When COVID-19 made landfall on the West Coast earlier this year, it hit a Seattle-area nursing home with hurricane force. The new strain of coronavirus sickened 129 people linked to the home — residents, staff and visitors — and killed 40.
As this viral storm continues to spread across the U.S., long-term care centers have proved especially vulnerable due to residents’ age, poor health and proximity to other residents and caregivers. It’s a grim reality that is rarely reflected during presidential press briefings and requires additional focus at the state level. One suggestion: Minnesota Gov. Tim Walz should dedicate a briefing to laying out a comprehensive battle plan to combat COVID-19 in elder care centers. Specifically, what lessons have been learned so far, and what improvements are needed?
While just 23 states make COVID-19 data from these facilities publicly available — a shocking disclosure gap — there have been more than 10,000 reported deaths in their long-term care facilities, including residents and staff, according to the Kaiser Family Foundation. That averages out to 27% of COVID-19 deaths reported by these states.
Minnesota, to its credit, provides an updated list of long-term care centers with at least one COVID-19 case among residents or staff. It also typically provides a daily update of deaths linked to the facilities. As of Friday, 75% of the state’s 221 deaths were long-term care residents.
Comparisons to other states are difficult due to the lack of data, differences in testing, wider spread of infection in the community and the varying definitions of care facilities, so it’s hard to say if care centers are harder hit here. “I think Minnesota is in the same boat as other states,” Joseph Gaugler, a professor of long-term care and aging in the University of Minnesota’s School of Public Health, told an editorial writer.
Still, the situation here is alarming. In the past week, the Star Tribune reported one of the state’s deadliest outbreaks at St. Therese of New Hope. Two other care centers have had dire staffing shortages from staff who are sick or not coming to work out of fear of infection. One evacuated its residents to other locations. The second required community reinforcements.
The U.S. Centers for Disease Control and Prevention is offering a tailored review of states’ COVID-19 responses in long-term care centers. Minnesota accepted, but it’s uncertain when the report will be released. In the meantime, there are clear improvements to be made:
• Ensure a staffing crisis plan is in place. Elder care facilities can sometimes be at the periphery during disaster preparedness. Plans that have been made may also assume a tornado-type situation instead of an ongoing event, meaning there may not be a strategy for a rolling staffing crisis. Assumptions might also have been made that the National Guard will do direct care when its assistance is typically more logistical. Emergency preparedness officials should proactively reach out to local care centers to update or put a plan in place before a staffing crisis hits.
• Boost personal protective equipment (PPE). Long-term care staff are on the front lines without adequate supplies of gear to prevent COVID-19’s spread. Some nursing homes lacking disposable gowns are adapting by sewing sleeves onto cloth patient gowns and using those. State and federal strategies are needed immediately to help centers acquire more PPE.
• Continue to prioritize testing. Minnesota is ramping up COVID-19 testing. As it does so, senior care residents and workers must be at the head of the line because of this setting’s unique vulnerabilities.
• Bolster state health department’s infection control ranks. State officials are already working with elder care centers to contain COVID-19. A temporary funding boost would add specialists and expertise to guide long-term care centers struggling with infection control.
• Ask if you can help with staffing. University of Minnesota expert Michael Osterholm has called for deploying furloughed health care staffers to elder care settings. While these workers may be recalled as elective surgeries return, the underlying idea is worthy. Minnesota is among the states setting up a medical reserve corps to recruit retired health care workers and students. More information is at MNResponds.org. LeadingAge Minnesota, the nursing home trade group, is seeking those without a medical background for a temporary training program to become “Basic Care Aides.” Those interested in learning more can e-mail Jenna Kellerman at jkellerman@LeadingAgeMN.org.
Many of the state’s nursing homes are making sensible changes such as dedicating wings or even separate buildings for COVID-19 care. Some centers with multiple locations have also limited staff from moving among sites. Another idea implemented elsewhere: having staff stay on site for extended periods to avoid being infected in the community.
It’s also critical to underscore the public’s ongoing role in infection control. COVID-19 doesn’t just appear in long-term care settings. Its presence reflects the disease’s circulation in the community. The push to “reopen” the state must take this into account and not undermine the already difficult battle to protect seniors and those who care for them.