Apr. 2—On March 10, 2020, Julie Hoffmann got a call that staff members were expecting at Avera Brady Health and Rehab and Assisted Living: Davison County had its first case of COVID-19.
Within an hour, the building was cleared of visitors and the facility was locked down to the outside. Nothing has been the same since.
More than a year later, there is still pain and challenges. But the facility has turned a significant corner is now allowing family members to visit the Mitchell long-term care facility on a limited basis. Another positive? Residents at Avera Brady are fully vaccinated, and so is much of the staff.
There has been so much pain and so many troubles and challenges that had never been faced before. Since the start of the pandemic, 26 Avera Brady residents have tested positive for COVID-19 and seven died. That's about one-third of the facility's general population that has battled the coronavirus. About the same rate of employees have contracted the virus as well, 48 employees out of about 150.
After all the hurdles from the past year, there are prevailing sentiments: gratefulness for what caregivers and residents have fought through, solemnity for those who have been lost, and dedication for continuing to ride out this battle.
"Here, it's like you're caring for your mom or your dad or your grandma or grandpa because you're here every day," said Hoffmann, the facility's administrator. "You know a lot about them and you come to know and love them. It felt like we were caring for our family members and that's who we lost."
For the Mickelson family, of rural Mount Vernon, they know all too well the pain that COVID-19 has caused at Avera Brady.
Elmer and Shirley Mickelson lived in the facility over the last year. But once COVID-19 posed a threat, there was no outside visitation. All that was available was visits to the window, phone and video calls.
"We kind of chatted with the rest of the family about what we would do if they had to go into the facility, and talked about being prepared for what might happen," daughter-in-law Karen Mickelson said. "And our worst nightmare happened."
Both Elmer and Shirley contracted COVID-19. Shirley Mickelson died on Oct. 8. She was 90.
"It's been a miserable year," Elmer said from his room. "You just sit and look at these walls."
The Mickelsons were married for 70 years. In addition to being a wife and mother, she was a teacher, she loved traveling and was passionate about helping her community and the Storla Lutheran Church.
At 93 years old, Elmer is a veteran and a lifelong farmer. He deals with dementia. In his free time, he reads and is a tough out in checkers, Karen said.
"He is feisty. But I'm used to it," she said. She joined Elmer in a video call for this story. She lives near Storla on the family's farm, north of Mount Vernon. She jumped at the chance to be a caregiver for Elmer with Avera Brady to make it easier to visit him.
"Having Elmer and being able to see him and spend time with him, that has been a true gift for us," Karen said.
"It's been a good gift for me, too," Elmer added.
Elmer's grandchildren still come to the window at Avera Brady to visit him. Sometime soon, they hope to be able to be outside and take some walks together. The Mickelson family is looking forward to the chance to have dinner together again. Karen and Elmer joked about whether lefse should be on the menu.
"We are most grateful," Karen said. "We know we have to be patient and let things continue to get better and we're certainly looking forward to those days."
The trying times
Of all the things that have made this pandemic difficult, Hoffmann said the length of this battle has been the most trying.
In her career, there's no parallel to the challenges that the coronavirus created. She's been administrator at Avera Brady since 2007 and worked in the field for 32 years. In past years, if there was a flu strain that got into the facility, it was possible to close down the building to visitors for two weeks. But anything longer than that was inconceivable.
"This was an entire year of trying to prevent the residents from getting sick," she said. "The entire part of our plan was about preventing this but at the same time, how do we make life meaningful and to provide quality of life and still have their families involved?"
Having families involved meant trying to keep the lines of communication with residents and families as open as possible, even when times were challenging. That included regular phone calls and virtual town hall meetings, and accommodated special needs such as compassionate care and end-of-life visits.
Those window visits and visits through a plastic sheathed booth? Those meant a lot, Hoffmann said.
"We saw the smiles in the residents' eyes, behind their masks, of course," she said. "It changed the atmosphere and it has gotten better every day since then."
The outbreak surge in the facility was in September and October, ahead of when Avera Queen of Peace Hospital was dealing with its peak number of cases across town in November and December. Avera Brady has not had a resident test positive since mid-October, Hoffmann said.
Since January, residents and staff have been able to be vaccinated, with nearly the entire facility rolling up its sleeves. After the first clinic, residents celebrated with champagne and threw a party, and after the second vaccine clinic, they enjoyed Orange Crush pop, symbolizing crushing the virus.
Now the balance is related to loosening restrictions but still being protective against the virus. Hoffmann said she has seen first-hand that the protective equipment — masks, gowns, faceshields, vaccinations — have helped keep the facility and the community safe. She said the collective efforts within Avera, given that there are more than 30 other Avera long-term care facilities, helped share best practices.
And there's an understanding that the battle at Avera Brady is quieted but it is not over.
"There's still a level of fear with staff, and there's still a level of risk," she said. "We've been in prevention mode and we're still trying to adapt to what we know and learn on a daily basis."
Avera Brady Health and Rehab has varied its testing staff depending on the severity of the outbreak in Davison County over the last year. Currently, residents test for COVID-19 once a week, while staff depend on the county case levels. For county case positivity rates above 10%, staff tests twice a week, which is where Davison County has been for months.
That's dictated by the Centers for Medicare and Medicaid Services, or CMS. Asymptomatic, negative residents are tested every 3-7 days if there's an outbreak (defined as a new infection anywhere in the building) for a period of at least 14 days.
"We can have a very part-time employee, even someone who works once every two weeks, and they can test positive and we're in outbreak status," Hoffmann said.
Earlier this week, when the Mitchell Republic visited the facility, the building was on outbreak status due to an employee having a positive test. What happens in the community has a direct impact on how nursing homes and long-term care facilities operate.
"This was as hard on staff as it was on anyone," Hoffmann said. "It's been an emotional year all the way around."
Appreciating every visit
It would be hard to blame Florence Hughes if she felt sorry for herself.
She fell in October and then had another fall and a stroke in February while living at Edgewood Assisted Living in Mitchell. She has been at Avera Brady for the past month rehabbing and doing physical therapy. She is progressing well, but in a time of the coronavirus, there are still nerves at age 86 about contracting the virus.
But once again, she's thankful for what she has. That includes visits from her daughter, Rita Beckman, who frequently comes over from her job with the Mitchell School District to visit. They meet in one of the large rooms in the facility — The Pub — which has about five tables, each with a plastic partition to allow for safe visits.
"It's been a blessing," Hughes said. "I've perked up every time she gets to visit. ... They've taken really good care of me here and I've gotten a lot stronger."
Beckman said she's appreciative that Avera Brady was able to take her mother in when it was time for her to do her rehab.
"You put everything into perspective, and you really think about caring for others and not just yourself," Hughes said. "We're glad she has been here."
Hughes is also motivated by a goal to get back to Edgewood and living there. She enjoyed playing cards and connecting with friends, including a woman she met 65 years ago in Alaska when their husbands were in the military.
"Can you believe that? After all these years, we met up again," Hughes said.