Green Ars Itami, a nursing care facility in Itami, Hyogo Prefecture, has resumed operations after a one-month closure following a mass infection of the novel coronavirus among the elderly enrolled in its day care program.
In an interview with The Yomiuri Shimbun, Shinichiro Shiota, 58, secretary general of the facility, discussed how care was provided for the program's members during the temporary closure and how providing information and income security to its employees were dealt with. His vivid account provides a glimpse of what it's like being the target of harmful rumors and reveals problems in its relationships with municipal governments and the fragile home-visit nursing care system. The following are excerpts from the interview.
The Yomiuri Shimbun: Could you give us any details on how the new coronavirus infection progressed at your center?
Shinichiro Shiota: We received confirmation on March 8 from a local public health center that one of our members was found to be infected with the virus on March 3. During a temperature check that morning, the member's temperature was near 36 C and they were experiencing no symptoms. So it definitely came out of the blue, indeed. In response to the two-week business suspension request from the prefectural government from March 9, we conveyed to the prefecture our intention to, along with publicizing the name of our facility, inform our members and related outside organizations of the details of the infection and our suspension of business. To avoid panic from a rush of inquiries, we decided to inform them of the situation before the prefecture was to make their announcement. As a result of subsequent PCR (polymerase chain reaction) tests, it was found that other members, their families and members of our staff were infected with the virus. Given the situation, we decided to extend the suspension of our business for an additional two weeks.
Q: How did you provide care for your care members during the suspension of business?
A: Our employees who were forced to stay home asked about their health conditions twice a day over the phone. Bathing, the most burdensome task, was usually undertaken by the member's families, however, of our roughly 150 members, 20 live alone and more than 40 suffer from dementia. Our corporation's caregivers and those from other associated nursing care homes visited their homes and tended to them while wearing protective gear. But even under normal circumstances, there is a deficit of caregivers available for home-visit nursing care at all such centers. Despite that, three homes offered to lend a helping hand. Things took an unexpected turn midway, and since then, we've been having a hard time.
Situation changes suddenly
Q: What happened?
A: Whenever PCR test results were reported at news conferences by administrative organizations and in media reports, only the name of our company, Ars, the number of infected persons and the number of those who died from the virus were revealed. As a result, the image of our facility being "a viral den" was planted in the minds of society, even though there were no infections within our already closed facility. Unlike ordinary businesses that handle many and unspecified general consumers, nursing care providers have the ability to ascertain user information and trace their whereabouts. Some of our associated nursing care facilities that had initially agreed to visit the homes of those who tested negative began to decline home visit requests, saying, "It's no longer possible [for them] to do so." Then, our care members and their families, who looked forward to seeing our services resume, began to rethink whether it is good for them to be associated with us. However, being unable to find any other facility, this left them at a loss on what to do.
Q: Were there any other harmful rumors?
A: Caregivers with no connection to our day care service were told by other nursing homes and members not to come just because they are associated with our facility. The list of other examples is endless, including one in which the family members of our employees were refused from reporting to their place of work. Even after a month has passed since our services resumed, the name of our nursing home is posted along with an illustration of the virus. We have, on the other hand, received an outpouring of encouragement from across the country. All of our staff members overcame such a difficult time with tears of joy.
Q: Could you tell me why your nursing care facility decided to disclose its name even though most municipal governments and nursing home operators do not reveal the names of facilities where infection broke out?
A: There was a fear that we would be subjected to discrimination and defamation, but I have come to believe that remaining open and honest is the most essential factor for crisis management.
Caution against infection
Q: What are some of the challenges on the management side?
A: For employees who asked to remain at home, we immediately guaranteed payment of 100% of their salaries in an effort to lessen their anxiety. We face tough business conditions having had to suspend business for a month as well as restrict the number of employees focused on bathing once business resumed. We are struggling to survive through both self-financing and emergency government financing. To be frank, there is no prospect is in sight.
Q: Is there any cooperation from administrative offices?
A: The local public health center did a really good job of responding to the infection. But the delay in PCR tests remains a problem. We hope that the administrative offices will provide accurate information and serve as a source of control without standing on the sidelines under the assumption that public opinion is moving toward exclusion rather than cooperation as the reputational damage has only been increasing with time.
Q: Is there anything on your mind now that business has resumed?
A: There are concerns about whether another virus infection will occur. The only way to eliminate all risk is to shut down the business, but doing so would lead to the collapse of Japan's nursing care system. We'll take all the possible measures. A message I'd like to make sure gets across is that the virus can even be transmitted by a person with no symptoms. If individual people carefully consider their actions and work from the mind-set of "helping each other," those who become infected would not reproach themselves as "offenders" and the discrimination against them would disappear.
Collapse of nursing care emerging as a real possibility
Mass coronavirus infections have occurred one after another at elderly nursing care facilities partially due to the fact that caregiving makes avoiding the "Three C's" ― closed spaces, crowded places and close-contact settings－ difficult. Because there is a high risk of the elderly becoming seriously ill and eventually dying, an increasing number of nursing care facilities have voluntarily suspended operations.
According to the Health, Labor and Welfare Ministry, a total of about 860 nursing care facilities, particularly those offering day care and short-stay services, suspended operation either at the request of municipal governments or based on their own judgment as of April 20. While this only accounts for a mere 1% of all such facilities, a large number of nursing care centers are believed to have curtailed operations, including implementing a reduction in their service hours.
When day care-type nursing homes close temporarily, a substitute method for home-visit services exists. However, the manpower needed for the home-visit nursing care business is acutely in short supply with 13 job offers per applicant.
A group of home-visit nursing care providers submitted written requests to the government on April 10. Misato Kojima, a representative of nonprofit organization Kurashi Net En, which is one such provider, said: "As the number of senior citizens either living alone or in households in which the elderly take care of the elderly increases, leading a life without the help of caregivers is impossible and there are even cases of lives being at risk. Despite this, nursing care fees have been curbed and manpower has not been sufficiently secured. Even if we were to be asked to provide home-visit nursing care services in place of day care employees, we lack the available personnel, protective gear and information necessary to prevent infection. A system must be established under which care can be provided with ease."
Toyo University Associate Prof. Tatsuaki Takano offered a warning, saying: "While the risk of a medical service collapse has been pointed out [in media reports in connection with the spread of new coronavirus infection], a collapse of nursing care services is also becoming more likely. Unless measures are taken quickly to assist the management of nursing care providing entities, they will be shut down one after another even if the virus infection is brought under control. This may lead to a situation where residents may not be able to receive necessary nursing care services in their communities."
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