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DHEC Recognizes National Ambulatory Surgery Center Month

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During the month of August, DHEC would like to recognize the 68 Ambulatory Surgery Centers across the state for National Ambulatory Surgery Center Month.  As COVID-19 has introduced new challenges to our healthcare system and patients, these facilities and their staff have shown great flexibility and commitment to providing solutions. 

The agency’s Healthcare Quality provides state and federal oversight of surgery centers. Ambulatory surgery centers must be licensed and can also be certified. 

Ambulatory surgery, also known as outpatient surgery, does not require an overnight hospital stay. Ambulatory Surgery Centers (ASCs), sometimes referred to as Ambulatory Surgical Facilities, specialize in this type of care and keep hospitals uncrowded and available for more invasive procedures and longer recovery times.  

ASCs also provide flexibility and a solution to scheduling issues and long wait times for what are considered common surgeries. Procedures occurring in these facilities cost significantly less when compared to hospitals, which saves the patient, insurance companies, and employers money.  

COVID-19 response 

In response to the coronavirus outbreak, three of South Carolina’s ASCs have converted into hospitals, while others have closed because of the restrictions on elective surgeries. These conversions help hospital capacity, assist with backlogs of procedures, and expand resources.  

An ASC must meet the Centers for Medicare and Medicaid Services’ (CMS) Conditions of Participation when converting to a hospital and, while operating as a hospital, it will temporarily no longer operate as an ASC. DHEC is proud of South Carolina’s ASCs and all they have done in order to comply with federal and state standards and waivers.  

The three ASCs that have converted to hospitals during the COVID pandemic are the Surgery Center at Edgewater in Fort Mill, Charleston ENT & Allergy, and Center for Colon & Digestive Diseases in Aiken.  

“ASCs provide high quality surgical care that is safe and cost-effective,” said Amanda Atkinson, Administrator of the Surgery Center at Edgewater. “They have a reduced risk of infection and patients have the convenience of receiving care in a smaller and more intimate setting.” 

Responding to COVID-19 at present, the facility is required to test all patients prior to their surgical procedure, adding extra steps to their pre-operation process. Additional staff were brought in to assist with the testing, but supply costs have risen for the facility.  

Many local hospitals have suspended elective surgeries to focus on providing care to COVID-19 cases, creating a backlog of procedures and patients on standby. By converting to a hospital, the ASC has been able to work on the backlog of surgeries waiting to be performed, improving the patient’s quality of life, and in many cases allowing them to return to work or normal daily activities.  

In addition to the extra duties and safety precautions within the facility, staff have also been dedicating time to testing the public.  

“Staff who are affiliated with MUSC have been staffing COVID 19 testing sites since the beginning,” Atkinson said. “Many of our staff continue doing so to ensure that we are doing our part to help with this pandemic. They have all been willing to work jobs outside their normal work duties as nurses and surgical technicians to help the greater good. These healthcare professionals have selflessly and courageously continued to provide excellent care to our patients and our community.” 

DHEC thanks all of our ASCs for their continued commitment to Promoting Teamwork and Service and Accessibility. Later this month, we will publish a second part in this Dashboard series to highlight our work with another ASC and how our staff is helping to protect patient care during this time.  

DHEC Applauds Ambulatory Surgery Centers for Adjusting During Pandemic

DHEC’s Healthcare Quality provides state and federal oversight of surgery centers. Ambulatory surgery centers must be licensed and can also be certified. August is National Ambulatory Surgery Center Month. 

Since the coronavirus pandemic began, hospitals have been reaching out to Ambulatory Surgery Centers (ASCs) in search of space, staff, intensive care unit (ICU) beds, operating rooms, overflow care, equipment, and more.  

When CMS released Hospital Without Walls, Charleston ENT & Allergy was quick to jump at the opportunity. CMS’s Hospital Without Walls essentially removes any regulatory barriers and allows ASCs to operate as a hospital outpatient department (HOPD). 

The facility has now performed several procedures it had never performed before, all without complications. Submitted claims have not been reimbursed, reporting requirements have changed, and regulations that did not previously apply are now in place.  

Despite these hardships, Mandy Hawkins, Director of the surgery center at Charleston ENT & Allergy, said the benefit outweighed the inconveniences.  

