Hebrew Rehabilitation Center - COVID-19 Update

Learn about actions on our Boston and Dedham campuses to reduce risk for patients, families, and staff.

Hebrew Rehabilitation Center is actively responding to the COVID-19 coronavirus outbreak at its Boston and Dedham campuses. As always, our number one priority is protecting our patients, residents, and staff. This page is being kept updated with the newest information for the seniors we serve, their families, and their loved ones. Please be sure to review the Q&A sections for details on operations, patient care, and patient and employee testing.

About Our Care

Hebrew Rehabilitation Center is a 675-bed long-term chronic care hospital, not a nursing home. As a hospital, people seek help here for their loved ones, usually sicker, more frail, and more compromised than patients in a traditional nursing home. We maintain an in-house, fully accredited Department of Medicine and all patients are under the care of physicians, nurse practitioners, and trained RNs and LPNs. We also have an on-site pharmacy, in-house clinical lab, and radiology services. All staff have the personal protective equipment that is clinically required, and are continually trained by our infection control team about its proper usage.

Testing for COVID-19

COVID-19 tests for Hebrew Rehabilitation Center patients are processed by our acute care hospital affiliate Beth Israel Deaconess Medical Center, with results in under 24 hours. Each Hebrew Rehabilitation Center patient has been offered a test, whether or not they showed symptoms, and many patients have been tested multiple times. Please review the Q&A at the bottom of the page for more on our testing efforts, including our employee testing policy.

Infection Control Efforts

Our population of medically compromised patients who require high touch nursing care is extremely vulnerable to COVID-19 infection and complications. Because up to 25-40% of people with the virus do not show symptoms, and seniors present with different symptoms than younger people, we continue to test asymptomatic patients. By identifying patients who are contagious before they show symptoms, the clinical team can physically separate patients with and without the virus, a key step in infection control. At Hebrew Rehabilitation Center, this is being achieved either by creating positive and negative cohorts, or by strict isolation of infected patients in their rooms, with the highest level of infection control precautions. 

Patient testing is paired with a process to identify and test asymptomatic staff members who had contact with newly diagnosed patients within the previous 48 hours. We are taking every effort to beat back this virus.

Reporting and Recovery

We are committed to transparency in sharing data, and in how we use data in our clinical practice to reduce the spread of the virus, contain any outbreaks quickly, and nurse those who can beat the virus back to health. 

Consistent with the April surge of the virus in Massachusetts, the majority of the COVID-19 infections and deaths at HRC occurred in April. With comprehensive testing strategies, patient cohorting, and contact tracing now in place, the infection rate and deaths have dropped significantly in May.

While this disease is extremely dangerous for our frail patients, it is also possible for patients to recover. According to the Centers for Disease Control, a patient can be considered recovered if they’ve had at least three days with no fever without the use of fever-reducing medications, their respiratory symptoms are improving, and at least 14 days have passed since their symptoms began. When considering recovery data, it’s important to remember that not all patients are diagnosed on the same day, and our clinical experience shows us that recovery can take a month or more.

As of June 2, 2020, we can report the following data about COVID-19 among our long-term chronic care hospital patients:

At the 455-bed HRC-Boston campus, there have been a total of 162 cases, with 19 of these since May 1. Of the total number infected, 51 patients have died and 108 have recovered.

At the 220-bed HRC-Dedham campus, there have been a total of 58 cases, with 7 of these since May 1. Of the total number infected, 29 patients have died and 15 have recovered.

The full focus of our highly trained physicians and staff is on caring for and protecting our patients, and supporting their ongoing recoveries.

End of Life, Compassion and Sympathy

Whether they are COVID-19 positive or not, patients at the end of life receive specialty palliative care: specially trained physicians, nurses, social workers, and chaplains who work closely with primary care teams to provide treatment of pain and symptoms, communication and compassion, guidance with difficult treatment choices, detailed, practical information and assistance, and pastoral support for patients and family members of all faiths.

We send our deepest sympathies to the families of those at Hebrew Rehabilitation Center who have passed away. With stringent no-visitor rules in place, it is heart-wrenching that families cannot visit their loved ones at the end of life. For those families who are in this situation, please know that your loved one is not alone. Our staff, including chaplains, have become surrogates for families who no longer can be at their loved ones’ bedsides. Every senior who passes away in our care will know that they are well loved.

