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WOODBINE – Three Woodbine Developmental Center residents have died from COVID-19, and internal memos describe a staff who are “tired, burnt out, out of their typical routines,” yet needing them to “come to the realization we have just started our battle.”
According to the May 10 Department of Human Services weekly COVID-19 report for five developmental centers in New Jersey, 28 residents and 28 staff have tested positive for the virus at Woodbine; four staff have recovered. Two hundred thirteen residents and 60 staff had tested negative there as of May 3.
“We are deeply saddened by the tragic passing of these valued members of our New Jersey community,” said Tom Hester, director of communications, New Jersey Department of Human Services. “We send our condolences to their family, friends, and caregivers and join in mourning their loss.”
According to 30 memos sent to the Herald, which appear to be authored primarily by Woodbine Developmental Center Director of Nursing Kathleen Hancock and Chief Executive Officer Michael “Micky” Kelly between March 26-April 30, insufficient staffing, insufficient locations to house asymptomatic residents, and lack of proper personal protective equipment (PPE) are prevalent at the Woodbine facility.
The memos provided to the Herald appear to be authentic but could not be independently verified.
Hancock wrote that she expected numbers to “grow tremendously with positive results,” as testing expanded throughout the facility. She said they have “some plans, but they are not foolproof.
“We are seeing more staff test positive in cottages where clients were negative, the staff are the carriers of the virus into the facility,” she wrote to her staff April 28.
Efforts to reach Hancock were unsuccessful.
“As universal testing rolls out, it is expected that more positive cases may become known, including those of asymptomatic individuals,” Hester said. “At Woodbine, all residents have been tested, and testing for staff continues.”
First Positive COVID-19 Cases
Kelly informed the center’s staff and families April 3 that a staff member tested positive for the virus, indicating they had last worked March 22 and wore appropriate PPE while at work. The building where the employee worked was not identified.
After contacting the local Department of Health, they were advised to review which residents and staff had “close contact,” defined as being within 6 feet of the person for longer than 10 minutes, and use special precautions for that population.
“We completed this review and determined that no resident or staff meet this criteria,” Kelly wrote. “Even so, we are continuing to closely monitor the health of all residents.”
He indicated that the facility instituted several steps to protect residents and staff, including restricting visitors, screening and temperature checks for all staff prior to beginning shifts, implementing mask policies for staff working with residents and in residential spaces, enhanced facility cleaning at least twice a day or more as needed, ending all communal dining, group therapies and activities, and enhanced monitoring of signs and symptoms of respiratory illnesses for center residents.
Kelly informed the staff April 13 that two more staff members tested positive, and those who were in close contact with the individuals were notified and asked to self-monitor.
“I believe that the low count of positive readings is because all of us are following the protocols,” he wrote.
The following day, Hancock wrote that they were getting reports of those testing positive with no temperatures, but mild symptoms such as an upset stomach and mild headache. She encouraged staff to “keep an eye on your clients for changes in behavior which may be related to some of these symptoms.”
Hancock said a question had been added to the employee screening process April 17, asking whether staff or someone they lived with had close contact with someone who had tested positive.
“That question was added because when we started this screening, very few people were diagnosed and had been tested at that point,” she wrote. “Now that more people are being tested, we are getting more information on staff who answer yes to this question.”
Kelly informed the Woodbine executive and senior staff, in an April 20 memo, that a resident tested positive for COVID-19. Although he identified the cottage where the resident lived, he did not make any association with it being the same building where a staff member had worked after potential exposure in March.
A day later, April 21, he reported another resident from another cottage tested positive. “In an effort to prevent further infection, we are thoroughly sanitizing the buildings,” he wrote.
That same day, Hancock reported clients in three buildings were all tested, and all tests came back negative. The following day, the CEO informed the staff that two residents from one of those buildings tested positive for the virus.
Hancock said they were awaiting results for tests from a fourth building, but did not associate it as the building where a client had tested positive and a staff member who had been exposed in March worked.
Another resident from that same building was asymptomatic but tested positive, according to an April 23 Hancock memo.
Hancock told staff April 23 that the two other positive clients were symptomatic and tested randomly.
“If that doesn’t send a message it should,” she emailed the staff. “It brings me back to the days when HIV first came to light. What did they teach us….they taught to assume every patient was HIV positive. I think we are at that stage of the game, assume every client is positive.”
“You all know how to protect yourself with your mask wearing, hand washing and distancing,” she wrote. “We can’t express this enough to you.”
According to Hester, Human Services has worked “proactively to address the critical needs of individuals at all developmental centers, including Woodbine, during this unprecedented event. We have been in regular communication with individuals and families about steps being taken to keep residents and staff safe. While centers always have infection control policies and procedures in place, center planning for prevention and mitigation of COVID-19 began in February, with screening of staff and closure of the centers to visitors in mid-March.”
Staffing Face Increased Demands
It was March 23 that a staff member who shared a household with her daughter, whose co-worker tested positive, apparently was “told” to come to work because she didn’t have a fever, according to a memo by Diane Wakefield, one of the center’s nurses. That employee was assigned to work in Cottage-9 because where she normally worked had been shut down.
It was in this cottage that the first resident who tested positive lived, according to an April 20 memo from Kelly.
