For the past three months, the administration of Gov. Tim Walz has made COVID-19 testing a primary tool in its battle to contain the rapid spread of the novel coronavirus in senior living communities.
But despite urging widespread testing of residents and staff, the Minnesota Department of Health has sent dozens of its inspectors inside nursing homes and assisted-living facilities without first checking them for the deadly virus.
In interviews with the Star Tribune, two state health inspectors said they sometimes visit several senior care facilities a week with COVID-19 outbreaks and are exposed to the contagion on an almost daily basis. In some cases, they spend up to eight hours a day inside to ensure residents and staff are complying with rules on infection control and quality of care, said the inspectors, who spoke on the condition of anonymity.
Yet Minnesota is among a number of states that do not require long-term care inspectors to be tested, despite growing concerns that people who are not showing signs of the illness could unknowingly spread the virus. State Health Department officials said they recommend that staff get tested if they think they have been exposed, but the agency does not routinely or preemptively test inspectors for the virus.
In response to questions from the Star Tribune, Health Commissioner Jan Malcolm said Wednesday that the agency has recently discussed the issue and intends to start testing staff who visit long-term care facilities. The agency is still trying to determine when and how often such testing would occur, she added.
“We do think that testing of our staff would be consistent with the recommendations that we are making for others,” Malcolm said.
State Health Department officials also noted that inspectors do most of their surveying remotely via video conference. When they do go inside facilities, they are screened like any other employee or visitor and wear protective gear, including masks, eye protection and gowns. The department has not had any cases of COVID-19 among the 70-plus regulatory staff who do surveys and investigations inside long-term care facilities, said spokesman Doug Schultz.
“Our investigations show the greatest risk for introducing COVID into a facility is from workers who are infected via community transmission,” Schultz said.
But some elder care advocates, lawmakers and public health experts said they are alarmed by the lack of systematic testing of the inspectors, particularly amid a troubling resurgence of COVID-19 cases in senior homes.
Despite some easing of restrictions this summer, many aging residents of long-term care facilities have not had face-to-face contact with their children and other loved ones since the pandemic began nearly six months ago. Many have died without relatives by their side.
“It’s hard to justify,” Tamara Konetzka, a professor of health services research at the University of Chicago, said of the lack of testing. “If we are cautious enough to continue limiting inside visits of family members, with known devastating costs to physical and emotional well-being of residents, what can explain the lack of caution with respect to surveyors being tested?”
Sen. Karin Housley, R-St. Mary’s Point, and chairwoman of the Senate Family Care and Aging Committee, said the absence of routine testing of inspectors poses needless health risks to long-term care residents and staff. It also undermines efforts by the state to hold facilities accountable for infection-control lapses when the Health Department does not appear to be holding itself to the highest safety standards, she said.
“The guidelines to keep our seniors safe should apply to everyone, including government employees,” Housley said.
Limitations of testing
Even as they have encouraged more coronavirus testing, state health officials have repeatedly warned of the limits of such tests. They are an important tool in identifying and isolating those who are infected, but they should be done in conjunction with more preventive measures, such as wearing masks, physical distancing, hand washing and not allowing people with symptoms to go to work.
“We are not going to be able to test our way out of this pandemic,” said Dr. Ruth Lynfield, state epidemiologist and medical director at the Department of Health.
Still, in early May, Walz made expanded testing of residents and staff a key part of a five-point “battle plan” to address the mounting death toll from COVID-19 in long-term care facilities. The Health Department even deployed the Minnesota National Guard to help with testing. Since then, the agency and the Guard have helped 85,000 staff and residents be tested for the virus at nearly 500 long-term care facilities statewide.
The deployment of the National Guard enabled many facilities to test everyone who lived and worked in their communities for the first time, as opposed to the sporadic testing that occurred during the early weeks of the pandemic.
But the weekly count of coronavirus cases in long-term care facilities has increased dramatically since early July, which has state health officials and others concerned that more deaths are likely to follow. So far, 75% of the 1,738 people who have died from COVID-19 in Minnesota were residents in long-term care facilities. About 250 nursing homes and assisted-living facilities statewide have active outbreaks of COVID-19.
Despite a resurgence of the virus, both in Minnesota and nationally, more than half of all states do not require their inspectors to be tested for COVID-19 before going inside nursing homes, according to a recent analysis by the Wall Street Journal.
Kristine Sundberg, executive director of Elder Voice Family Advocates, said it’s “totally illogical” to allow inspectors to move freely between senior living communities without testing while many family members are still being barred entry.
“The department’s infection control professionals constantly preach that testing is a high priority and is fundamental to slowing the spread of COVID-19,” she said. “Why aren’t they listening to their own experts and adopting best practices, which includes routine testing?”
The Minnesota Department of Health has 64 staff members available to make onsite visits to federally regulated health providers, including nursing homes. Another dozen staffers make onsite visits to investigate allegations of maltreatment. Currently, the agency does not have a testing regime in place for these inspectors.
In an interview, a state health inspector said she visits up to four long-term facilities a week but is never told whether they have outbreaks of COVID-19. As a result, she has to look up the information on her own. In many cases, the inspector said she will spend several hours inside a facility with cases of the coronavirus but never be tested.
“I feel like the state should lead by example and we’re not,” said the inspector, who declined to be identified for fear of retaliation.
Joseph Gaugler, a professor who focuses on long-term care and aging at the University of Minnesota’s School of Public Health, said the absence of routine testing for inspectors is surprising given the mounting evidence that outsiders are bringing the virus into facilities. The prevalence of COVID-19 in the community around a senior home is the strongest predictor of whether it will have an outbreak, according to a recent study
“If anyone should be tested, it should probably be [the inspectors],” Gaugler said.