Coronavirus creates emergency in nursing homes

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By Jessie Hellmann, The Hill 04/01/2020

 Coronavirus creates emergency in nursing homes
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Nursing homes and long-term care facilities across the U.S. are facing a crisis as hundreds of elderly residents test positive for COVID-19, a disease found to be particularly lethal to older adults.

The disease caused by the new coronavirus is spreading like wildfire at hundreds of elder care facilities, which are already at high risk for disease outbreaks because of close quarters, understaffing, lack of supplies and lax government oversight.

Advocates argue that while federal and state governments should be doing more to stop the spread of COVID-19 in nursing homes, officials are instead relaxing regulations intended to keep residents safe and are not being transparent about where outbreaks are occurring.

“Once you get the virus in a nursing home, it could be a death sentence,” said Charlene Harrington, a registered nurse and a professor at the University of California San Francisco who studies nursing homes.

“It’s really an emergency situation, but I don’t see them treating it that way,” Harrington said of the federal government.

About 1.5 million people live in 15,000 nursing homes throughout the U.S. according to the Centers for Disease Control and Prevention (CDC). Nursing homes have long faced issues with controlling the spread of infectious diseases and viruses, and that weakness has been exacerbated by the coronavirus pandemic.

A CDC spokesperson said the agency is aware of cases at more than 400 long-term care facilities as of Tuesday. Last week, it said it knew of cases at 147 of those facilities, highlighting the speed at which the virus is hitting nursing homes.

But it is not known how many nursing home residents have COVID-19, or have died from it, because the federal government hasn’t released that information to the public.  

The CDC spokesperson did not respond to questions about how many total cases there are at those 400 facilities and how many resulted in death. The spokesperson also said the agency doesn’t receive the names of the facilities caring for residents with COVID-19.

However, local media reports from around the country, and some information released by state governments, show the problem is widespread.

Former CDC Director Tom Frieden called nursing homes “ground zero” for COVID-19, noting that the first outbreak in the U.S. occurred at a center in Kirkland, Wash.  

“The experience from Kirkland, Washington was a warning. It’s what we call a sentinel event, it is a sentinel for what was inevitably going to happen,” Frieden said.

A spokesperson with the New York State Department of Health told The Hill that as of Tuesday, 1,456 cases of COVID-19, including 278 deaths, have been confirmed at 188 nursing homes in the state. In Florida, at least 66 cases have been confirmed in long-term care facilities; 47 cases have been confirmed at nursing homes in Arkansas, while Pennslyvania has reported 132 cases in 167 nursing homes. 

Information released by other state governments about outbreaks in nursing homes varies and is in some cases sparse.

New Jersey Department of Health Commissioner Judith Persichilli said this week 81 of the 375 long-term care facilities in the state have reported at least one confirmed case of COVID-19. But the department didn’t respond to questions about how many cases that amounted to.

A spokesperson with the California Department of Public Health did not provide the number of cases at nursing homes in the state because it doesn’t break down data by facility type.

With the dearth of information from governments, families have been left to scour local media reports, press releases and statements from nursing homes to figure out whether their relatives are staying at a facility experiencing an outbreak. Some states have not named the facilities affected by the outbreaks, leaving families and residents in the dark, advocates say. 

“It’s very cruel to leave nursing home residents to worry about whether they’re being exposed to a deadly disease that might infect them,” said Michael Connors, an advocate with California Advocates for Nursing Home Reform.

Connors said his organization has been flooded with calls from families and residents desperate for information and advice.

Controlling the spread of infectious diseases has long been a problem at nursing homes.

Advocates say a combination of factors has created a perfect storm for outbreaks of COVID-19 at these facilities. About 75 percent of nursing homes are understaffed, forcing employees to juggle multiple patients and making it harder to follow proper infection control protocol.

“The infection control deficiencies are the most common problem in nursing homes, and now we see what happens when you don’t wash your hands and there’s a virus out in the world,” said Toby Edelman, senior policy attorney with the Center for Medicare Advocacy.

Staff are often underpaid and don’t get paid sick leave, which forces them to come to work sick, Harrington said.

In the battle against the COVID-19 outbreak, many nursing homes have been left without armor,  lacking in personal protective equipment, like gloves and masks, which protects employees from getting sick and from spreading viruses to patients.

Nursing homes have also complained that they don’t have enough test kits for employees or staff. The Centers for Medicare and Medicaid Services (CMS) and state governments are recommending nursing home employees have their temperatures checked before coming to work. But data has emerged showing that some people who have the virus may not show symptoms.

CMS has also recommended facilities stop allowing in visitors, including family members, to limit the introduction of the virus to nursing homes. CMS also said it would focus its required nursing home inspections on infection control to ensure guidelines are being followed by employees.

However, in the few weeks since CMS released that guidance, more nursing homes have reported infections, indicating that the problem might be beyond control as the coronavirus rages across the nation.

Seventy-seven residents have tested positive for the virus at Pleasant View Nursing Home in Maryland. At Cedar Mountain Post Acute Rehabilitation Center in California, 51 residents have tested positive. Arkansas has reported 47 cases of COVID-19 in its nursing homes. And at Gallatin Center for Rehabilitation and Healing in Tennessee, at least74 residents have tested positive.  

In Virginia, 44 cases at one long-term care facility make up 33 percent of the state’s total number of confirmed cases.

Advocates say the government is also relaxing regulations that are intended to keep residents safe. In California, the state public health department waived minimum staffing requirements at nursing homes.

CMS also released guidance stating that nursing homes can’t refuse readmission to residents solely because they have tested positive for COVID-19, which advocates worry could introduce the virus to people who don’t have it. California, New York and other states are following that guidance.

“We just think that’s extraordinarily ill-advised,” Connors said.

“It’s like California has declared war on nursing home residents. The state knows that forcing nursing homes to admit COVID-19 patients will cause deadly outbreaks, and will kill residents, but is doing it anyway.”