“During this crisis we have been able to take on higher acuity cases freeing up valuable hospital space,” she said. “We have been able to proceed with cases that were being postponed within hospital systems preventing the possibility of worsening the prognosis for the patient.”  

They also test their physicians and staff daily as well as patients and families both on the day before and of the operating procedure date. Staffing and obtaining personal protective equipment PPE have been a challenge at times, but Hawkins says that the pandemic’s obstacles have improved the teamwork among her staff.  

“Our team has grown closer, working together through difficult times,” she said. “I absolutely love being part of my ASC. Working closely with the Governing Board of Ambulatory Surgery Center Association (ASCA), the Lowcountry Healthcare Coalition, DHEC, the South Carolina Emergency Management Division (SCEMD), and a myriad of ASC leaders throughout the state and  country, I have built relationships with healthcare providers, public service workers and people I never knew I would need at an ASC.” 

DHEC encourages the public to learn about the importance of ASCs, their mission, and their commitment to providing reliable and safe options to South Carolina’s communities. We value the staff, stakeholders, and constituents that continue advocating for these important assets to the great state of South Carolina and its people.  

DHEC Recognizes National Parents’ Day at Long-Term Care Facilities

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DHEC Recognizes National Parents’ Day at Long-Term Care Facilities

Sunday, July 26, 2020, is National Parents’ Day and DHEC celebrates the wonderful relationships of families who have elderly parents residing in licensed long-term care facilities throughout South Carolina, including our 194 nursing homes and 497 assisted living facilities. This observance is a poignant tribute to the parents, grandparents, and even great-grandparents residing at these facilities who are heavily affected by the pandemic. These residents are at high risk for contracting COVID-19 and therefore visitation restrictions are still in full effect for nursing homes and assisted living facilities, with the exception of end-of-life situations. These necessary infection control measures have hindered physical social visits from family members in a time where human connection matters more than ever.

A resident at Bishop Gadsden Health Care Center in Charleston, SC using a tablet to teleconference with her daughter and grandchildren.

“Nat Turner said it best when he said that good communication is the bridge between confusion and clarity,” states JoMonica Taylor, Interim Section Manager for Residential Facilities Oversight in Healthcare Quality. “This is why DHEC works with facilities and the families of residents in making sure that we can all create innovative ways to let communication happen, like window visits and utilizing technology. As we navigate through our new norm, it is vital for all of the elderly parents in facilities to keep in contact with families in any way possible, especially since many of them might not fully be cognizant of the pandemic or why their families aren’t coming over anymore. Nothing can replace physical touch or presence, but picking up the phone or scheduling a closed window visit shows them that they have not been forgotten and that their families love them.  It gives them a ray of hope that better days are on the horizon.”

A resident at Brightwater Assisted Living in Myrtle Beach, SC having a closed window visit with her daughter, son-in-law, grandchild, and great-grandchild.

Having an elderly parent reside at a facility can be a daunting decision for any family to consider making, especially when responding to a public health threat of this magnitude. Arnold Alier, EMS Division Director in Healthcare Quality, knows this personally. “My father, up until last year, had lived in multiple nursing homes and assisted living facilities for about ten years,” said Arnold. “The experience has given me the opportunity to help other families going through the same process with a loved one, even now facing COVID-19 lockdowns and safety measures.”

Alier goes on to express how, “After taking care of Papi at home for three years, it reached the point where he needed around the clock oversight that I could not provide. It was an extremely difficult decision and there are no manuals or courses that can prepare you, so I empathize and know all too well how terrifying the decision is; how terrifying the unknown is when your sick parent is involved.” Luis Alfredo Alier, Sr., father of Arnold Alier, sadly passed away last year after a long battle with Lewy Body Dementia. Alier recalls several occasions where the long-term care facilities where his father was residing in would be on lockdown for several weeks at a time, either due to hurricanes or being at the height of flu season; lockdowns with physical restrictions similar to what many families are now facing with the ongoing state of emergency due to COVID-19.

Luis Alfredo Alier, Sr. and his son, Arnold Alier, at the Easley Retirement Center in Easley, SC.

