The Square
News and perspectives from Covia.

Dr. Timothy Gieseke, who served as the Medical Director at Spring Lake Village from its opening in 1986 until 2019, sat down on Monday, December 14 for an interview with Laura Darling, Covia’s VP of Communications and Spiritual Care, to give his perspective on the safety and effectiveness of the COVID-19 vaccines. Gieseke is a member and past President and Board Member of the California Association of Long Term Care Medicine (CALTCM). The full interview is available online here.

Dr. Gieseke gave an overview on how these novel vaccines were developed and how they work. Using a well-established technique that has been in use for the past 10 years for cancer therapies, scientists created a messenger RNA, or mRNA vaccine for SARS CoV2. Not using the COVID virus itself, the mRNA vaccine “creates a sideshow, if you will…so the body sees it as a foreign protein and makes antibodies against it. So that when the virus actually does infect us, or attempt to affect us, very quickly it’s identified as something foreign to be destroyed and the virus is destroyed.”

Like every other therapy approved by the FDA, Dr. Gieseke explained that the COVID vaccines went through three trial phases. “Physicians get interested in the phase three study, which is where they had 43,000 volunteers” – 30% of whom were from ethnically diverse backgrounds, and 45% between the ages of 45 to 85.

After a phase 3 trial lasting two weeks longer than the usual period and review by committees, including the Vaccine Related Biologicals Products Advisory Committee (or VRB PAC), “at a federal level, they felt that this vaccine was effective at a 95% level, which is really amazing.”

It’s effective. But is it safe? Dr. Gieseke explained that although “this was a rapid review, rapid approval process, but the actual scientific process was the same.”

“There’s things that we don’t know about this, but that’s true of everything in medicine, that’s new,” he says, “But the potential value of this vaccine is so large that I can tell you I’m signing up, all my associates at Spring Lake, Drs. Greene and Rao are signing up. I had another colleague say, ‘Where can I get it?’ And I can tell you, physicians are just really excited that this vaccine is available.”

A review of the side effects did not raise any alarms for him. “I mean, there are always problems with these medications and there’s problems even after you get your emergency use, but the common ones were the ones you’d expect,” he said. Side effects were similar to those of the flu vaccine: soreness at the injection site, or a systemic immune response, “feeling like you’re getting the flu, because that’s part of your immune system, how it gets rid of the flu and actually SARS CoV2 as well.” Dr. Gieseke said these side effects were found in less than 3% of trial participants after receiving the first injection, and less than 7% of people after receiving the second.

The vaccines are given in two doses because “you get more effectiveness and better safety if you split the doses,” Dr. Gieseke explained. “So rather than giving a big dose all at once, you give a tolerable dose and then you repeat it three weeks later.”

“I think it’s effective and safe and it’s something that when your turn comes I would be, ‘I’m gonna be the first in line,’ quite frankly,” Dr. Gieseke says.

The Pfizer vaccine has already been approved, and the Moderna vaccine is not far behind. Dr. Gieseke thinks the Moderna vaccine may be the one more likely to be given to Covia residents and staff. “The Moderna vaccine which is an mRNA vaccine has very similar 94.7% effectiveness, differs in that it does not require the cold storage that the Pfizer vaccine does. So it’s more like a normal vaccine, has a better shelf life.”

So when will we all be vaccinated? “Hard to know,” Dr. Gieseke says. “Experts are predicting anything from May, June, to more likely the Fall, September, something like that, because these companies are selling to the world. It’s not just the United States.”

In the meantime, Dr. Gieseke says we need to continue to follow public health guidelines – including wearing masks, avoiding gatherings and enclosed spaces, and cleaning. “What we know about SARS CoV2 is public health actually works. But you really have to practice it effectively and I’ll just give you a couple principles that you may not want to hear:

“Now that medical masks are available, that’s what you should be wearing. And the reason medical masks are more effective than the cloth masks is, they actually have electrostatic forces that trap the virus embedded within them,” he says. Dr. Gieseke reuses his masks, storing them in a paper bag to allow them to dry out and be used again.

“Number two: Always use a mask when you’re outside your apartment because you just don’t know… all it takes is one person to not mask to blow the whole thing open, and I see that happen all the time.”

Number three: “follow public health guidance. So right now we’re on lockdown. Because in December, every week we’re doubling and tripling the prevalence of COVID. And what we know is the more common the COVID is in the community, the more likely we are to get COVID.”

