On March 11, 2020 with more than 118,000 cases in 114 countries, and 4,291 deaths, the World Health Organization characterized the COVID 19 situation as a global pandemic [1,2]. One day prior, on March 10, the first two cases of COVID-19 were reported in the State of Michigan. That same day, Governor Gretchen Whitmer issued Executive Order 2020-4, which declared a state of emergency to address the situation . Because of the subsequent spike in cases, on March 27, the US Surgeon General characterized the Detroit area as a national “hotspot” [4,5] with more than 1200 cases reported just on that day. Local officials anticipated a surge of COVID cases for the following few weeks, likely leading to the hospital systems quickly reaching capacity. As a domino effect, most subacute rehabilitation facilities were anticipated to fill as recovering patients were discharged from the hospital. In addition, it was anticipated that most assisted living and group homes would be placing holds on any admissions due to fear of spread of the virus within their facilities.
Huron Valley PACE (Program for the All-Inclusive Care of the Elderly) is an alternative long-term care setting where the goal is to keep patients in their homes as long as possible through an interdisciplinary approach to care and is located in Ypsilanti (approximately 30 minutes west of Detroit) and serves almost 200 participants in the surrounding areas, covering 45 different zip codes. PACE programs generally do not house patients in their Day Centers, with most participants residing in their own homes, but with some in adult foster care homes and traditional long-term care settings like assisted living or nursing homes. PACE programs often use subacute rehab facilities after their participants are hospitalized. In order to abide by the Governor’s “shelter in place” directive, PACE Day Center activities collapsed and the majority of services transitioned to taking place in participants’ homes. Only a handful of participants attended the Day Center on a daily basis in order to maintain social distancing and limit large gatherings of our older adult participants and PACE staff. The impact of the COVID pandemic weighs heavy on Huron Valley PACE’s service area and the participants we serve due to the inevitable gap for many of those requiring access to a higher level of care. In addition, the pandemic creates an elevated risk to our participants, not only of contracting the virus, but of caregiver burnout leading to potential elder abuse and neglect. In response to this situation, Huron Valley PACE created a multidisciplinary committee to prepare, plan and enact our organization’s response to the current COVID crisis by repurposing our Day Center to be able to provide temporary 24/7 rehabilitation and respite care for our participants who have no other options available for an alternate living situation.
Operation Safety Net is our attempt to mitigate the many overarching risks this pandemic poses to our participants. We anticipated multiple scenarios in which this plan would be needed:
1. Care for participants who are positive for COVID 19 with mild symptoms, but not needing or wanting hospitalization
2. Participants discharged from the hospital and in need of subacute rehab, regardless of COVID status
3. Respite Care for participants with caregivers at risk of burnout
4. Respite Care for participants with caregivers hospitalized with COVID and thus unable to provide care for our participant
The Day Center at Huron Valley PACE is large and lends itself nicely to being divided into two separate but equal areas for participant care and oversight. For Operation Safety Net, the area of the building previously used as a Memory Unit is now designated as the quarantined area for COVID positive participants, complete with its own care rooms, bathrooms, kitchen and separate entrance, while the other area is designated for COVID negative participants with access to similar facilities.
Staffing is divided as well, with certain staff designated to work only on the quarantined side. Orders and requests for donations for PPE, hospital beds, partitions, food and linen services went out immediately once planning started. Through these efforts, supplies and enough PPE for all staff were secured prior to admitting our first participant. Multiple in-service educational sessions were scheduled for training non-clinical staff on proper patient transfers as well as instruction for all staff on the proper donning and doffing of PPE according to CDC guidelines. A schedule of staff was set in 12 hour shifts for both sides of the building.
With nursing/physician support scheduled onsite 24/7, this new model of care launched at Huron Valley PACE on April 10, 2020. Cases of COVID in the local area has spiked once again, and stress on the post-acute care system has remained high. To date, Operation Safety Net has provided temporary subacute/respite care for 5 of our participants, all COVID negative. Even in the midst of this global pandemic, Huron Valley PACE is dedicated to fulfilling our directive of providing all-inclusive care by repurposing our Day Center and creating a safety net for our participants within their community. In summary, Operation Safety Net represents an innovative use of the PACE Day Center, given the lack of access to many traditional long-term care settings like assisted living, nursing home and subacute facilities during the current pandemic.
The authors would like to thank Sonja Felton (Executive Director, Huron Valley PACE) and the wonderful staff at Huron Valley PACE for all their support and work in the implementation of Operation Safety Net. The authors affirm that we have listed everyone who contributed significantly to the work and no other contributors other than the authors.
Conflict of interest
Each author declares no personal or financial conflicts and declare “the authors have no conflicts.”
Authors listed were involved in the conception of Operation Safety Net and the writing of this manuscript.
- The State of Michigan (2020). Coronavirus. [Retrieved from https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html].
- WHO Declaration of pandemic. [https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020].
- The State of Michigan (2020). Coronavirus. [https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html].
- Deaths Spike in Michigan; Top Doctor Warns About Detroit BY DAVID EGGERT, Associated Press Wire Service Content March 27, 2020, at 11:17 p.m. [https://www.usnews.com/news/best-states/michigan/articles/2020-03-27/surgeon-general-on-pandemic-detroit-will-worsen-next-week].