A multidisciplinary team from Hebrew Rehabilitation Center is carefully assessing the factors that would allow us to resume family visits. Plans have been reviewed with the HRC Family Advisory Council and will need approval by the Department of Public Health and Boston Public Health Commission.

We are continuing to restrict entry to essential personnel only. We know that this is difficult, and we remain incredibly grateful to family and friends for your partnership and understanding. As of April 7, 2020, based on guidance from the Boston Public Health Commission, we made the incredibly difficult decision to temporarily suspend visitors for end-of-life circumstances. Our staff cares deeply for each and every patient and chaplains are available to all patients for spiritual and emotional support, including at the end of life.

Since this crisis began, family members have received regular communications from HRC leadership and proactive calls from nurse managers. Staff on each floor have notified families if their loved one has been exposed to COVID-19, so if you have not received notification this means that your loved one has not been exposed.

Recognizing how important it is for you to have virtual visits with your loved one, we are facilitating one-on-one video chats between patients and families. We are eager to maintain the connection between families during this crisis.

We are physically screening each employee, each shift, for a fever of 100.4o Fahrenheit or higher and other signs and symptoms of illness to protect patients and fellow staff members.

We are providing HRC employees a host of supports to maintain a stable and available workforce, including flexible schedules to accommodate child care concerns, meals, scrubs, and accommodations paid for by HRC if employees choose to separate themselves from their families.

To further reduce the potential for infection, in an abundance of caution, we are not allowing drop off or delivery of personal belongings, care packages, flowers, or food. We cannot risk bringing large volumes of items up onto the floors that are potentially contaminated.

We’ve bolstered our already strict infection prevention and control protocols with increased cleaning of high-touch areas, modification of dining services to accommodate social distancing, and cessation of group programming. Virtual programming, including religious services, is available through closed-circuit television. Our life enhancement and social work teams, among others, have increased their presence with patients in order to engage them with individualized programming, and to help alleviate feelings of social isolation and depression. Local children have been invited to mail pictures, drawings, and cards and these are being shared with patients to bring joy and community connection.

Our medical, pharmacy, and food and beverage supplies are being delivered as scheduled. We have an adequate supply of the personal protective equipment (PPE) needed to follow clinical requirements issued by the Centers for Disease Control.

We have temporarily suspended rehabilitation services for long-term chronic care patients. During normal operations, Therapy and Fitness staff members float to all households and floors, and we are suspending services to limit patient exposure. Specifically:

  • Physical and occupational therapies are suspended for long-term chronic care patients at HRC-Boston and HRC-Dedham
  • Speech-Language Pathology Services will remain available in both locations for urgent referrals
  • Shoe clinic is suspended
  • Circle of Fitness in the gyms are closed at both sites
  • Messages from the teams that indicate there are other URGENT issues requiring the skills of a therapist to address will be reviewed regularly and addressed appropriately

Outpatient services at HRC-Boston and HRC-Dedham, including outpatient rehab therapies, specialty outpatient care, adult day health, Get Up and Go, and in-person visits to Hebrew SeniorLife Medical Group are suspended.

Hebrew SeniorLife's Center for Memory Health continues to provide telemedicine and virtual support services to patients and families via videoconference and telephone. To learn more about our telehealth options, please call 617-363-8600.

FAQs for HRC Families

 

General Questions

We are committed to sharing updates on our campuses in as timely a manner as possible. In addition to the frequent letters to families and phone calls to families from floor managers and social workers, we maintain a dedicated COVID-19 section on our website where families can learn the latest updates.

Each floor team has established a schedule for virtual visits for all patients in their care. The goal is to ensure that each patient and family can meet at least once a week. If you have not had someone contact you about a schedule, please notify the social worker or the manager of the floor to request one.

Despite our best efforts, in this fast-paced situation there may have been an unintentional oversight and we welcome you to contact our staff to correct the oversight. Please know that these virtual conversations are not only important to you as family members but also to us as well. We are doing our best to manage these calls in and around taking care of our patients and their health needs.

Although formal programming involving outside guests has been suspended and our primary volunteer programs are temporarily halted, we have put in place a programming schedule that provides opportunities for patients to stay engaged. We offer “friendly visits” on the floors, which consist of a variety of activities such as chats on a variety of topics, poetry readings, coloring, helping with books, crosswords, and word searches. Patients are offered art supplies to continue with their art making and music therapists play live music in the common spaces.

