In a pandemic that has become a daily deluge of numbers — new cases, new deaths, testing positivity rates — an important Dec. 13 Star Tribune story about COVID-19's rampage through a Twin Cities senior center brought back into focus the lives lost to the pandemic.
Leonard "Smokey" Novak, a 91-year-old who loved hamming it up as bingo night's emcee. Joan Wittman, 88, who kept a well-worn Bible at her bedside. David McCawley, 81, a former postal worker who celebrated Halloween in a big way. And Polly Van Waes, 89, who once picked cotton to pay for her education.
All were residents of North Ridge Health and Rehab. Their lives had dimension and depth but were tragically cut short when the state's deadliest outbreak occurred there last spring. By late June, according to reporters Chris Serres and Glenn Howatt, at least 73 residents had died.
These losses should be mourned, not just callously written off, as some COVID skeptics continue to do, because those who died were older. The outbreak also needs to spur action at both the state and federal levels to fortify the system to which families entrust their elders.
Tragically, the outbreak at North Ridge isn't an outlier. Instead, it's part of a heartbreaking national pattern, with large lethal outbreaks occurring in senior facilities elsewhere. Minnesota is one of 18 states where long-term care residents account for least 50% of all deaths from COVID-19, a recent Kaiser Family Foundation report concluded. In three states, that percentage tops 70% — New Hampshire, Rhode Island and Connecticut.
While the elderly are at much higher risk of severe COVID, the pandemic has still laid bare long-standing weaknesses in long-term care. Staffing, low pay and turnover were problems long before the pandemic, leaving little flexibility when workers were sidelined this year due to illness or quarantine.
Regulators are also spread thin and have struggled to keep pace with evolving senior care options. For example, Minnesota didn't pass its assisted living licensure law until 2019.
The Star Tribune story highlighted another senior care trend: for-profit chains acquiring care centers. Florida-based Mission Health Communities bought North Ridge in 2014. An eye-catching chart that ran with the article showed that the Minnesota facility's health and safety violations increased as per-resident income rose. How can regulators better address this?
The COVID outbreaks have revealed even broader problems. Emergency preparedness planning fell short when it came to long-term care, a problem state Health Commissioner Jan Malcolm has acknowledged. The slow development of a COVID test and shortages of personal protective gear also revealed a health care pecking order that gave hospitals priority. A look at whether this could have been better calibrated is in order.
None of these have easy solutions. It will take time after the pandemic subsides to identify smart fixes and funding for them. The challenge is not to let urgency fade. The retrospective analysis should include what went right. One of the highlights is a practical new state program that provides emergency staffing to care facilities in crisis. The collaboration between North Ridge and the state's hardworking public health teams merits a look as well.
After a disastrous spring at North Ridge, improvements brought COVID under control. "Since the first week of June, there have been 4 facility-onset cases in residents," state health officials said Thursday. "Since the second week in June, there have been 3 deaths in facility-onset cases in residents. Of note, those 3 individuals first tested positive in April and May."
The improvements are significant, because North Ridge was continuing during this time to take in COVID patients discharged from hospitals. The numbers suggest strong infection control procedures were put in place. It also addresses lingering concerns that discharged patients brought the virus into North Ridge and caused outbreaks at it or other care facilities. (Worth noting: Discharged patients are typically beyond or at the end of their infectious period.)
The work to strengthen long-term care is urgent. That's why it defies logic that the Republican-controlled Minnesota Senate blocked the inclusion of $6.4 million in funding for long-term care infection control and staffing in the state COVID relief bill that passed Monday. A fix will likely come during the regular session, but there's no good reason for a delay.