48 Hours with Pegasus’ ‘Field Commander’ Leading Covid-19 Fight

When Dr. Sandra Petersen joined the health and wellness team of Pegasus Senior Living as a consultant in early February, she expected to help roll out a new memory care program. Then came Covid-19, and everything seemed to change overnight.

Now, Petersen is in the thick of managing the Dallas-based provider’s Covid-19 response. From her home office in Dallas, Petersen is guiding nurses over the phone, monitoring test results and making sure that Pegasus has enough personal protective equipment (PPE) to weather the pandemic — every single day of the week.

At the same time, she’s also juggling her duties as a professor with the University of Texas System and as a private-practice geriatrician who makes weekly house calls and telehealth visits.

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“I’ve never had just one job, ever, throughout my entire career,” Petersen told Senior Housing News.

Petersen is a veteran medical professional, with more than three decades working with older adults. She also spent five years working in disaster management with the Texas State Guard, and compares her role as a medical consultant with Pegasus to serving as an “incident commander” in the military force.

“What the incident commander does is assign people to certain roles,” Petersen said. “It’s like being a field commander.”

As of April 6, Pegasus had four confirmed Covid-19 cases, all among residents at a community in Colorado. But the provider is on the lookout for more cases throughout its 37 senior living communities spread throughout the U.S. With Petersen’s help, the company is working to procure hundreds of thousands of surgical masks, and last week made Covid-19 tests available onsite at all of its communities through a relationship with Magnolia Labs.

Petersen credits Pegasus co-founders Steven Vick and Chris Hollister, its regional and executive directors and all of the company’s frontline and clinical staff for meeting the challenge head-on. Though she is working long, hard days, she’s not alone in her efforts, as other team members are in consultation with her from early in the morning until late at night.

“They’ve all stepped up,” she said. “There’s been no expense spared in doing the right thing by residents.”

To learn more about how Pegasus is handling its Covid-19 response, SHN spoke with Petersen on Monday. She shared a snapshot of two of her recent days on the job. What follows is a play-by-play of Petersen’s day, starting in the early morning hours.

Day One: Friday, March 27

Petersen usually starts her day between 4:30 a.m. and 5:00 a.m. She uses the first hour or her morning to reflect on her day ahead by reviewing her notes and going through her to-do list. Then, around 6 a.m., regional nurses from across Pegasus begin calling and sending emails to inform Petersen of new issues or concerns that may have arisen overnight. Included in these messages are usually updates on residents or staffers feeling ill, current PPE inventories and general logistics.

By 8 a.m., Petersen has logged in to an online lab portal to check for any polymerase chain reaction (PCR) test results that came back overnight. The tests can pick up on a variety of diseases, and Pegasus uses a respiratory panel that can detect Covid-19 as well as influenza and the respiratory syncytial virus, which usually causes cold-like symptoms but can be serious for older adults. She’s also holding one-on-one calls with members of the provider’s executive and regional teams, as needed.

Then, at 10 a.m., Petersen holds her first meeting of the day with the provider’s regional nurses. On this particular day, she’s updating the nurses on some of the latest guidelines from the U.S. Centers for Disease Control and Prevention (CDC). She also informs them that PCR testing is now available in all of Pegasus’ 37 communities, updates them on testing protocols and PPE inventories, and explains the company’s latest isolation plans to be used in the event of a new positive case of Covid-19. Corporate memory care and life enrichment directors as well as other representatives of the operations team in attendance also provide input during the meeting.

By 11 a.m., Petersen is engaged in “trifecta calls” with leaders from the provider’s sales, operations and nursing departments.

During these calls, she’s checking in and getting a “state of the union” regarding the company’s properties. Then, between 1 p.m. and 3 p.m., Petersen steps away from her duties with Pegasus and takes about two hours’ worth of telemedical visits with some of her private-practice patients.

“My youngest [private-practice] patient is 72 and my oldest ones are in their 100s,” Petersen said. “I’m seeing them for, usually, chronic disease management.”

