Meet Marlene Cestaro. She works as the subacute manager for the Dogwood Unit at the Bartley Healthcare campus in Jackson, N.J., and is what her bosses call a “special person” entrusted with the care of residents for a decade. She started as a certified nurse assistant, rising to licensed practical nurse before graduating to a unit head more than four years ago as she studies to be a registered nurse.

Cestaro is one of the thousands on the front lines in the battle to stave off the coronavirus (COVID-19) from attacking the frail and elderly who live in nursing centers and assisted living communities from coast to coast. In her job, and more importantly in her actions, she is a leader, showing her charges the practical ways to put on masks, wear gowns, and the 1,001 other things it takes to practice nursing at a time when mistakes in safety protocols inside and outside the Bartley community can be especially hazardous.

As we enter the later stages of April, in what many experts are saying is only the end of the beginning of a long process to endure the pandemic, Cestaro is remembering the start of what is now the new normal for her and her staff.

“We started preparing the first week of March. We implemented a lot of the things that AHCA [American Health Care Association/National Center for Assisted Living] recommended to screen people coming into the buildings,” she tells Provider. Eventually, that first guidance from the association led to federal restrictions banning all but essential staff and survey inspectors from entering facilities for fear of increasing the chances for spreading COVID-19 infections.

Another big job, in addition to her regular duties, was and is the thorny task of securing and maintaining supplies of personal protective equipment (PPE). Making sure staff are not only healthy but protected is a huge priority considering the rampant spread of the virus and the worldwide shortage of PPE, such as masks and gowns.

“We very early on started using all of our connections we have throughout the state and the country to start getting supplies, and we gradually accumulated it,” Cestaro says. “We’re in pretty good shape.”

In a sign of the times though, at one point before PPE was secured, she and her team were going to have to wear some of the 400 rain ponchos donated by the local minor league baseball team, a Philadelphia Phillies affiliate. But, using the ponchos has not had happened to date.

“We have N-95s [masks], we’ve done all of that work to get prepared, so we have these supplies,” she says.

When asked what the greatest challenge has been in battling the pandemic, Cestaro says with this virus there is only so much you can know about it and do about it as the situation seems to shift all the time.

“Patients and their families are of course anxious, so we try to keep up to date with these families. We’re also doing FaceTime with family members and patients and educating staff so they’re not so anxious, but we all watch the TV and see the news,” Cestaro says.

“If you have a patient or staff member who coughs you right away think, ‘What’s going on with them.’ That’s the bad part right now about what’s going on.”

All Bartley staff also live in the world outside the buildings, and that makes for another level of risk and challenge, to keep safe for their own families. Cestaro, for instance, says she lives with a sister who has multiple sclerosis and has a boyfriend who had a tracheotomy several years back. So, coming and going to work is now a defined process meant to protect her loved ones from any harm that may come from her work protecting her residents from harm.

“I have to be very cautious. My garage is now my entrance place, where I disrobe waist down as best I can and put on a robe and run to the shower,” she says. “Everything that comes from work stays in the garage. But you also have to go to the grocery and do everything like everyone else does, too. It’s a balancing act I suppose.”

For Bartley and what this pandemic is all about, the mantra is the same as it has always been, says owner Phil Scalo, which is to give high-quality care to those who need it most, pandemic or no pandemic.

“People, like Marlene, are just doing their jobs,” he says. “I think they understand internally that they’re doing something special. And actually, we have a sign outside that says ‘Heroes Work Here.’ Our people have been reacting to that because it is true.”

Not all heroes wear capes, many wear caps and gowns, and ponchos if needed.

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