Alier not only faced the challenge of not being able to physically visit his father when a facility was on lockdown, but he also could not make a phone call due to his father’s severe hearing problems. Video teleconferencing became Luis Alfredo, Sr.’s lifeline to his son. Arnold gives thanks and is indebted to the amazing nursing home and assisted living facility staff members throughout the years who worked with him in ensuring that he could always find some creative way to communicate with his father, working around his father’s disabilities instead of disregarding them. Seeing the face of a loved one, even if it’s simply through a tablet or computer screen, can be the different between loneliness and hopefulness. Alier had to watch his elderly parent go through a terrible battle with a relentless disease, and yet he knew that the love he carried for his father would always be evident no matter what medium he reached out to him through.

Amazing connections are formed between all families that have parents residing at these facilities. “I formed close ties with the relatives of other residents and Papi’s caregivers at these facilities,” states Alier. “We would even check in on each other’s parents as much as we could. The power of communication is incredible. In many ways, we all became a larger family. I saw how the staff would bring Papi a coffee and a banana, his favorite snack, whenever he was feeling down. How a Spanish-speaking staff member would always go out of there way to have genuine discussions with him in his native language. I remember all of it. Connections with elderly parents can happen and be maintained no matter what crazy circumstances are occurring. I’m so grateful that these facilities know that patient care goes beyond meeting a resident’s basic medical needs.”

A resident at Greer Rehabilitation and Healthcare Center in Greer, SC celebrates his 77th birthday with family members and his favorite frappuccino.

Facilities and families are coming together these days to not only create new ways that they can spend quality time with parents in the age of COVID, but also develop non-physical social gathering events that will further enrich their parents’ lives. South Atlantic Health Care’s Capstone Nursing Home in Easley, SC has integrated virtual games and stimulating group activities through the use of tablets in their social event calendar in order to ensure that residents can still chat and play with one another without having to constantly be in the same room.

The Place at Pepper Hill in Aiken, SC is an example of a nursing home that only has one closed window available for visits. Its staff have not only worked tirelessly to schedule appointments, but they have also designated it the “Family Connection Window” and have decorated it accordingly.  NHC Healthcare in Greenwood, SC gives family members the option to visit closed windows at their elderly parents’ room and use the front entrance of the nursing home, which contains a row of glass doors and windows, to conduct large closed window visits, as well. The nursing home even encourages residents to write loving messages to their loved ones on the outside glass of the entrance, as visible in the picture below. Little moments of joy and little flares of loveliness add up. The benefits that these visits are having is invaluable.

Residents at The Place at Pepper Hill in Aiken, SC speak to their children through the “Family Connection Window.”

The front entrance of NHC Healthcare in Greenwood, SC allows a resident to receive a large closed window visit from his children and grandchildren.

Shirley Klee, Activity Director at Brightwater Assisted Living in Myrtle Beach, SC, is overwhelmed with gratitude for the creative problem solving of her staff. “I am blessed to have a team of Life Enrichment Leaders that have really moved the needle keeping our residents and their loved ones connected,” states Shirley. “We have used Skype, Facetime, and closed window visits. We use them every day! We have been moved to tears many times watching these families connect and seeing their emotion. These are certainly difficult times, but we are grateful for technology. I just could not imagine such a time as this without the means to keep families together.”

A resident at Brightwater Assisted Living in Myrtle Beach, SC is visited by her daughter and sister.

Sarah Tipton, President and CEO of Bishop Gadsden Health Care Center in Charleston, SC, states that, “While residents and families may not be able to be physically together, it has been wonderful to be able to facilitate virtual connections. These visits have been so special, even emotional, for not only the family and residents, but for our team members as well. We very much feel like we are a part of the families’ lives and empathize with them in these challenging times.”

A resident at Bishop Gadsden Health Care Center in Charleston, SC video chats with her newborn great-grandchild that she has yet to meet.

We celebrate Parents’ Day by acknowledging how our own parents have impacted our lives and how vital communication is to a healthy life. DHEC continues to communicate with these nursing homes and assisted living facilities to ensure that infection control and prevention practices are being implemented correctly, but also that the quality of life for residents remains an ongoing discussion of significant importance.

