By Mara Hoplamazian, The Sacramento Bee, June 8 2020
Denise Plank visits her father, Ed, 84, through his nursing home window at Fresno’s California Armenian Home nearly everyday. It’s her only way of connecting with her father due to the coronavirus lockdown at the facility. BY CRAIG KOHLRUSS
Deaths in California nursing homes from COVID-19 more than doubled during the month of May, as skilled-care facilities for the elderly continue to disproportionately bear the brunt of the pandemic across the United States.
A total of 1,190 nursing home residents died from the disease last month alone, representing more than half of the state’s coronavirus-related deaths for the month.
There are about 400,000 residents in licensed long-term care facilities in California, or just 1 percent of the population of 40 million people. Yet residents of nursing homes and long-term care facilities now account for about half of the total COVID-19-related deaths in California since the pandemic began here, public health data shows.
Out of the state’s 4,422 deaths from COVID-19 as of Thursday, 2,244 of them have occurred in nursing homes or assisted living centers, according to data from the California Department of Public Health and the California Department of Social Services.
Just under 32,000 residents in nursing homes across the country have died after testing positive for COVID-19 — around 30 percent of the total deaths due to COVID-19 in the United States — according to data released on Thursday from the Centers for Medicare and Medicaid Services, which oversees nursing home facilities.
About 95,000 cases have originated in nursing homes, and research shows that many of the worst outbreaks occurred in facilities with a history of problematic inspection records, according to the Centers for Medicare and Medicaid Services. Even before the start of the pandemic, infections were already a serious problem in long-term care facilities across the country, sickening and killing hundreds of thousands of residents per year.
However, not all of the worst outbreaks have happened in facilities with poor track records. Stollwood Convalescent Hospital, part of the St. John’s Retirement Village complex in Woodland, has a five-star overall rating on Medicare.gov, and a four-star “above average” health inspection rating. Their outbreak, first reported on April 13, has been particularly serious.
Thirty-two residents in the facility, which has only 48 beds, have tested positive for COVID-19. Thirty-four staff members have tested positive for COVID-19, and 17 people in the facility have died, according to the Yolo County Public Health dashboard. At least 15 of those deaths were residents, according to the California Department of Public Health. Eleven of the 17 deaths occurred in May, though no new cases have been reported among residents or staff.
The impact of the coronavirus on skilled nursing facilities has been devastating for residents, families and health care workers, said Deborah Pacyna, a spokesperson for the California Association of Health Facilities, which represents the nursing home industry.
Part of the problem is the lack of personal protective equipment and testing that was available to skilled nursing facilities throughout the first months of the pandemic, she said.
“From the beginning, we have been asking whoever would listen to prioritize nursing homes for personal protective equipment and testing,” Pacyna said. “It has taken quite a while for things to finally fall into place. For so many months we had inadequate masks, gloves — the equipment that you would need to keep an infection from spreading.”
On Tuesday, the California Department of Public Health sent a letter to all skilled nursing facilities, recommending that all residents and health care workers get tested for COVID-19.
After all residents and workers get tested once, nursing homes are required to test 25 percent of health care workers in their facilities every week, ensuring that every staff member is tested once every month. If anybody does test positive, the facility is required to test every resident and health care worker once a week, until there are no positive tests for two full weeks.
Under the new guidelines, nursing homes are required to report the results of baseline testing to the California Department of Public Health. These guidelines come after the Centers for Medicare and Medicaid Services announced requirements for nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention in April.
Nursing homes are also required to inform residents, their families and representatives of COVID-19 cases in their facilities.
“The month of June is going to be ‘testing month’ in skilled nursing,” said Pacyna. With more testing, she hopes facilities will have a better idea of where they can direct other resources, like personal protective equipment.
IMPACTS ON HEALTH CARE WORKERS
Nursing home staff have also been hit hard by the pandemic. In May, COVID-19 cases among health care workers in nursing homes more than doubled and COVID-19-related deaths quadrupled. Fifty-five nursing home health care workers have died as of June 4.
In addition to a lack of PPE and widespread testing, health care workers face another daunting challenge: social distancing is impossible in many nursing homes, said Mike Dark, a staff attorney for the California Advocates for Nursing Home Reform.
“There is no such thing as social distancing inside a nursing home. You can’t have safe social distance between a nursing aide and someone she’s feeding, for example,” Dark said.
On top of increased exposure within skilled nursing facilities, many health care workers work between multiple facilities to make ends meet, said Dark. This increases the risk of transmission across nursing homes and exposes health care workers to even greater risk.
“One easy, low-tech thing that we could do that would be an immediate, effective infection control, is to start paying those aides better,” said Dark. “Unless we double their pay, it’s not going to be possible for those workers to stay just at one facility at a time.”
Nursing home workers face higher exposure to COVID-19 at work, but this exposure impacts their communities, too, said Arnulfo De La Cruz, the Executive Vice President of SEIU Local 2015, a union that represents home care, skilled nursing facility and assisted living center workers.
“If you’re a nursing home worker, you go into work, you’re coming back to your family, you’re coming back to a community,” De La Cruz said.
Health care workers, concerned about transmitting the virus to people inside and outside of the facilities they work in, are making their need for PPE and testing clear. On May 28, employees at the Windsor Care Center of Sacramento authorized a strike after saying the nursing home management has not provided the necessary testing or PPE.
VISITING REGULATIONS
As the pandemic reached nursing homes, residents’ lives changed dramatically. As shelter-in-place orders came into effect, the state put restrictions on visitation, meaning that many residents have been unable to see loved ones throughout the pandemic. Group activities and communal dining have also been canceled, leaving residents without the kinds of social interaction they had before the pandemic started.
In a letter to all long term care facilities on June 1, the California Department of Public Health provided expanded recommendations on visiting that included restricting visitation to family members who have no symptoms, have not had contact with anybody with COVID-19, have not traveled internationally and do not live in a community where community-based spread of COVID-19 is occurring. The statewide visitation restriction is set to expire on June 30, but until then, visiting loved ones in nursing homes is still restricted.
“That’s a tragedy on top of a tragedy,” Pacyna, of the California Association of Health Facilities, said of visiting restrictions. “Our nursing residents depend on seeing their families and loved ones. It’s a welcome distraction.”
Pacyna’s group has started a working group to address the problems with visiting during the pandemic. Possible solutions include setting up a tent in the parking lot of a facility and instituting a protocol for outdoor visits with family members and residents at a distance of six to eight feet.
“Assuming everyone has the proper mask, gowns and gloves, we would like to see better interaction between our residents,” she said.
Many Californians who are cared for in long-term care facilities rely on visiting family members to stay physically and mentally healthy. “It’s just been a constant battle to keep up with the latest guidance while caring for residents who are very sick,” said Pacyna.The Bee’s Michael McGough contributed to this story.