Dr. Gieseke says that, even with the vaccine, “continue to do all the public health measures until public health says this no longer makes sense.”

Dr. Gieseke does have words of encouragement for everyone who has been dealing with the limitations imposed by COVID over the past year: “Number one, this is not forever.”

“I think the vaccines is going to allow us to have a more normal life, even if the virus has the ability to change like influenza and becomes a persistent problem,” he says. “I don’t think we’re going to see it out of control, like it is right now…Going forward, I think this will be a part of our lives. But I think it’s going to be a manageable part of our lives.”

Although the vaccine is good news, for right now his guidance is, “mask as much as you can. That’s kind of where you live at this point in time.” But, Dr. Gieseke assures us, “this too will pass.”

All five Covia Communities are among the 21% of U.S. skilled nursing facilities that have been recognized as a Best Nursing Home for 2020-21 by U.S. News & World Report.

The communities received Best Nursing Homes status by achieving a rating of “High Performing,” the highest possible rating, for Short-Term Rehabilitation, Long-Term Care, or both. Canterbury Woods in Pacific Grove, St. Paul’s Towers in Oakland, and San Francisco Towers all received the recognition for Short Term Rehabilitation. Webster House Health Center in Palo Alto was recognized for its Long Term Care. And Spring Lake Village in Santa Rosa received the honor for both Short Term and Long Term care.

U.S. News gives the designation of Best Nursing Home only to those homes that satisfy U.S. News’s assessment of the appropriate use of key services and consistent performance in quality measures. This year, to accompany the new ratings, nursing home profile pages were updated to include a patient safety summary that reflects COVID-19 data alongside other measurements of safety and related advice on choosing a home or facility amidst the pandemic.

“I am so proud of all our Covia teams and their leadership, especially their implementation of the infection prevention processes that resulted in exceptional resident outcomes during this challenging pandemic,” says Cynthia Shelby, Covia’s Regional Director of Quality and Care, RN, RAC-CT.

All of the communities noted the extraordinary care and efforts given by their team members. Max Brodsky, Health Care Administrator at San Francisco Towers, says, “As I make my rounds checking in with the residents staying at the Health Center, one thing I hear over and over is ‘You have the most wonderful staff working here. They are kind, hard-working, and always do their best.’  It’s our culture of respect and integrity, and staff who embrace our philosophy that makes us the best and a five star facility.”

At St. Paul’s Towers, Health Care Administrator Connie Yuen says, “Our staff works from the kindness and love in their hearts. We’ve been told time and time again we do not work with patients, we work with residents that become a part of our family that we love and care for. The staff go above and beyond to connect with residents and take it a step further by providing updates, photos and spontaneous phone calls to give loved ones peace of mind.” Executive Director Mary Linde adds, “We at SPT are delighted to be among the best nursing homes in the country.  But it comes as no surprise because we see the care, and the relationships that drive that care, on a daily basis. I believe the staff in our SPT SNF are, indeed, among the best in the industry.”

Kris Hermanson, Health Care Administrator at Spring Lake Village which was rated as High Performing for both Short Term and Long Term care, says, “It’s satisfying knowing you are giving quality care to our residents who deserve and have earned it!”

Now in its 11th year, the U.S. News Best Nursing Homes ratings and profiles offer comprehensive information about care, safety, health inspections, staffing and more for nearly all of the nation’s 15,000-plus nursing homes. The Best Nursing Homes ratings reflect U.S. News’ exclusive analysis of publicly available data using a methodology defined by U.S. News that evaluates factors that it has determined most greatly impact patient and resident care, safety, and outcomes.   

“U.S. News strives to provide access to information that allows consumers to make educated decisions on all types of care,” said Ben Harder, managing editor and chief of health analysis at U.S. News. “Updating the profiles to include a patient safety summary that highlights COVID-19 data paired with other measures of care arms families, caregivers and patients with the information needed to make a decision that keeps safety at the highest priority.” 

The Best Nursing Home finder features ratings on both long-term and short-term care. The Long-Term Care Rating aims to provide prospective residents who need help with daily activities, and their families, with analysis and information regarding the quality of care provided by nursing homes. The rating includes data on staffing, success in preventing ER visits and pneumonia vaccination rates, among other metrics. The short-term rating incorporates measures of quality including consistency of registered nurse staffing, use of antipsychotic drugs and success in preventing falls.

