Q&A: ‘I have never seen anything like it,’ Orchard nursing home administrator says about Covid-19
Martin MacKenzie leads facility that has quarantined residents, trying to slow the spread of virus
MEDINA – Martin MacKenzie has worked the past four years as the administrator of the Orchard Rehabilitation and Nursing Center in Medina, a nursing home with 160 beds on Bates Road. The nursing home, formerly known as Orchard Manor, is owned by Personal Healthcare LLC.
“Personal has moved Heaven and Earth to keep us supplied with PPE,” MacKenzie said.
He previously worked as an administrator of the Villages of Orleans Health and Rehabilitation Center in Albion, and also and nursing homes in Rochester, Williamsville and Warsaw.
MacKenzie started his career as a CNA and then a registered nurse before going into administration 10 years ago. He has been wearing nursing scrubs to work during the Covid-19 pandemic.
The following interview was conducted outside the nursing home last Wednesday, May 20. At that point, Orchard had three confirmed cases of Covid-19. After all the residents and staff were tested for Covid-19, the number of confirmed cases is now 31 with six deaths from the coronavirus.
MacKenzie said the staff, including the housekeeping department, has worked hard to tried to contain the virus.
Question: Before getting into administration, how long we you working as a nurse?
Answer: I’ve been a registered nurse since ’94. I was a CNA prior to that.
Question: Is that an unusual trajectory to become a nursing home administrator, starting as a CNA?
Answer: I couldn’t even tell you. There are a few nursing home administrators who did start out as nurses. There are some who are social workers who are finishing up their master’s degrees and then take the state test for administrator.
Nursing has always been my passion.
Question: Is this your normal work attire, or is it just in the past two months?
Answer: No, this is a suit job, but when Covid came the staff was scared. Being a nurse, I’ve always tried to be hands-on with the patients.
Two things happened. For one, as a nurse, I understand infection control pretty well. So your clothing gets dirty. If I’m wearing a suit, with all the dry cleaners shut down, it just wasn’t feasible.
I told the staff and I meant this: I knew we were going to have some Covid patients, even before the directive came out that you had to. In my mind that’s what you do. That’s why we’re here.
So we set the building up where we quarantined one of our units. Anything beyond that point we considered contaminated.
A crew was set up with infection control. We were fortunate we had enough PPE. Orleans County Emergency Management helped us a lot. Our parent company really moved Heaven and Earth to keep us supplied.
Why I am wearing scrubs is I started going over there when we admitted our first Covid patient. Everybody was really scared. I insisted I would be the first one into the room. And since then the staff hasn’t dropped the ball.
Question: The first cases, they didn’t contract it here? You accepted them in?
Answer: We started off taking patients who were from the community. They were recovering from Covid in the hospital. They came in her for rehab services and everything. They were still quarantined on the floor for 14 days.
Question: You had to accept them or you had the option not to?
Answer: There is a lot of hype about that. My personal feeling is I know we would accept them anyways. I believe that is what a nursing home is, it serves the community. The directive came out and there was a lot of hype about this directive. The directive is not new. I’ve been around a long time. When HIV-AIDS came out, you couldn’t discriminate against that. Any disease you can’t discriminate from. That directive has always been there. You are going to take sick people.
Now this virus is a nightmare. Obviously it turned the world upside down. Should they have made nursing homes take them that weren’t ready for them? I’ll let somebody else judge that.
Question: With 160 beds, were you close to capacity when you started to quarantine people with Covid?
Answer: Some of the safety measures were put into place and we shuffled even before the first Western New York case showed up. The outside is where they are going to get this virus, right.
So we took one wing and emptied it out pretty much and moved all of the patients around and emptied out 12 beds. That is where any new admits come in this place and they are there for 14 days until we know they are not sick and then we move them out.
For the rest of the facility the danger I saw was dialysis patients and patients who went out to the doctors. So we moved those patients over to this side too to a separate wing, but on the same unit. Because I wanted to keep as little traffic as possible coming into the long-term side.
Question: So if they go to appointment when they come back they are in the two-week quarantine?
Answer: Yes, even if they go to the hospital for whatever reason.
Question: How many beds is that total in the wing?
Answer: 40 beds. The rest of the building is 120 beds.
Question: That staff with the 40 beds can only stay on that side?
Answer: Exactly. We set it up pretty good. The staff all come in one door here. They all punch in. They get a mask everyday.
For the staff that works this unit, they don’t come off the unit. Dietary sends the food over. The staff exits out the one door. Once they go into that unit, nobody comes back out (to the long-term care side).
Question: I would think people would be nervous about working in that unit with the Covid patients or people in quarantine.
Answer: They are.
Question: Is that why you put on the scrubs and went in first?
Answer: You can’t sit behind a closed door and give orders to these folks. They are young moms. They are a brave crew. They led me as much as I led them. We didn’t mandate anybody. It was volunteers.
The therapy department – we have quite a therapy department – we also separated that. The main gym and the therapy department is in the center of the building. So we had four or five therapists who volunteered and therapy assistants and we turned the dining room over here into a mini therapy gym. We moved some equipment over there. We’re not using the dinign rooms right now, obviously.
Question: When you accepted Covid patients that didn’t show up publicly in the reports from the local health department? They weren’t considered your cases?
Answer: No. We accepted patients from the hospital who were recovering. We self quarantined them and did all of the steps.
We didn’t have anything we did not expect until a couple days ago when a patient on the long-term side tested positive.