By 5:00 p.m., Petersen is holding a call with Pegasus’ regional teams to discuss having enough PPE for new potential Covid-19 cases. In the early days of the pandemic, the provider set aside some of its office space as a staging area for shipments of equipment. Pegasus tracks its inventory via an Excel spreadsheet that is frequently updated.

“Our procurement person in Dallas picks that up on Tuesday and Friday mornings, and we make sure that we have adequate numbers [of PPE] either drop-shipped or direct shipped to the buildings,” Petersen said.

She also reviews creative solutions for communities that lack enough PPE, such as procuring masks and gowns from local paint stores, making hand sanitizer from alcohol and aloe vera gel from the local dollar store, spraying shoes with alcohol in the absence of shoe covers and making cloth masks with coffee filters inserted in the center.

Additionally, Petersen reviews processes for receiving deliveries, and how to practice zone staffing to minimize exposure to residents with Covid-19. And, she reminds the team how to calibrate thermometers, fit test masks, set up isolation rooms and how and when to administer a test.

But Petersen’s efforts don’t end here. Over the weekend, she’s fielding questions regarding testing, readmissions, quarantine and isolation procedures. She also uses her time to compose a weekly clinical leadership team report that summarizes the week for Pegasus’ leaders.

“Assisted living is 24/7,” Petersen said. “You can’t say, ‘Sorry residents, I can’t help you out, I’m not working this weekend.’ It doesn’t work that way.”

Day Two: Monday, March 30

By 8:00 a.m. on Monday morning, Petersen is back at it.

She starts the week by hosting a call with Pegasus’ executive team to update them on what transpired in the previous week and over the weekend. During this call, the company’s vice presidents also update the team on their respective area of responsibility — such as human resources, legal or accounting — and the team also discusses its plans for the week ahead. The meeting’s agenda doubles as preparation for the company’s “Covid-19 All Call” with all of the company’s employees at noon.

At 10 a.m., Petersen holds a telephone meeting with the provider’s regional directors and executive leadership team. She uses the regional directors’ feedback to adjust the agenda for the coming “All Call.”

Then, at noon, the companywide call begins. On the call are Pegasus CEO Vick and partners Hollister and Ed Barneswith; point people for the company’s supplies, HR, media, clinical and isolation and quarantine efforts; and any employees from the field that want to listen in, ask questions or provide input. The call lasts anywhere from 30 to 45 minutes, and is used to get all of the company’s employees on the same page.

Input from the call also helps inform Pegasus’ Covid-19 playbook, a “living document” housed on the company’s share drive that acts as a repository of information for everything learned amid the pandemic. Included in the document — which is essentially a big PowerPoint presentation, Petersen said — is information shared during previous calls and emails as well as procedures that can be used by employees in the field.

“[For example], if you need instructions on how to teach someone how to put on a mask, it’s got a link to that and a video on how to do it,” Petersen said. “Or, if you don’t know how to do the nasal swab, it has a video and step-by step-instructions.”

By 4 p.m., Petersen dons a lab coat and is out seeing more of her private-practice patients. While many of her patients prefer telehealth, Petersen said there’s also still big demand for house calls in Dallas. Between visits with patients, she’s still fielding calls regarding Covid-19 testing, sending electronic requisitions for tests and e-prescribing medications.

In addition to Petersen’s duties with Pegasus, she also teaches doctoral and post-masters courses with the University of Texas at Tyler on Monday, Tuesday and Wednesday evenings.

“I’ve used some of my assisted living connections in my class as guest lecturers,” Petersen said. “I feel like it brings a depth and breadth to teaching that sometimes you don’t have when you’re teaching in a university and not in an active practice setting.”

By 10 p.m., the class is over, and just in time — Petersen is getting a call from a Pegasus executive director regarding test results for some of his residents. While others might be winding down or even going to bed at this hour, Petersen is watching lab results processing live on the web portal. On the phone, the executive director remarks that Petersen is the only person he knows who watches Covid-19 tests process in real time. Other people, he jokes, watch TV for fun.

“It would never occur to me to do anything else,” Petersen said. “It’s what I do, and it’s what I’ve done for 30 years, so why would tonight be any different?”

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