U.S. News & World Report is the global leader in quality rankings that empower people to make better, more informed decisions about important issues affecting their lives. A digital news and information company focused on Education, Health, Money, Travel, Cars and News USNews.com provides consumer advice, rankings and analysis to serve people making complex decisions throughout all stages of life. More than 40 million people visit USNews.com each month for research and guidance. Founded in 1933, U.S. News is headquartered in Washington, D.C. For more information behind both U.S. News ratings please refer to the FAQ.

Cynthia Shelby worked for 15 years as a hospital nurse – including emergency rooms, ICUs, and medical/surgery – before she took a position as an Assistant Director of Nursing in a skilled nursing community in Ohio. As a hospital nurse, Shelby notes “You become a very good clinician and you have good diagnostic skills and you’re real quick on your feet.”

But skilled nursing is a different world. She adds, “Nobody just jumps into this field. It takes experience. You have to learn all the regulations and all the little pieces of the puzzle that have to get put together before someone can go home.”

For the past three years, Shelby has worked for Covia as a Regional Quality and Care Nurse, providing support to six Skilled Nursing Facilities, from Pacific Grove to Santa Rosa. She, along with other members of the Clinical Team, offers guidance on the complexities of skilled nursing, including regulatory requirements, preparing for surveys from state regulators, billing questions, staffing concerns, training, and even filling in for key roles as needed.

Covia offers skilled nursing care within its four Life Plan Communities and at Canterbury Woods, a multi-level community.  Skilled nursing care “illustrates key parts of our mission,” says CEO Kevin Gerber. “It’s about the continuum of care and how the full team help residents transition through changes. Skilled nursing is also about the whole person – not just thinking about their physical needs, but all of their needs.”

Skilled nursing facilities “have always had a bad reputation and many joke it’s a death sentence,” says Connie Yuen, Healthcare Administrator at St. Paul’s Towers. “Yet, while skilled nursing care can be the final home for some who are frail and sick, it can also represent an environment to rest, strengthen and recuperate so one can continue living life and even return to a prior home. Working in skilled nursing care means that I have the privilege of providing great care to our residents during difficult times and uncertainty.”

May 10-16 is National Skilled Nursing Care Week. This year, it comes as skilled nursing facilities have become the face of the COVID-19 pandemic on top of the stereotype of the “nursing home.” Add in a few bad actors who skimp on care for profit, it is not surprising that the perception is negative. 

The negative perception exists in the nursing profession itself. “I too was a nurse for years in big medical centers,” says Mary Linde, Executive Director at St. Paul’s Towers. “People thought I was nuts when I moved to long term care. But the beauty of the skilled nursing home is the relationship with the residents. Because it’s a long term relationship, the care can really be tailored to that person’s personal preferences.”

Far from causing a reduction in the care and services residents receive, the COVID-19 crisis has only encouraged new ways of serving Covia’s skilled nursing residents. “I have been astonished and amazed in the most beautiful ways at watching the staff adapt to how they do care,” says Linde. “Staff who are normally behind the medication cart are now finding ways to do one-on-one activities with residents. Because if they weren’t doing them, they may have times of isolation. They are innovating and caring in new ways, and it’s amazing to witness.”

Covia has been able to get staff the supplies they need, ordering Personal Protective Equipment (PPE) like masks in larger quantities and distributing to the different communities as needed. Shelby, as part of Covia’s COVID-19 Task Force, reports daily on the needs and concerns of the skilled nursing teams, as well as the creative solutions they are implementing – such as turning sections of the health care center into isolation areas should a COVID-19 positive resident need to be kept separate from others. During weekly Infection Prevention Zoom calls, team members share best practices, discuss concerns, and answer questions to ensure that the Covia’s health care services are prepared for what might happen next.

“We’re making history,” says Shelby. “We’re doing things we’ve never done before. We’re introducing lots of new technologies, new ways of doing things, new ways of communicating to our families. Everyone as a team comes together for that.”

“I get to work with a team of intelligent, compassionate, kind individuals that provide and coordinate care to older adults with various healthcare needs,” says Yuen. “Together, we promote healthy aging, safety, well-being, quality of life, dignity and meaning if one becomes more frail towards the end of life.”

“What happens over time is love,” says Linde. “The care is driven by that relationship and there’s not another word for it. It is love that happens there.”