Caregivers at heart: Images from MSF’s work in Houston, Texas, nursing homes

United States 2020 © Christopher Lee
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The elderly, and the health care workers who look after them, are among the most vulnerable people to COVID-19. As the pandemic spread through nursing homes and other long-term care facilities across the United States in 2020, it became clear that these care facilities were in dire need of in-person, targeted infection prevention and control (IPC) training. In particular, the environmental services staff (EVS)—the people who clean, cook, and do laundry for the residents—were dangerously overlooked when it came to receiving IPC training, despite the fact that they are a critical part of preventing the spread of disease. Doctors Without Borders/Médecins Sans Frontières (MSF) teams responded by providing IPC training to clinical and non-clinical workers at 80 long-term care facilities in Michigan and Texas.

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Covid-19: More nursing home staff need training to prevent spread of infection

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Nursing home staff have been working long hours, often without the tools and resources they need for effective prevention. Many have experienced the trauma of watching residents and colleagues fall sick and die. Some have become sick themselves. They’ve worried about bringing the coronavirus home to their families, or bringing the disease to residents. Recognizing the extreme pressure these essential staff have been under, MSF teams provided mental health and wellness training sessions at 59 of the facilities where they also performed IPC training.

These are images from MSF’s work in Houston, Texas, which wrapped up in October.

A resident at Focused Care at Beechnut, a long term care facility in Houston, Texas, watches TV inside his room. MSF conducted infection prevention and control (IPC) training and mental health and wellness training with medical and non-medical staff at Beechnut and other nursing homes in Houston during the summer and fall of 2020.
A resident of Focused Care at Beechnut nursing home in Houston watches television in his room. With social distancing measures in place, residents of facilities across the country have said they feel more isolated than ever, and due to staff shortages, employees’ work hours are often quite long and difficult.
United States 2020 © Christopher Lee
A resident was visited by a family member for her birthday at Focused Care at Beechnut, a long term care facility in Houston, Texas. During COVID-19, visitors must stand outside on the other side of a window and communicate by phone with the resident.
Some nursing homes facilitate visits from relatives by assisting them to communicate through windows. Here, Focused Care at Beechnut staff help a resident talk to her visitor on a cell phone.
United States 2020 © Christopher Lee
A facility staff member helps a resident eat lunch in her room at Focused Care at Beechnut, a long-term nursing care facility in Houston, Texas, that was affected by the global COVID-19 pandemic.
A staff member helps a seeing-impaired resident eat her lunch. Many of the people who work closely with residents at nursing homes develop meaningful bonds with them. “I've been at this facility for four years and a lot of residents, I treat them as my family,” said Johnny Rodgers, the environmental services (EVS) manager at Focused Care at Beechnut. When some of those residents passed away due to COVID-19, he said, “I can honestly say I broke down and cried because I had never seen nothing like that before.”
United States 2020 © Christopher Lee
An environmental services (EVS) staff member cleans a resident's room at Focused Care at Beechnut, a long-term nursing care facility in Houston, Texas, that was affected by the global COVID-19 pandemic.
An EVS staff member cleans a resident’s room while the resident watches television. EVS workers are the people who clean, cook, and do laundry for residents. They play a critical role instopping the spread of infections in nursing homes, but they often do not receive IPC training.
United States 2020 © Christopher Lee
MSF's IPC nurse manager Kira Smith and MSF nurse Jonathan Garcia provide infection prevention and control guidance for an environmental services worker at Misty Willow Healthcare and Rehabilitation Center, a long-term care facility in Houston, Texas.
MSF nurse manager for IPC, Kira Smith, led a training at Misty Willow Healthcare and Rehabilitation Center in Houston. Here, she demonstrates a cleaning method to an EVS staff member. At many facilities, MSF teams provided group training and then followed up with individual staff members to help improve specific elements of infection control.
United States 2020 © Christopher Lee
MSF's IPC nurse manager Kira Smith and MSF nurse Jonathan Garcia provide infection prevention and control guidance for an environmental services worker at Misty Willow Healthcare and Rehabilitation Center, a long-term care facility in Houston, Texas.
Follow-up IPC training, also called “embedding,” is an opportunity to teach new skills hands-on. Smith explains, “That looks like going in and saying, ‘Okay, show me your cleaning practices. Why don't you show me how you clean a room?’ Then based on that, I'll clean the next room and show maybe some different techniques for a higher standard of IPC in cleaning. Then we'll go on to the following room, and she can show me what she learned. We continue that way, practicing new skills.”
United States 2020 © Christopher Lee
Three medics standing in a hallway, putting on personal protective equipment.
Part of IPC training includes instruction on how to properly don (put on) and doff (take off) personal protective equipment (PPE). Here, Smith demonstrates proper donning of a gown. During the pandemic, many long-term care facilities lacked PPE and knowledge of how to use it correctly.
United States 2020 © Christopher Lee
Masked woman sitting next to a patient's bedside playing the ukulele for patient.
United States 2020 © Christopher Lee
Masked man standing in a conference room in front of four masked people who are sitting, explaining things to them.
Perry McAfee, MSF wellness support officer, conducts a mental health and wellness training session at Focused Care at Beechnut nursing home. “My role is to bring some stress management and peer support to the nursing facilities,” said McAfee. “Our strategy is to build a peer support network. If the staff are working better together, they're communicating better, that can reduce their stress on the job.”
United States 2020 © Christopher Lee
A staff member at Focused Care at Beechnut, a long-term nursing care facility in Houston, Texas, participates in a training session on mental health and wellness support for nursing home staff.
A participant in the wellness training contributes to a list of stressors that they are dealing with on a daily basis during the pandemic. A main goal of the training is to help staff recognize what causes their stress and how they can better cope with it.
United States 2020 © Christopher Lee
A group of nursing home staff stand together in a circle self-embracing.
At the end of the wellness training session, McAfee leads the participants in a socially distanced group hug. Both MSF’s IPC and wellness training materials are being offered to schools of nursing throughout the US for integration into their curricula. More long-term care facilities need this support and the nursing schools located in their communities are well placed to provide it.
United States 2020 © Christopher Lee

Learn more about Infection Prevention and Control at doctorswithoutborders.org/IPCtoolkit