk group.  Others have been busy trying to find ways to engage residents without actually going to their rooms.  Three staff members have been busy sewing cloth masks and gowns every day in our OT Department.  Many are performing duties they would have never anticipated, like filling bleach bottles, making and adapting masks, scrounging for PPE, etc.  It’s been an all-hands effort.

Each day Medical Director Dr. Mary Simmers, Director of Nursing Colleen Lobb, Vice President & C.O.O William Coleman and myself (Bob Crouse) engage in a triage meeting, trying each day to keep up with new advisories from CDC and CMS and address the needs of the day.  For the first two weeks, the need was usually masks and gowns.  Now the focus is on cleaning supplies, especially bleach wipes.  There are none to be found.  We can clean with diluted bleach from a spray bottle, but that unfortunately has a ten minute kill time so it’s not very practical.  We’re hopeful that some of the supply lines will open up in the next week.  Thanks to all of you who have helped us obtain thermometers, gowns, masks and numerous other items.  Your help has been invaluable.

The Health Department is now supplying our N-95 masks.  These medical grade masks are only effective when properly fitted.  Yesterday, they sent a team to The Home to perform the fittings on our Nurses.

Finally, I would be remiss if I didn’t mention the tireless efforts of numerous staff members lead by Colleen Lobb, Director of Nursing, William Coleman and of course Dr. Simmers.  I’d hate to think where we would be without them.  They have everyone functioning at a very high level.  Not only is the effort very high, but the intelligence they’ve displayed is impressive.  Their ability to absorb and react to the mountains of advice, directives and regulation that changes almost daily is impressive.  I hope you’re as proud of this group as I am.

I hope you’re all staying well and being careful. Thanks for your continuing support and prayers.

Bob Crouse, President & C.E.O.

For additional information, please visit the CDC or VDH websites.

https://www.cdc.gov

http://www.vdh.virginia.gov

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Date: 03/14/2020 COVID-19 Update #3

Subject: COVID-19 Update #3, change to visitation guidelines.

To Our Residents, Friends and Family Members:

This letter is written in follow up to the letters sent out 3/10/20 (Update #1) and 3/13/20 (Update #2). Copies of these letters are posted to our website and can be reached at the following link: https://www.thevirginiahome.org/events/covid-19-update/

Since our last communication, the CDC has published updated guidelines for restriction of visitors to nursing homes. The most recent guideline can be found at the following link: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

  • Below is an excerpt from the guideline:
    Updated guidance to recommend that nursing homes:
    • Restrict all visitation except for certain compassionate care situations, such as end of life situations
    • Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)
    • Cancel all group activities and communal dining
    • Implement active screening of residents and HCP for fever and respiratory symptoms
    COVID-19 is being increasingly reported in communities across the United States. It is likely that SARS-CoV-2 will be identified in more communities, including areas where cases have not yet been reported. As such, nursing homes should assume it could already be in their community and move to restrict all visitors and unnecessary HCP from the facility; cancel group activities and communal dining; and implement active screening of residents and HCP for fever and respiratory symptoms.
    Therefore, according to CDC guidance, The Virginia Home has determined that a complete ban of visitation is required at this time due to the COVID-19 pandemic. We apologize for this abrupt notice.

We have made this difficult determination for the safety and well-being of our residents, staff and visitors. While we understand that visiting friends and family is important to maintaining relationships, our overarching responsibility is to the health and safety of our residents who are among the most vulnerable population in the healthcare system.

Effective immediately, visitors are not allowed at The Virginia Home except for very specific situations. If you feel you need to visit, please complete the TVH Visitation Request below and we will assess your request within 2 business days. We ask for your patience in the coming week as our staff members juggle many competing demands including continued preparations for COVID-19 and staying up to date with changing public health and emergency management recommendations.

We understand the gravity of this decision and the impact it will have on the residents and their families. For all that we know about COVID-19, these actions could indeed be life-saving. We will work closely with families to determine the best way to manage this crisis situation for each individual resident.

TVH Visitation Request
The Virginia Home has implemented a ban on visitation except in very specific situations (essential visits) due to the COVID-19 pandemic. We will review requests for visits within 2 business days.

Please email your completed request to William Coleman at [email protected] and we will assess your request within 2 business days.

Your Name:
Resident’s Name:
Today’s Date:
Requested Visit Day and Time:
Please State the Purpose for Your Visit:

We will notify you via email of any updates to our COVID-19 preparation and response plans. In the meantime, specific questions from friends and family should be directed to Colleen Lobb, Director of Nursing at 804-359-4093, ext. 251 or [email protected]

Thank you for your assistance in ensuring the health and safety of The Virginia Home community.

For additional information, please visit the CDC or VDH websites.

https://www.cdc.gov

http://www.vdh.virginia.gov

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Date: 03/13/2020 COVID-19 Update #2

Subject: COVID-19 Update #2, change to visitation guidelines

This letter is written in follow up to previous post on 3/10/20.

 To Our Residents, Friends and Family Members:

To begin, please be aware that we plan to provide regular email updates to residents, friends and family.  In the coming days, staff members will be reaching out to all friends/families by phone to verify current contact information, including email addresses. Alternatively, you may call or email a resident’s social worker to provide updated contact information.

As noted above, email will be the primary way that we communicate important building-wide information.  Any resident-specific information (i.e. new illness, etc.) will continue to be communicated by phone.  Specific questions from friends and family should be directed to Colleen Lobb, Director of Nursing at 804-359-4093, ext. 251 or [email protected].

As you all know, the COVID-19 situation in the U.S. is rapidly changing.  This week, the Centers for Medicare and Medicaid Services (CMS) and the American Health Care Association (AHCA) have issued new guidelines regarding specific actions that all nursing homes should take to try to prevent COVID-19 infections in residents and staff.  At this time, there is no community-based transmission of COVID-19 in the Richmond area.  The actions outlined below are precautionary.  Implementing these measures now allows us time to work out logistical issues and answer any questions that arise.

