Five months after the coronavirus outbreak engulfed Minnesota's senior homes, state health regulators have begun testing nursing home and assisted-living inspectors for the deadly virus.
The Minnesota Department of Health ordered the testing last week after the Star Tribune reported that, since the beginning of the pandemic, the agency had been sending dozens of inspectors into nursing homes and assisted-living centers without first checking them for the virus.
The lack of routine testing of state inspectors, also known as surveyors, had alarmed some public health experts and elder care advocates, who have been troubled by a resurgence of the virus. In interviews, inspectors said the Health Department was sending them into facilities, including some with coronavirus outbreaks, without testing them to make sure they were not spreading the virus. Two inspectors, who asked not to be identified, said they were exposed to the virus on a near-daily basis and would spend several hours a day inside facilities with known outbreaks.
In a written statement, the Health Department confirmed it has begun testing of staff who inspect long-term care facilities, though the agency declined to disclose how many inspectors were being tested and how often, citing data privacy laws. The agency also declined to disclose whether any inspectors have tested positive for the virus.
"We want to note that we are doing this in order to reinforce best practices and to be extremely cautious due to concerns about community spread and asymptomatic transition," the agency said in the statement. "Implementation was not started in response to any cases traced back to our on-site surveyors."
In early May, Gov. Tim Walz made expanded testing of residents and staff a key part of a five-point "battle plan" to address the mounting death toll of COVID-19 in long-term care facilities. The Health Department even deployed the Minnesota National Guard to help with testing. The state's efforts 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.
Yet this aggressive expansion of testing did not extend to the state's own inspection staff. As of two weeks ago, the Health Department still did not have a system in place for routine COVID-19 testing of its 70-plus regulatory staff who do surveys and investigations inside long-term care facilities. The agency did require testing for inspectors with symptoms of the virus, and it required them to be screened and wear personal protective equipment when entering facilities.
Since late March, nursing homes and assisted-living facilities across the state have barred family members from indoor visits with residents to prevent the spread of the virus. The Health Department began easing guidelines for visitor restrictions in June, but many senior homes have maintained the lockdown because of a resurgence of the virus and a high rate of cases in their local communities. As a result, residents have suffered prolonged periods of social isolation and depression, and some have died without their relatives by their side.
State Sen. Karin Housley, R-St. Mary's Point and chairwoman of the Senate Family Care and Aging Committee, questioned why families were subject to such strict infection-control measures while state inspectors were allowed to go from one facility to the next without being tested.
"I find it appalling that while a possibly infected inspector could go into a nursing home, a family member at the same time is forbidden to see their loved one living in the home," Housley said Friday. "It absolutely made no sense."
Minnesota was not alone, however. Despite a resurgence of the virus, 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 report last month in the Wall Street Journal.
Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota's School of Nursing, said the lack of testing of inspectors is "especially disturbing" given that researchers and state health officials have known for months that a high percentage of people with the virus do not show symptoms. "The need to routinely test surveyors should be considered a basic public health preventive measure that is urgent and long overdue," he said.
The respiratory illness caused by the coronavirus is known to be especially lethal to older adults and those living in nursing homes and assisted-living facilities, where people live in close quarters and workers move from room to room.
In Minnesota, as in much of the country, long-term care facilities remain the epicenter of the pandemic. About a third of Minnesota's 370 nursing homes have active outbreaks of the virus, defined as a COVID-19 case within the past 28 days. Some 11% of assisted-living facilities also have active outbreaks, the Health Department reported this week. As of Friday, 73% of the 1,847 deaths from the coronavirus have been residents of long-term care facilities.
State health officials have repeatedly warned of the limits of testing, noting that it should be done in conjunction with more preventive measures, such as wearing masks, physical distancing and regular hand-washing.