While visitation remains restricted, DHEC is allowing nursing homes and assisted living facilities to choose to offer Closed Window Visits to residents and their loved ones. DHEC’s Closed Window Visit FAQs for Nursing Homes and Assisted Living Facilities has more information for facilities, residents, and visitors to learn more about this opportunity.

DHEC also supports the Centers for Medicare and Medicaid Services’ (CMS) COVID-19 Communicative Technology grant opportunity that provides federal funding so nursing homes can purchase virtual communication devices for their residents. More information regarding the COVID-19 grant opportunity for nursing homes is available here.

Families can find more information in DHEC’s FAQs for Nursing Homes and Assisted Living Facilities and by visiting both of our COVID-19 Nursing Homes and Healthcare Facilities pages for current guidance, memos, and relevant publications.

A resident at NHC Healthcare in Greenwood, SC holds a picture frame showing her graduation photo from nursing school while receiving a closed window visit from her granddaughter, dressed in her cap and gown, on her very own graduation day.

Parents’ Day is a wonderful opportunity to schedule a closed window visit, teleconference, or phone call with a parent residing at a long-term care facility.

We celebrate the families determined to work with both loved ones and facilities in order to come up with creative solutions that keep parents connected with their children, grandchildren, and great-grandchildren. We celebrate the facility staff that create ingenious forms of communication and engagement to keep families connected, and who recognize that treatment of care goes beyond the physical. We celebrate the strength and perseverance of the love between a parent and child, and how love can lead to invention.

DHEC Observes National Alzheimer’s and Brain Awareness Month

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June is Alzheimer’s and Brain Awareness Month, and DHEC recognizes the vital work that healthcare facilities, healthcare professionals, and caregivers do in providing treatment and improving the quality of life of those afflicted with brain trauma and disorders. There are currently over 95,000 people living with Alzheimer’s disease and other related dementias (ADRD) in South Carolina. According to the South Carolina Alzheimer’s Disease Registry, 25% of the ADRD population in the state resides in a long-term care facility (LTCF), including nursing homes and assisted living facilities, while the remaining 75% live independently or with loved ones in the community.

It comes as no surprise that COVID-19 has been an unexpected hurdle in providing special care to each resident or patient afflicted with these diseases. The risk for persons with Alzheimer’s disease and other dementias poses a unique challenge for caregivers, families, and facilities. Changes to routines, use of unfamiliar personal protective equipment (PPE), and disruption to daily schedules can lead to fear and anxiety resulting in increased depression and worsening behavioral changes, such as agitation, aggression, and wandering. While the Centers for Disease Control and Prevention (CDC) recommends specific guidance to facilities for infection control and prevention, it also recommends keeping environments and routines as consistent as possible for patients and residents suffering from ADRD and other brain disorders.

As facilities and caregivers continue to care for patients and residents, the following tips can help improve brain health for those afflicted with these diseases while preventing the spread of COVID-19:

  • Maintain the same environments and routines for the patients or residents while introducing frequent hand washing, social distancing, and use of cloth face coverings (if tolerated).
  • Introduce virtual games and activities for enrichment and memory care.
  • Use face coverings wisely. Face coverings should not be used for anyone with breathing issues or who is unconscious, incapacitated, or unable to remove the mask without assistance.
  • Keep staff consistent in memory care units at facilities.
  • Structured activities may need to occur in the resident’s or patient’s room, or be scheduled at staggered times throughout the day in order to maintain social distancing.
  • Provide safe ways to remain active, such as staff going on walks around the unit or outside with the patient or resident.
  • Limit the number of people in common areas while practicing social distancing.
  • Frequently clean often-touched surfaces, especially hallways and common areas.

Those suffering from ADRD may not be able to communicate that they are feeling ill. It is important to be informed and able to recognize symptoms in order to protect our most vulnerable from COVID-19. Early signs to recognize for a patient or resident who cannot communicate their symptoms are cough, shortness of breath, difficulty breathing, fatigue, or vomiting. Emergency warning signs are trouble breathing, new confusion, inability to wake or stay awake, and bluish lips or face.

Family and friends that would still like to visit loved ones in facilities are encouraged to use messaging systems such as emails, phone calls, cards and letters, recorded video messages, care packages, and even song and poem dedications through the facility intercom. The Centers for Medicare & Medicaid Services (CMS)’s Civil Monetary Penalty (CMP) Reinvestment Program is a great funding opportunity for facilities wishing to procure technical equipment for communication purposes. Nursing homes can also benefit from applying to CMS’ COVID-19 Communicative Technology grant that provides funding for residents to communicate with loved ones.