Some may ask why these measures are necessary.  Unfortunately, older adults and individuals with chronic health conditions are more likely to have severe illness if they are infected with COVID-19. Therefore, CMS and AHCA have recommended taking aggressive and decisive actions to decrease the likelihood of COVID-19 causing widespread infections within nursing homes.

The recommended actions fall into 5 broad categories.

  1. Restrict who can enter the facility and limit the movement of those individuals who do enter.
  2. Cancel activities/outings that would increase risk of resident exposure.
  3. Actively screen all individuals that enter the facility, including all staff and visitors.
  4. Stress the importance of hand-washing, especially upon entry to the facility.
  5. Set up processes for communication.

The outline below shows the specific steps that are being taken within each of the 5 categories.

Action 1: Restrict who can enter the facility and limit the movement of those individuals who do enter.

  • Family/Friend Visitation:
    • All family/friend visits are strongly discouraged. We request that family and friends do not visit the center.
    • For those that must visit, visitation is limited to immediate family and close friends.
    • Family/friend visitors must stay in the resident’s room and limit movement within the facility.
    • Visitors will not be allowed in the resident dining rooms or at group activities.
  • Volunteers and outside groups: No visitation.
  • Contractors, vendors and outside healthcare providers: Limited visitation for urgent/necessary issues. For those that need to enter, movement within the facility will be restricted.

Action 2: Cancel activities/outings that would increase risk of resident exposure.

  • Community outings/trips are cancelled until further notice.
  • We strongly discourage families from taking residents out in the community as this would increase their risk of exposure. We ask that families/friend do not take residents out of the building except to walk to the park, etc.
  • The Sock Hop Ball next week is cancelled.

Action 3: Actively screen all individuals that enter the facility, including all staff and visitors.

  • All visitors must enter through the front door and answer a series of screening questions before they can enter. The screening questions correlate with the criteria outlined in the letter sent 3/10/20. Any individual with respiratory illness will not be permitted to enter.
  • All staff members will complete the same screening process at the start of each shift.

Action 4: Stress the importance of hand-washing, especially upon entry to the facility.

  • All visitors will be asked to wash their hands with alcohol-based hand sanitizer before entering the building.

Action 5: Set up processes for communication.

  • As noted above, staff members will be reaching out to all friends/families by phone to verify current contact information, including email addresses. Email will be the primary way that we communicate important building-wide information. We plan to continue with regular email updates.
  • Please contact a resident’s social worker if you need assistance connecting with your loved one. Our social work and occupational therapy departments will work to devise a communication plan that might include phone calls, emails, video chats, etc.

In conclusion, we request that family and friends do not visit the facility. We are posting signs on our entryway doors to notify visitors of this policy, and we will begin actively screening all individuals who need to come into the building.

We will notify you of any updates to our COVID-19 preparation and response plans.  In the meantime, specific questions from friends and family should be directed to Colleen Lobb, Director of Nursing at 804-359-4093, ext. 251 or [email protected].

Thank you for your assistance in ensuring the health and safety of The Virginia Home community.

For additional information, please visit the CDC or VDH websites.

https://www.cdc.gov

http://www.vdh.virginia.gov

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Date: 03/10/2020 COVID-19 Update #1

To Our Residents, Friends and Family Members:

We know many of you are concerned about the spread of the 2019 Novel Coronavirus (COVID-19) and how it may impact us here at The Virginia Home. We want you to know that The Virginia Home is committed to maintaining the health and safety of our residents and staff and we are prepared to respond to the challenges that COVID-19 may bring.

At this time, we don’t have any cases of COVID-19 in our facility. The Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health (VDH) have recommended a variety of steps that we are implementing to help reduce the potential for the virus to enter our building. However, we need your help in battling COVID-19.

As a precaution to best protect our residents and staff, we ask that individuals do not visit The Virginia Home if:

• You are experiencing any symptoms of respiratory illness (cough, fever, sore throat, runny nose, and/or shortness of breath). Please return for a visit once you are symptom-free.

• If you have recently traveled to any of the countries with a Level 2 or 3 CDC travel advisory. For an updated list of countries, please see: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html.

• If you have recently traveled to an area within the U.S. that is experiencing community-based spread of COVID-19. As of 3/10/20, this would include parts of Washington (state), Oregon, California and New York. For an updated list of regions within the U.S., please see:
https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html#2019coronavirus-summary

• If you have recently had contact with someone with a confirmed or suspected COVID-19 infection.

Please keep in mind that the CDC currently recommends that individuals who have had a possible exposure to COVID-19 stay at home for 14 days and practice social distancing (avoid close contact with other people). We will keep you informed if the CDC recommendations for our area change.

If you are unable to visit in person, due to any of the above precautions, please let us know. We understand the importance of connecting with your friends and family at The Virginia Home and want to make sure you can stay in touch with your loved ones. We can help you connect though Skype, Facebook, text, email or phone.

We understand that the public health response to the spread of COVID-19 is changing rapidly and we are ready to adapt and seek assistance as needed. The leadership team at The Virginia Home is closely following updates from the CDC, VDH and our local health department. We are also a participating member of the Central Virginia Healthcare Coalition (CVHC), our regional emergency preparedness alliance.

We will notify you of any updates to our COVID-19 preparation and response plans. In the meantime, please feel free to contact Colleen Lobb, Director of Nursing at 804-359-4093, if you have questions or concerns.

Thank you for your assistance in ensuring the health and safety of The Virginia Home community.

For additional information, please visit the CDC or VDH websites.

https://www.cdc.gov

http://www.vdh.virginia.gov