Lynn Wendt was initially taken aback when, for the first time in her memory, she was asked to identify herself upon visiting her elderly parents at a senior home in Delano, Minn.
Then came a polite warning from the concierge: Because of the spread of the new coronavirus, the assisted-living facility was urging all visitors with a cough, fever or other flu-like symptoms to stay away.
"It was a relief, honestly … just knowing that people are taking this virus seriously," Wendt said.
Across Minnesota, from Rochester to Duluth, nursing homes and other facilities that care for seniors are rolling out a series of new measures to protect residents from the spread of the coronavirus and to develop contingency plans in case patients need to be quarantined. They are stockpiling masks, gowns and other emergency medical supplies; training staff on infection control, posting warning signs, and preparing for staff shortages in case workers get sick. And starting Tuesday, long-term-care facilities across the nation began taking unprecedented steps to protect their vulnerable population by screening visitors.
State health regulators are also changing their practices. Based on new guidance from the federal government, the Minnesota Department of Health is shifting its work to respond more quickly to complaints concerning infection control, focusing inspections on facilities with potential coronavirus and other respiratory illnesses. So far, agency officials have announced three presumptive cases of COVID-19, the disease caused by the virus, though no cases have been reported in Minnesota's long-term care facilities.
State and industry officials are trying to avoid the nightmare scenario still unfolding at a nursing home near Seattle, where at least 18 residents have died from the virus and scores of workers have become sick. The facility, Life Care Center of Kirkland, Wash., has struggled to get all its patients and staff tested for the virus because of a shortage of test kits.
"We are doing scenario planning over scenario planning," said Patti Cullen, president and chief executive of Care Providers of Minnesota, a long-term care industry group. "We would rather over-plan than be caught unprepared."
Federal and state guidance over how to respond to the crisis is shifting daily, sowing some confusion over how senior care facilities should respond in case a patient becomes infected. As recently as last week, officials were recommending that any resident of a long-term care facility with symptoms of COVID-19 be transferred to a hospital. Now that guidance has changed: Public health officials are telling senior care facilities to examine each case individually and to isolate residents with milder symptoms of the virus, due to concerns that moving them could spread infection.
As of Tuesday afternoon, facilities across the state were scrambling to respond to revised federal guidance around restricting visits. The federal Centers for Medicare & Medicaid Services (CMS) is now advising nursing home providers to "actively screen and restrict" visits from anyone who has signs of respiratory illness, as well as people who have had contact with those who appear sick within the past two weeks, according to new guidelines. Facilities should also discourage nonessential visits and offer alternative ways of communication (such as video chats) for family members, CMS advised.
"This is a rapidly evolving situation that is changing by the day and by the hour," said Joseph Gaugler, a professor who focuses on long-term care and aging at the University of Minnesota's School of Public Health. "Unfortunately, there does not seem to be unified guidance on how to respond."
In a sign of how urgent the crisis is, representatives of Minnesota's long-term care associations are in talks with state officials over a "disaster relief" package for senior living facilities — one normally reserved for natural disasters such as floods. The package would provide funds for upfront costs associated with hiring more staff and buying supplies, officials said.
"We are trying to be several steps ahead, anticipating when we would have to move to an even deeper level of emergency preparedness," said Gayle Kvenvold, president and CEO of LeadingAge Minnesota, a long-term care industry group.
'Have to be vigilant'
More than 80,000 Minnesotans live in nursing homes and assisted-living facilities. Their residents are considered particularly vulnerable to an outbreak. Early information from the federal Centers for Disease Control and Prevention suggests that older people and those with chronic health conditions, such as heart and lung disease, are at a higher risk of getting sick from the virus. In nursing homes, many patients have weakened immune systems and live in close proximity; in some cases, patients live two to a room, with only a curtain separating them.
Studies in the Journal of the American Medical Association looked at the initial coronavirus infections in China and found that few involved children. And while the death rate in one sample group in China was around 2.3%, the rate increased to nearly 15% for COVID-19 patients who were older than 80.
The threat of the coronavirus also comes amid a late-season surge in seasonal influenza outbreaks in long-term care facilities. The state reported 80 such outbreaks so far this winter, which is not unusual, but nearly half occurred in the last four weeks. "Influenza is extremely high right now," said Karen Martin, senior epidemiologist at the state Department of Health.
At Roseville-based Presbyterian Homes & Services, which operates 48 senior living communities in Minnesota, Wisconsin and Iowa, preventive measures began in earnest about a month ago, after news broke of infection at the nursing home in Washington state. The nonprofit has posted signs warning visitors who are sick or may have been exposed to the coronavirus to stay away, and it has developed plans for reassigning employees in case of a wider outbreak or staff shortage. The provider is also working with suppliers to ensure guaranteed delivery of protective gear, such as masks, gowns and gloves.
On Tuesday, Presbyterian Homes directed its facilities to limit visitors except in special circumstances, such as end of life or when a visitor is essential for a resident's emotional well-being and care, in response to the new guidance.
"We are going to assume that we might have a case," said Jan Koomen, vice president of clinical services at Presbyterian Homes. "We have to be vigilant."
Some facilities unprepared
Some public health experts are concerned that many smaller facilities are understaffed and unprepared. Minnesota is home to hundreds of small, mom-and-pop assisted-living facilities that are still unlicensed and rarely inspected. A law passed last spring would license these facilities and subject them to minimum standards of care, but the new protections will not begin until August 2021.
Many adult children are caring for parents who are still living at home, and a top CDC official said these informal caregivers need to be stocking up on supplies for their parents and making contingency plans if they get sick or placed under quarantine for two weeks. "You may need to identify a backup who can take care of them if you can't," said the CDC's Dr. Nancy Messonnier.
Phil Speat, who has been bedridden since he suffered a stroke two years ago, described himself as "scared, really scared" of the coronavirus. The 58-year-old lives in a small, four-bedroom assisted-living facility in a quiet neighborhood in Brooklyn Center. Speat said he has been urging caregivers at the home to wash their hands and scrub down surfaces, but he says he has seen no evidence they have changed their regular routines. His fears are heightened by the fact that he was hospitalized last summer with viral meningitis, and his immune system is now weakened, he said.
"I told them a month ago to buy hand sanitizer, and I haven't seen any," Speat said on a recent evening, as he watched news of the coronavirus outbreak on the television in his room. "The problem is, people here are already predisposed to getting sick and we're in pretty cramped quarters. It's a potential breeding ground for infections."