Lexington Medical Center (LMC) Extended Care recently took advantage of this COVID-19 grant opportunity and purchased two iPads and three iN2L tablets for the nursing home. Though the facility encourages families to make phone calls and chat with loved one outside of the facility’s windows, the technology procured through the grant allows more residents the opportunity to connect with loved ones and to do is in the most convenient, readily accessible, and intimate way. The facility already averages 700 calls per month, not including the calls made by residents with their personal devices. The use of the virtual technology for tele-videos, texts, calls, games, and a myriad of other activities connects loved ones together and helps augment the quality of life for these residents, especially those most vulnerable to brain dysfunction and memory loss.

“Without this COVID-19 communicative grant funding and the opportunity for communities to purchase needed devices, our residents might not have the opportunity to see their family nor would their family see them, which could be detrimental to everyone,” states Debbie Bouknight, Lexington’s Life Enrichment Director. “It is both heartwarming and sometimes heartwrenching, but so worth it to see the interactions happen. I feel we would see far more decline in our residents’ physical and emotional well-being if they did not have these video visit opportunities.”

More ideas of how you can connect with loved ones during COVID-19 are available here.

DHEC would like to express its gratitude to all facility staff and loved ones keeping our Alzheimer’s and other dementias population healthy during COVID-19. Residents and patients suffering from these diseases are not just physically vulnerable during this pandemic, but they are also highly susceptible to mental anguish and confusion due to the necessary changes being made at facilities for infection control and prevention. We recognize the extraordinary cooperation between facility staff and families in ensuring excellent care for the quality of life of those afflicted with ADRD, as well as adapting to new forms of communication that keep loved ones both connected and safe.

Links

CDC – Considerations for Memory Care Units in Long-term Care Facilities

CDC – Supporting Your Loved One in a Long-Term Care Facility

USC, Arnold School of Public Health – Alzheimer’s Disease Registry

South Carolina Alzheimer’s Disease Report 2019: Annual Report

Alzheimer’s Association Facts Video

DHEC Recognizes National Nursing Assistants’ Week

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In observance of the 43rd National Nursing Assistants’ Week 2020, DHEC would like to recognize and thank all of South Carolina’s nursing assistants for their hard work and dedication, especially during COVID-19. During the week of June 18-24, we celebrate nursing assistants and all they do for the community. The compassionate care nursing assistants demonstrate is essential to the well-being of our loved ones in nursing homes, hospitals, and other settings.

What Are Nursing Assistants?

Nursing assistants, or certified nurse aide (CNAs), ) are crucial for the successful operations of nursing homes and other long-term care settings; they provide nearly 80-90% of the direct patient care. Nursing assistants also work in hospitals, as well as in correctional institutions, hospice programs, and home care. Working under a licensed nurse’s supervision, a nursing assistant will provide basic care to patients or residents, often involving extensive daily contact. In order to become certified as a nursing assistant or nurse aide, one must successfully complete a state-approved training program and examination, , and be added to the state registry, which in South Carolina is maintained through the South Carolina Department of Health and Human Services (DHHS).

Duties of a nursing assistant:

  • Taking vital signs of patients
  • Listening to patients’ health concerns, record information, report information to nurses
  • Helping the patients dress
  • Bathing and cleaning patients
  • Serving meals to patients and helping them eat

It would come as no surprise that the extent of contact nursing assistants have with patients result in friendships; there is no limit to their commitment to the happiness and well-being of their patients.   

COVID-19

“During National Nursing Assistants’ Week, we should be mindful that what has historically been a difficult job, has become a true exercise in selflessness,” said Matt McCollum, Administrator for Ridgeway Manor Healthcare Center. “As we navigate through the changes that COVID-19 has brought upon our industry, our CNAs have been put in a position that they’ve not been tasked with before.”

