By Brenda Gazzar, Los Angeles Daily News, July 16 2020
Long-term care homes are sounding the alarm of a potential new wave of COVID-19 outbreaks in light of major spikes in overall cases in California and other states.
The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) warned Gov. Gavin Newsom and other governors this week that “urgent attention” was needed to prevent further outbreaks in skilled nursing and assisted living facilities.
They called on states to help expedite lab-test processing times as well as on-site testing, to secure more N-95 masks and gowns and to coordinate closely with long-term care providers in reopening facilities to visitors.
About 40 percent of the state’s more than 7,080 COVID-19 related deaths have been from nursing home residents, according to state data. As of Tuesday, hard-hit Los Angeles County — which makes up about a quarter of the state’s population — claimed about 60 percent of the state’s 2,804 nursing home resident deaths.
“Given the fact that the level of COVID in the community surrounding a nursing home is a leading indicator of cases in the facility, the major spikes of COVID cases in many states comes at a very challenging time as many states plan the reopening of long-term care facilities and return of visitations from loved ones,” the letter to the National Governors Association (NGA) and state governors said.
A recent ACHA/NCAL survey of nursing home and assisted-living facilities found that 87 percent said getting test results from lab companies is taking two days or longer, while almost a quarter said it was taking five days or more, according to the organizations.
California Health and Human Services Secretary Dr. Mark Ghaly on Tuesday announced new plans for COVID-19 testing in the state, including updated testing guidance. With increased testing there’s been growing delays in processing times, he said in a statement.
The updated guidance prioritizes those who have COVID-19 symptoms and people without symptoms who fall into high-risk categories, including people who live and work in nursing homes, homeless shelters and prisons, healthcare workers and patients in hospitals, according to the agency. In addition, two new co-chairs will now lead California’s Testing Task Force, a private-public partnership that has taken the lead in expanding the collection and processing of COVID-19 specimen testing.
Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine and medical director of Eisenberg Village – a skilled-nursing and assisted living facility in Reseda — said getting test results can take 48 hours or even a week.
“Nursing homes are often being required to test once a week but they don’t even have the results back from the previous week — that’s ludicrous,” Wasserman said.
The AHCA/NCAL letter also noted that nearly one out of five nursing homes report to the Centers for Disease Control and Prevention that they either do not have or have less than a week’s supply of personal protective equipment. Meanwhile, more than half of assisted living centers have less than a two-week supply of N-95 masks and gowns.
“Given the fact we are several months into the response of this pandemic and the lack of PPE supplies is still an issue is very concerning,” the letter said.
The California Department of Public Health, which oversees most skilled nursing facilities in the state, said in an email Wednesday that facilities can notify them during a daily survey process of any needs they may be experiencing, including in possible personal protective equipment shortages.
“We work with any of these facilities daily to assist in providing the PPE that is needed in an expedited manner,” the statement said. “Additionally, these requests are relayed to the Medical and Health Operational Area Coordinator system, that assists these facilities in securing PPE.”
Hundreds of millions of masks are being distributed as the state builds up its stock of personal protective equipment, Newsom said at a news conference on Monday.
The California Department of Public Health said protecting the health and safety of “some of our most vulnerable populations” remains its “top priority.”
The department noted it instituted a requirement for nursing homes to develop a COVID-19 mitigation plan with six elements on testing and infection control. It also said it remains ready to deploy strike teams of healthcare infection prevention experts to work in partnership with local health departments and other partners to help facilities with outbreaks.
Wasserman said that both widespread testing in local nursing homes and assisted living facilities as well as abundant personal protective equipment have been needed as early as March. He also argued that large nursing home chains could have found the money to help provide both testing and equipment.
“I agree that the government has a responsibility to step in and help but I believe it needs to be a partnership between the government and the industry,” Wasserman said. He argued that the nursing home industry was more concerned about liability protections amid the pandemic than protecting nursing home residents.
AHCA and NCAL said in a joint response that they’ve appeared on multiple national television outlets starting in March to call for help. They said they’ve also released a number of media statements calling on public health officials “at every level to help with PPE, testing and staffing at least since early March.”
