When COVID-19 started to sweep across this country, much of the attention focused on New York, New Jersey, the city of New Orleans and a fewer other hot spots.
But from the start of the outbreak in this country in February, when residents of the Life Care Center in suburban Seattle started to fall ill and die, it was evident that nursing home residents would be among those most vulnerable to infection by the SARS-CoV-2 virus and serious illness and death from COVID-19. By late April, news organizations had tallied 7,000 COVID-19-related deaths among nursing home residents and people connected to nursing homes. That was about 20% of the total number of COVID-19-related deaths in the country at that time. State and federal government officials have been slow to release nursing home-specific COVID-19 statistics, citing privacy and other concerns. Some critics say that reluctance has obscured the scope of the problem and delayed actions to mitigate it. CMS Administrator Seema Verma changed the reporting procedures in April so nursing home deaths would be reported directly to the CDC rather than local health officials.
The deaths in nursing homes have led to some horrifying situations, such as one in Sussex County, New Jersey, where an overwhelmed nursing home piled 17 bodies in a morgue meant for just a few. The deadliest outbreak was in the Canterbury Rehabilitation & Healthcare Center outside Richmond, Virginia, where 46 deaths had occurred by the end of April. As COVID-19 flared up in nursing home after nursing home, evidence of a history of poor infection control surfaced for some facilities. Especially damning was a report by the Washington Post that found that 40% of the 650 homes with publicly reported COVID-19 cases had been cited more than once for infection control violations.
CMS has responded in several ways. In mid-March, the agency issued a memo restricting all but a few people from visiting nursing homes and ordered the cancellation of group activities and communal dining. About a week later, the agency suspended routine inspections to focus on infection control. The agency also relaxed transfer and other rules so residents with COVID-19 could be grouped together and separated from residents without the disease. And in April, CMS increased the reimbursement rate for testing, partly to accelerate the pace of testing of nursing home patients and staff.
“People will end up blaming nursing homes and talking about how terrible we are, but it is the complete lack of prioritization that has put us in the position we are in,” tweeted Mark Parkinson, former governor of Kansas and now president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), a federation of state groups for nursing homes and assisted living facilities.
Beth Martino, a spokesperson for the organization, says nursing homes are doing everything they can with the resources they have been given to slow the spread of the virus.
“Our providers are struggling due to lack of testing, insufficient personal protective equipment (PPE) and a workforce shortage due to school closures and employee illness,” she says. “We desperately need more PPE in nursing homes, priority testing for our healthcare workers and residents, and the ability to quickly recruit and hire more staff.”
Richard Feifer, M.D., M.P.H., FACP, senior vice president and chief medical officer for Genesis HealthCare in Kennett Square, Pennsylvania, has been working nonstop with the employees across the for-profit company’s network of 381 skilled nursing and assisted living facilities. “This is a deadly, highly contagious virus with a high mortality rate in nursing homes; in fact, up to 20%,” he says. “These are frail … seniors who are the least able to withstand even common infections, let alone a virus like this. The cruel reality is that once COVID-19 enters a nursing home, its spread is incredibly challenging to prevent, no matter how many precautions and controls you have in place — and we have been very rigorous.” Genesis’ stock price at the end of April was half what it was at the beginning of March.
Feifer says the company has had to be resourceful and at times creative in determining ways to protect Genesis’ patients, residents and employees. He says nursing homes need help from federal and state health officials in three areas: prioritizing broader, faster testing; allocating PPE; and charting a sensible, collaborative approach to addressing a shortage of hospital beds without introducing the virus into the nursing homes.
“We need to make sure we are helping our elderly community, as well as the employees who are the true heroes,” says Feifer. “They are putting themselves at risk every shift they work to serve their patients and residents each and every day.”
Eric T. Mizuno, M.D., medical director at The Admiral at the Lake, a continuing care facility in Chicago, says that nursing homes aren’t equipped with the screening necessary to keep the SARS-CoV-2 virus out of their facilities. “Many of these facilities are less sophisticated than hospitals and are not used to dealing with infection control at the same level. If it gets in, it’s like setting the match to gasoline. The staff isn’t trained on how to not spread it, and there are more mortalities.”