Concerts are streamed twice weekly through the in-house TV channel, using performers who are familiar to our patients, and maintaining the entertainment schedule that has become routine to the community over the years. Technology also plays an important part in our programming. For example, we help patients and family members schedule video calls, and we offer patients iPods and iPads for music listening and viewing of musicals.

We also provide joint virtual sing-alongs and encourage patients to participate in other video programming, such as art lectures, fitness programs, and regular religious/spiritual observances and celebrations.

Sick patients are quarantined in their rooms and placed on enhanced infection control precautions, following guidelines from Infection Control/CDC/DPH. Although we have full confidence we are following every best practice, we, along with every other health care organization, are fighting against a virus that is largely unknown. Our providers and nurses are working together 24/7 to identify symptoms, order testing, and then determine a plan to prevent further spread.

We have two special COVID-19 units at Hebrew Rehabilitation Center, one each on the Boston and Dedham campus, with 37 beds total. Patients are moved to these units based on clinical and infection control needs. The units are fully staffed by a dedicated team of trained clinicians. Regardless of whether a patient is moved to the COVID-19 Unit or not, they are quarantined in their rooms and placed on strict infection control precautions.

Patients who need feeding assistance continue to receive that support through their direct care team. Nurse and patient care associate support is provided by staff who have been redeployed to assist the front line and who have completed training. These individuals have taken on “meal mate” positions. They have been trained by a speech pathologist or other trained professionals prior to assisting with meals. Any other training needs, such as use of PPE, has been provided by our Professional Development team. Meal mate assignments are overseen by the nursing staff. Having “extra hands” has ensured that there is more 1:1 support before, during, and after meals. Meal mates become “friendly visitors” and help with providing engagement and coordinating video chats between patients and family members.

 

HRC Testing Approach

Staff are continually monitoring all patients to watch for any symptoms of COVID-19 or changes in health status. The decision to test patients is made by our on-site medical team based on the impact it will have on clinical care and infection control. Through a special relationship with our acute care hospital affiliate Beth Israel Deaconess Medical Center, all COVID-19 tests for Hebrew Rehabilitation Center patients are run at the hospital and returned in less than 24 hours.

When a COVID-19 confirmation results from the testing, Hebrew Rehabilitation Center’s infection protocols continue and in addition, we conduct in-house contact tracing to allow the clinical team to determine if other patients or employees may have been exposed. If yes, then these cases are evaluated on an individual basis to determine the need for additional testing or surveillance.

Initially, there were only a limited number of testing kits available in Massachusetts. Because we had access to very few kits, our focus was on testing symptomatic patients and other patients who may have been exposed. We now have an adequate supply of testing kits and have been able to offer tests to all symptomatic and asymptomatic patients, and continue to offer tests as the clinical team determines is necessary. Some patients have been tested multiple times.

Our mitigation efforts include an in-house contact tracing effort, led by our Infection Control team, to identify employees who’ve had contact with a newly diagnosed patient in the previous 48 hours. These identified staff, including those without symptoms, are tested and monitored and not allowed to work if they test positive.  Any employee who shows any concerning symptoms is not allowed to work even if they test negative, given the chance of a false negative test.

The question of whether to proactively test all asymptomatic employees continues to be challenging across health care organizations. We do not currently have the resources or testing kits to test and continually retest all employees. Test results are only meaningful for a short window of time, as someone who is negative on one day could test positive two days later. The amount of testing and retesting required for us to make reliable staffing decisions based on the results is not currently possible. 

Employees who have a cough, fever, sore throat, or any other symptoms are required to contact Occupational Health and may not report to work. If an employee presents at work with symptoms, they are to leave immediately and we begin back-tracing of their contacts. 

Staff cannot return to work if they continue to have upper respiratory symptoms, even if they test negative for COVID-19. Our Occupational Health team follows each employee closely, managing each situation based upon the staff’s medical condition and clinical factors. Staff members whose symptoms have resolved and test negative for COVID-19 can return to work. Staff members who test positive for COVID-19 are required to stay out of work for two weeks and must be symptom-free for 72 hours before returning.

In addition to the contact tracing program to identify employees who’ve been in contact with a newly diagnosed patients, other mitigation strategies include taking the temperature of each employee at the beginning of every shift, meticulous hand hygiene, and wearing a mask at all times.