“The reality is that long-term care providers are facing an unprecedented situation that has left them begging for resources to battle this virus,” the statement read in part. “Just like hospitals, we called for help. In our case, it was difficult to get anyone to listen for months, leaving devastating consequences for our residents and staff. ”
That sentiment was echoed by the California Association of Health Facilities, which said in a statement that while their partnerships with county and state regulators are “stronger than ever” due to the pandemic, “we can’t make progress against the virus without proper equipment and COVID-19 tests that do not deliver rapid results. We continue to be impacted by supply chain issues and testing result delays.
Some nursing homes, however, have taken matters into their own hands.
When the not-for-profit Motion Picture and Television Fund’s congregate living facility in Woodland Hills needed rapid COVID-19 testing, administrator Bob Beitcher bought a point-of-care Biomeme system in April for roughly $11,000. It allows scores of COVID-19 tests to be conducted in a day while getting results in less than two hours.
Beitcher, the president and CEO of the Motion Picture and Television Fund, has described it as “a lifesaver for us in the entire testing protocol.”
Beitcher has also said that they’ve also scrambled to get adequate personal protective equipment, paying up to 10 or 12 times more than what they normally would pay due to shortages.
Tuesday’s letter to the governors also requested that state public health agencies work in close coordination with providers to ensure every facility has adequate PPE supplies, testing and staffing in place to safely reopen.
They applauded strategies such as ensuring long-term care facilities have adequate personal protective equipment for staff, residents and visitors and ensuring screening and monitoring of residents, staff and visitors with temperature checks, symptom screening and access to handwashing stations or hand sanitizer when entering and exiting the building.
They also favor limiting the number of family members per visit, scheduling visits in advance and engaging residents in outdoor activities when possible while remaining at least six feet apart.
California issued guidance last month for visits to resume in nursing homes, but few are reportedly happening as coronavirus cases have surged in recent weeks.
While there’s a need to be deliberate and careful about how nursing homes are reopened, “we need to reopen them for visitors,” said Tony Chicotel, a staff attorney at California Advocates for Nursing Home Reform. “The time has passed for that.”
“The safest way to have visitation is outdoors, socially distanced with masks and that ought to be required in all 50 states,” Chicotel said.
In mid-June, Barbara Ferrer, Los Angeles County’s public health director, announced that friends and family could visit their loved ones in nursing homes under certain restrictions and only if 28 days have passed since any coronavirus cases were detected at a facility.
Randy Odette, whose mother has been at the Astoria Nursing & Rehabilitation Center in Los Angeles’ Sylmar community since late January, has been frustrated that she hasn’t been able to see her 96-year-old mother with late-stage Alzheimer’s in-person in recent months.
Odette, who was previously her mother’s caretaker for over a decade, said she was told in May or June that her mother had tested positive for COVID-19 but that she didn’t appear to have any symptoms besides a dry cough. More than 80 residents and nearly 60 staff members from Astoria tested positive and 23 people have died of COVID-19, according to county data.
Odette said that she was able to see her mother through a glass door a couple of weeks ago. However, she longs to see her without “a glare” and to be able to hear her voice and be heard.
“When my mom passes, she’s going to go to sleep and she’s going to pass,” she said. “I want to see her in person because this is my mom. It’s just very important I see her.”
It was not immediately clear when someone at Astoria had last tested positive. The administrator could not immediately be reached for comment Wednesday.
Ferrer and other health officials throughout Southern California have said the situation of COVID-19 has improved in nursing homes in recent weeks largely due to widespread testing and masking.
“We’ve experienced so much loss at our skilled nursing facilities because of this virus … but I do want to note that the 7-day rolling average of daily COVID-19 deaths is going down,” Ferrer told reporters Monday.
The decline in overall COVID-19 deaths the county has seen is a reflection of the decline of such deaths at these nursing homes, she said. Meanwhile, overall coronavirus cases and hospitalizations are still on the rise.
“It also doesn’t mean we’re out of the woods because COVID-19 is a deadly virus and …. deaths are a lagging indicator and unfortunately, we’re likely to see increases in deaths in the weeks ahead,” Ferrer said.