By Melba Newsome

Each Monday at noon, Janice Somers closes her office door at Westwood Hills Nursing and Rehabilitation and puts her phone on Do Not Disturb. For the next 90 minutes, the nurse administrator and four team members join hundreds of employees from over a hundred North and South Carolina facilities for the Nursing Home COVID-19 Action Network, a four-month online course designed to establish common guidelines for infection control in nursing homes.

The training is a way to share best practices and other practical information. But Somers says the camaraderie is important, too.

“I want to know what other people are doing,” says Somers. “We’ve all been so isolated. Ever since March, everything is a Zoom meeting.”

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Long-term care facilities have been ground zero for the COVID-19 pandemic but many proved ill-equipped for the challenge. Though facilities are required to have someone focusing on infection control, only 3 percent of those staff have taken a basic infection control course. The North Carolina Health Care Facilities Association, the statewide industry group for skilled nursing facilities, sent out a memo about an upcoming course being offered by the Mountain Area Health Education Center and Somers signed right up.

Nursing Home COVID-19 Action Network’s training series is just one of eight pandemic-related continuing education series operated by MAHEC using this model. They include screening/treating COVID-19 in primary care; acute care for hospital inpatient; and developing resilience in the healthcare workforce.

A way to expand learning

After seeing patients wait a long time to be treated for hepatitis C, Sanjeev Arora, a liver specialist at the University of New Mexico Health Sciences Center in Albuquerque, got the idea of teaching rural physicians how to screen, diagnose and treat patients.

Arora believed that if patients didn’t have to drive six hours to see him, many more of these hepatitis cases could be treated effectively.

That’s where Project ECHO comes in. Instead of moving people, the ECHO (Extension for Community Healthcare Outcomes) model, using remote learning technology to involve people who are actually delivering the care in the teaching process. The technique moves knowledge out to more people, allowing for expanded treatment capacity and making better health care available, particularly in remote and rural areas.

The model was so successful it has been replicated all across the country, particularly in areas when geographic and socioeconomic barriers make access to specialty care difficult, if not impossible. Topics include advanced disease management techniques for conditions ranging from Type II diabetes, epilepsy and chronic obstructive pulmonary disease to substance use disorders and other complex behavioral health problems.

Bringing Project ECHO to MAHEC

When Lourdes Lorenz-Miller, MSN, trained to bring Project ECHO to MAHEC in September 2017, she was told that it takes six months to get similar programs up and running.

A month later, UNC Health Sciences at MAHEC became one of the first academic health centers in the state to offer a continuing education ECHO for rural physicians. In January 2018, they unveiled the school nurse ECHO, followed by one for treating chronic pain in patients with opioid use disorder.

“Project ECHO allows us to share what we have learned with providers and their patients across the region,” says Lorenz-Miller. “ECHO learning isn’t from up top but from each other who are on the front lines. It has the potential to address health challenges in a big way by reaching more people. That is what makes this model so exciting.”

To date, MAHEC has developed 10 different ECHO series: chronic pain management, behavioral health, rural medicine, high-risk prenatal care, geriatric care, oral health, adverse childhood experiences and school health. These workshops have trained more than 8,000 participants from all 16 WNC counties and 96 counties statewide.

The training model

The training sessions follow a standard pattern. Actual case studies are submitted by participants or experts in advance for feedback and recommendations for next steps. In each training session, MAHEC’s experts share specialized knowledge in real-time with providers who, in turn, share their first-hand experiences. The other participants on the call get a chance to weigh in with suggestions and tips about what’s worked for them in similar situations.

Nurses, physicians and pharmacists receive continuing education credits for participating.

Programs are paid for in a variety of different ways. For example, the ulcerative colitis ECHO is free to participants because it attracts sponsors. In contrast, an eight-week school nurse training costs $115.

The nursing home ECHO is supported by the federal Agency for Healthcare Research and Quality (AHRQ) in collaboration with the non-profit Institute for Healthcare Improvement (IHI).

Participating nursing homes receive a $6,000 stipend.

The training program is designed to meet five key benchmarks:

  • keep the virus from entering nursing homes;
  • identify infected residents and staff;
  • prevent spread between staff, residents and visitors;
  • provide safe and appropriate care to residents with mild and asymptomatic cases of the virus;
  • ensure staff is adequately trained to implement best-practice safety measures.

Somers and her staff welcomed the detailed plan.

“The information stream has been very confusing, not only for physicians but for people that work in clinics and nursing homes because there wasn’t any kind of national strategy,” says Somers. “The CDC was saying something, the state was saying something else and there was a lot of confusion. This way everybody gets the same training and information.”

Most of the participants work for standalone facilities and struggle to keep abreast of ever-changing directives. However, Westwood is one of many nursing homes owned and operated by Principle Long Term Care. Somers and her team have relied on the corporate office to sort through and keep them informed on the latest coronavirus-related news and policies.

Nonetheless, she still believed there were reasons to participate in the ECHO, like hearing from someone going through the same thing.

“It’s an unbelievable experience when you find out that COVID is in your building and that the staff has got COVID,” says Somers. “It takes long hours and everybody has to do many different jobs.

“One night, my job was to collect trash in all the rooms because the housekeepers were out. Thank goodness my dietary staff never went down because I would have had to be in there cooking and that might have been a problem.”

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Melba Newsome is an award-winning freelance writer with more than 20 years' experience reporting on news and features. Her feature credits in many prominent publications including the New York Times, Bloomberg...