Mike Thirtle, president and chief executive officer of Brookfield-based Bethesda Lutheran Communities, made the call in late February that its residential facilities would shelter in place – a decision that came weeks before most governors began issuing social distancing orders.
Bethesda operates group homes, apartments and programs in 13 states for individuals with intellectual and developmental disabilities, a population that in some cases is at higher risk of COVID-19 infection and severe illness because of their underlying medical conditions.
Bethesda’s leadership team had been monitoring the COVID-19 pandemic in China and Italy, and anticipated that the U.S. would soon be hard hit by the virus. Acting swiftly paid off for the organization, allowing it to mitigate the spread of the virus, get ahead of the personal protective equipment supply chain issues and identify vulnerabilities at each of its locations. Thirtle said he drew from his experience as a former U.S. Air Force officer in responding to the crisis.
“What we implemented was very similar to what the military would do during wartime, we set up an incident command system,” he said. “When we shut things down before many other providers and the government, it helped us a ton because we were able to get people safe immediately.”
But taking an aggressive approach to preparing for the virus has also come at a cost. Bethesda’s shelter-in-place policy has barred visitors – including residents’ family members and guardians – from entering its facilities. Many family members have pleaded with Thirtle to allow them to see their loved ones, he said.
“Because we got ahead of it, we had a lot of people who disagreed with our decision because they thought it wasn’t going to be that bad, that it was going to be like the normal flu. But what we saw was, no, it’s not,” Thirtle said. “One of the most difficult things as a leader, and as an individual in this case, is how do you cut through where the truth is at? Because you’re trying to make decisions based on that cost-benefit of people’s health and safety versus their freedom.”
To date, the organization has seen a few COVID-19 cases and one fatality – a man who died after contracting the virus while attending another organization’s day services program in Illinois.
While many businesses are beginning to prepare to reopen, Bethesda isn’t ready to let up on its lockdown measures yet. The slope hasn’t begun curving downward in the states where it operates facilities, Thirtle said.
“There’s this perception in the country that things are getting better than they were a week ago, but they’re not, if you look at just the raw data across the U.S.,” he said.
On Friday, Wisconsin reported 375 new confirmed COVID-19 cases, the second-highest single-day total since March 12. The total number of positive tests has increased in recent weeks as the state’s testing capacity has grown.
Over the past 10 weeks, Thirtle said he has held 50 town hall meetings with parents, guardians, donors and Bethesda’s roughly 2,000 direct service providers to keep them informed.
It’s also begun delivering many of its services virtually and added many new programs, including Zoom meetings with parents, bingo, virtual dance parties, cooking and arts & crafts classes, weekly devotions and a concert series.
“We’ve tried to set up all these frameworks that, honestly, if it wasn’t for this crisis and challenge, we might have gotten to someday, but this has created an entirely different wonderful Bethesda for people,” he said. “…It’s created a different organization, which I absolutely love.”
The organization has also seized the opportunity to address one of its biggest challenges in recent years – high vacancy and turnover rates among its employees. Intellectual and developmental disabilities providers like Bethesda have a roughly 50% employee turnover rate annually, according to the National Alliance for Direct Support Professionals.
“It’s been very, very difficult to find staff to do what our staff does,” Thirtle said. “It’s a very difficult job. They are jacks of all trades. They have to do cooking, cleaning, caring for people, everything.”
Anticipating that people would be losing jobs because of the shutdown, Bethesda began aggressively recruiting workers in March, holding virtual job fairs and expediting its onboarding process from three weeks to one week.
Over the past 10 weeks, Bethesda’s employee vacancy rate in its homes has decreased by 33%.
“I look at this right now as an opportunity to hire great people,” Thirtle said.
With more employees than the 500-employee threshold to qualify for Paycheck Protection Program funds, Bethesda has not received supplemental funding during the pandemic.
Medicaid covers about 80% of Bethesda’s costs, with the remaining 20% coming from philanthropic dollars. Thirtle said he’s been making more calls to donors to help cover the gap, with the organization’s increased expenses of providing PPE and hazard and overtime pay.
Bethesda has advocated in support of several pieces of legislation that could offer relief, including a bill that would provide $60 billion to nonprofits of all sizes impacted by the pandemic, a temporary increase in the Federal Medical Assistance Percentage to make up the gap in state Medicaid rates, and eliminating ambiguity over whether direct support professionals are considered essential under the CARES Act’s definition of health care workers.
“People with intellectual and developmental disabilities, to be brutally honest, are the last in line for everything,” Thirtle said. ”They’re the last in line for funding, for policy oversight, for advocacy. We’re not whining about it, we’re trying to shape that change in the country right now.”
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