During COVID-19, nursing assistants have shown great flexibility to the changes needed to keep patients and residents safe. Not only have South Carolina’s nursing assistants adapted well and continued to perform at high standards, but they have also taken on new challenges as routines and activities have come to a halt. Nursing assistants have creatively managed to keep residents active and in touch with loved ones and friends, while still following safe distancing measures and precautions.

 “These ladies and gentlemen have always done what is often a thankless job with compassion and care in their hearts, but now they are literally putting themselves in a position of potential jeopardy to provide that care to the most vulnerable Americans among us,” states McCollum. “They are truly the unsung heroes of this pandemic and no amount of thanks will ever be enough to express how blessed we all are to have them as our allies during these trying times.”

Join DHEC in thanking a CNA during the week of June 18-24. To all of South Carolina’s nursing assistants, we thank you and appreciate everything you have done for our loved ones. You are truly heroes!

June 19th is #WorldSickleCellDay

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Today (June 19th) is World Sickle Cell Day!  Every year, the international health community recognizes Sickle Cell Disease (SCD) as a debilitating genetic disease that impacts families across the globe. Keeping individuals and communities informed about the struggles that come with daily management of SCD, can help raise awareness as well as debunk stereotypes and stigmas associated with persons who have SCD.   

SCD affects millions of people worldwide and is particularly common among people originating from sub-Saharan Africa, Saudi Arabia, India, South America and Central America, and Mediterranean countries, such as Turkey, Greece and Italy.

SCD affects approximately 100,000 Americans and occurs in about 1 out of every 365 African-American births. Individuals living with SCD suffer from both acute and chronic complications that require frequent contact with the medical system. These complications include acute sickle cell pain, fever, and acute chest syndrome (ACS), which is the term used for a number of different findings that includes chest pain, cough, fever, hypoxia and new lung infiltrates.

Here are some quick facts about SCD:

  • Sickle Cell Disease is a group of inherited red blood cell disorders. The red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle” and the cells die early, which causes a constant storage of red blood cells. Healthy red blood cells are round and move through small blood vessels to carry oxygen to all parts of the body.
  • To get SCD, the trait must be inherited from both parents who already have the SCD trait. People with the trait usually do not have any of the signs of the disease and live a normal life, but they can pass the trait to their children.
  • SCD is diagnosed with a simple blood test.  It is most often found at birth during routine newborn screening tests. Early diagnosis and treatment are important.
  • There are several treatment options available for individuals living with different complications of SCD, but the only cure for SCD is a bone marrow or stem cell transplant.  Transplants are very risky, and can have serious side effects, including death.  For the transplant to work, the bone marrow must be a close match (usually a brother or sister). 

SCD and COVID-19

Amid the COVID-19 pandemic, there is significant concern that the overlap of lung disease from COVID-19 with ACS may result in increased complications and amplification of healthcare utilization among individuals with SCD. Patients with SCD often have underlying cardiopulmonary co-morbidities that may predispose them to poor outcomes if they become infected with COVID-19. Source: hematology.org. 

Below are recommendations from the Sickle Cell Disease Association of America (SCDAA) for patients with SCD regarding COVID-19:

  • Patients and parents should be educated about COVID-19 signs and symptoms and the importance of physical distancing to limit chances of exposure and infection.
  • Patients and parents should receive counseling to continue to monitor for fever or other signs of infection. Call  hospital, doctor, or nurse first for advice on where to go for an evaluation.
  • Be sure that patients have an ample supply of all prescribed medication at home (including analgesics) to manage both acute and chronic pain.
  • Patients should adhere closely to the correct use of medications.

SCD Partnerships

DHEC is committed to educating the community and public about the availability of resources and services for individuals and families living with sickle cell disease.  DHEC’s Division of Children and Youth with Special Health Care Needs (CYSHCN), provides assistance to persons with sickle cell disease by covering services, such as, medical expenses, physician visits, durable medical equipment, medical supplies, and prescription drugs.  Assistance is offered to both children and adults who meet eligibility requirements. 

Additionally, CYSHCN engages with the four Sickle Community Based Organizations in the state — the James R. Clark Memorial Sickle Cell Foundation, – Louvenia D. Barksdale Sickle Cell Anemia Foundation, – Orangeburg Area Sickle Cell Foundation and – COBRA Human Services Agency Sickle Cell Program – to ensure persons living with SCD have access to community resources and support services.