However, in a memo the following day, Hancock wrote that cases appearing from that cottage are “a puzzle, no staff have reported symptoms themselves or family members. Quite possible that someone may be asymptomatic carrying the virus. We all know this is probably a big reason this virus is so tricky to get under control in this world.”
Hancock alerted staff, in a March 26 memo, that she was working on alternate scheduling for nursing. “The intended purpose is to keep as many staff off as possible maintaining safe operations, cutting down the number of employees in the facility,” she wrote. Staff were also told they were expected to remain home to decrease their exposure.
Another memo by Hancock April 7 indicated alternate scheduling started for staff, but she had to call in three people for coverage due to the number of call-outs.
“Negativity about the process at shift change is not necessary,” she wrote. “Leave your doom and gloom in your car.”
A week later in another memo, Hancock wrote that some departments were having issues with call outs, “leading them to have less than optimal staffing.”
By April 24, Hancock emailed the staff, saying they had a “greater need to call staff in due to the increased demands of our quarantine and observation areas. We are doing the best we can. Unfortunately, the finger pointers, complainers, those who feel entitled are slowly undoing what we tried to put in place.”
“Keep your chin up, keep moving forward, you are our heroes, and I’m sure if your clients could tell you they would say the same thing,” she wrote.
Three days later, Hancock sent another email, canceling all alternative scheduling days due to the “increased operational demands on the department.”
“We decided to cancel alternative scheduling days as we now need all hands on deck,” Hancock wrote to the staff April 28. “We are going to need all the help we can get at this point. I’m hoping if things settle down we may be able to implement the time off, time will tell.”
According to an April 29 memo, Hancock said there were five nurses in the center’s COVID unit, indicating a 5:18 staff to patient ratio.
“As was the case before the COVID-19 pandemic, Woodbine follows all Centers for Medicare and Medicaid Services regulations, including those related to staffing,” Hester said.
Personal Protective Equipment in Question
In a memo March 26, Hancock reminded staff when it was appropriate to wear a face mask, writing “if we waste all our supply now unnecessarily we could end up with no required equipment when it is needed.”
She encouraged co-workers “to go home and put a scarf or hankie across their nose and mouth to get an idea what it feels like to wear a mask. Not the greatest feeling,” she wrote. “If the time comes we need to mask staff, we will.”
Masks were given to all staff with client contact April 1, according to a Hancock memo that day. “One surgical mask, asking us to see if it will last a week. You can wear a protective mask over it. These are to prevent us from giving to the population we serve. If you wear a mask cover you must wash it after every shift you use it. They are hot when worn for a period of time. Wear your mask when around the clients, alone in clinic you can remove it if need be. You will need a break from wearing it.”
At the same time, she said a shortage in pumps for hand sanitizers was possible, asking the staff to save empty bottles.
Staff were informed April 15 that they would be issued a new surgical mask at the start of each shift as they entered the facility and were screened. Cloth masks could be worn over the surgical masks and washed after every use.
“In accordance with Centers for Disease Control and Prevention and Department of Health guidelines, Woodbine follows universal precautions and provides recommended PPE to employees,” Hester said. “Centers have always stocked PPE and higher levels of PPE utilization have been required during the pandemic for the safety of residents and staff. PPE levels are regularly monitored to ensure proper supply is available.”
Shortage of Space?
In an April 4 memo, Hancock informed staff that they were running out of room in one of the cottages, and they would be opening a building not in use at the time, for COVID-19 suspected cases. Those who test negative coming from the hospital were being kept isolated as an extra precaution for 14 days.
By April 28, with 17 positive clients, 71 pending test results and 66 negative tests, Hancock indicated “the room at the inn is filling up quickly.” At the same time, eight staff reported positive, with 39 negative and 23 pending results.
“We are seeing clients who test negative then show symptoms, become positive. Within a couple days of testing negative,” she wrote to her staff. “We developed some protocols yesterday with the physicians as far as positive clients returning to cottages.”
“Clients in hospital with symptoms who can return, where do they go?” she wrote. “Clients sent to hospital for non-COVID-related, possible exposure, where do they go? Our usual clients who can’t be cared for in their building. Where do they go? What if more than half a building pops up positive when we start more testing? We have tentative plans for all these scenarios, and then what…”
According to Hester, “adequate space is available at Woodbine to cohort residents.”
More Demands, ‘Our Role Just Starting’
“As many of you can feel, there are more and more demands on us and our role with this virus is just starting to come alive in our facility,” Hancock emailed her staff April 29. “I understand you are getting tired, burnt out, out of your typical routines, but I need all of you to come to the realization, we have just started our battle.”
She said that all clients had been tested at least once, and they had 21 positive clients from five cottages.
She expected a “huge volume” of results April 29.
“As more clients become positive, we are also seeing more staff going out for positive tests also, which means, less resources, more work for those who are here,” she continued, “and this is in all areas, not just nursing. We constantly are adjusting plans, trying to come up with ways to handle these situations.
“I welcome any suggestions, unfortunately it’s not more staff, start thinking about how you will work with less staff, that is a reality,” she added.
She said that currently five nurses were operating the COVID unit, and “it’s hard, it’s hot, it’s not what we typically do when we come to work. Prepare yourself to be reassigned where needed, pick up an extra building, maybe two, bring extra shoes, a set of clothes in the event you are now working in a quarantined cottage, so you can then change before you get into your cars and go home. Start thinking about your role in these scenarios.”
To contact Karen Knight, email email@example.com.
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