Question: Is there much of a chance that could be a false positive test?
Answer: I personally I believe it could be. You know this whole Covid thing came on so quick. These tests are manufactured rapidly. Labs are overwhelmed. Could they be false, yes, but you still need to react to them.
Question: If you get a positive in the long-term care side, they would be shifted over to the Covid wing?
Answer: Yes. Anybody who spikes a fever, who is symptomatic we send them over to that side.
Question: And now you have to do the twice a week testing?
Answer: Yes, until they are cleared. We just started this. Some of the new mandations from Albany came out.
On Tuesday and Wednesday (May 12 and May 13) we swabbed every resident in the building. Most of the results (a week later) are still pending.
Question: Is that 150-160 residents?
Answer: The census is 142 today. So every resident was swabbed. Staff testing, we’re starting today (May 20) and that mandate is twice a week. So we’ll do it today and I think the director of nursing wants to do it every Monday and Thrusday.
Question: Do you administer it yourself or does somebody come in?
Answer: It can be done both ways. I’ve heard of faciltiies where the state has showed up and helped them. We’re prepared ourselves. Our director of nursing, Mary Luckman, she is educated and took an online course and she and some of the supervisors are ready to start swabbing.
Question: So you get all the samples and they send them out to a lab?
Question: People do say Covid is just the flu. Can you talk about how you view it as a nursing home administrator?
Answer: Nursing homes took the most frail with comorbidities. They are very challenging. Flu season is always a nightmare in a nursing home. And actually some of the steps we set up here are from many, many years ago when I was in a nursing home as a nurse and we had a bad flu outbreak. One of the things we did here we separated dietary completely. I learned that from the flu outbreak and that was I think back in 2000.
Question: Were the nursing homes somewhat prepared because of past experiences with the flu?
Answer: I think we were, but this virus is different from anything we’ve ever seen. Orchard has been fortunate but I’m not a fool. I know we will start getting some more positive cases because it’s everywhere. We have two very attentive docs on top of it, and the staff has been absolutely incredible. So I’m very, very fortunate.
Comparing it to the flu, no, this thing is very, very aggressive. We communicate every day with other nursing homes and some of the homes that have had it really bad, it literally spreads like wildlife down a hall.
We have the PPE and the staff is very well trained and shows up. I love the staff. And another thing, Orchard is very fortunate to have one hell of a housekeeping staff. They are literally keeping us alive. I wish I could show you the building, Tom. It’s never been so clean.
‘To the family member who has a mom in here, the CNAs are the most important person. If anybody deserves credit it is the frontline staff, the aides, the nurses, the housekeepers that show up everyday.’
Question: When there is an outbreak in a nursing home, I think people assume it may not have been clean or the owners were cheap. But you are seeing top-rated 5-star facilities with outbreaks.
Answer: I can tell you wholeheartedly there isn’t one nursing facility in the whole country that invited this bear into its walls. Most of the staff in nursing homes are young. They are young moms with young families. They come in every day scared. Some of the things we shuffled around here, some of the staff change their clothing before they go home.
Question: I’ve tried to imagine how hard it would be at a nursing home where there are many deaths, and how hard it would be on the staff, especially the 20-year-olds. It would seem like you’re being sent to war. It must be traumatic.
Answer: Very much so. That’s a good word. It is not only here because you’re on your toes when you go to a local grocery store. But also the residents. These poor folks haven’t seen their families, shy of a window visit, in two months. Now for the last six weeks, with the masks, they haven’t even seen the staff smile at them. I’ve never seen anything like this. I go back to when AIDS first came out, and when MRSA first came out. I have never seen anything like it. And I know a lot of my staff have complimented me. But I will tell you honestly if it wasn’t for the staff here I would have cracked about a month ago.
The CNAs are always underrated. The administrator of the nursing home, I’m the most important. Well, that’s a façade. To the family member who has a mom in here, the CNAs are the most important person. If anybody deserves credit it is the frontline staff, the aides, the nurses, the housekeepers that show up everyday.
‘The residents of the facility have been so strong through this. They tell the crew everyday that it is going to be OK. We’re going to get through this.’
Question: How did you get drawn to this field? Why are you passionate about it?
Answer: It was strange. I grew in Niagara Falls in the ’70s. All I was going to do was work in a factory. I’m a big guy. But then all the factories closed. I’m actually a high school drop out.
When I was about 25, I realized the world was moving on. So I go to sign up for college. I was never the sharpest tack in the box. So I’m going to take an EKG course with heart monitors. But I had to get a GED first. So anyways I get into college and I do well, which kind of shocked everybody who knows me. They gave me a scholarship for a year free in nursing. They needed male nurses. It was in the very early ’90s, late ’80s. So I got into that and I did well.
The thing that kept me was personality, not that I have a good one or a bad one. I enjoy meeting and talking to the people that have worked under me.
Question: Was there something about nursing homes that appealed to you, rather than a hospital scene?
Answer: I worked in Erie County for a few years at ECMC. I worked at Erie County Home actually but we moonlighted at ECMC too. There was excitement at the hospital, but I think a lot is lost with the elderly. They have so much wisdom. The residents of the facility have been so strong through this. They tell the crew everyday that it is going to be OK. We’re going to get through this. They are very interesting to talk to.
When I graduated as an RN there was a girl I went to school with who worked at Oddfellows in Lockport. She said to come work here but I told her I didn’t want to work at a nursing home.
I started working there and never left long-term care. I like getting to know the people I work with.