As local nursing homes see their first COVID-19 cases, officials running them are determined not to repeat the tragic errors that inadvertently made a Washington State nursing home one of the first U.S. epicenters of the rapidly spreading disease.
As chronicled this week by the National Review, a widening spiral of infection that began in February with a few COVID-19 cases at the 120-resident Life Care Center in Kirkland, a town near Seattle, Wash., is now thought to have caused nearly half of all U.S. coronavirus deaths.
In Monroe County, coronavirus statistics as of March 25 included three deaths out of 121 confirmed cases. Those numbers are certain to grow and could increase rapidly, officials caution. The county’s total was up from the previous day by 15 new cases. It’s unknown how many undiagnosed individuals, including those not yet experiencing symptoms, might be spreading the disease.
The 121-case total includes the first nursing home cases chronicled by the Monroe County Department of Public Health. There is one case each at two of the region’s five largest skilled nursing and senior living complexes, St. Ann’s Community in Rochester and Jewish Senior Living in Brighton.
St. John’s Living, whose Highland Avenue skilled nursing facility also is among the county’s five largest, as of Tuesday had not reported any COVID-19 cases among residents and active staff. However, President and CEO Charles Runyon reported in a letter to staff and residents that a non-clinical staff member on leave had been diagnosed.
The spread of the disease from the Life Care Center in Washington occurred because the coronavirus caught staff and management of the nursing home as well as local government and public health officials unawares.
As Life Care Center residents in early February began to suffer upper respiratory symptoms, staff called in emergency medical technicians who took no special precautions, while visitors continued to come and go unchecked and some residents were moved to other facilities. By the end of February, the disease had spread to other Seattle-area nursing homes and even a North Carolina case was traced to the Life Care Center outbreak
Barely a month later, as COVID-19 spreads here, says Marie Aydelotte M.D., Jewish Senior Life medical director, in addition to coordinating daily with local public health officials, other area health system and skilled nursing facility colleagues, “we’re learning from the experience of colleagues around the country including Washington State.”
“So far we’re following all the guidelines,” Jewish Senior Life CEO Michael King says.
Restrictions in place
The nursing home coronavirus guidelines laid down by Gov. Andrew Cuomo and state Department of Health officials are exhaustive and specific. They include enforcing social distancing, restricting outside visitors and screening of personnel.
On balance the guidelines are helpful, St. Ann’s president Mike McCrae says. But the flow of information has not always been smooth.
“We’re getting new or revised information all of the time—it seemed like every 15 minutes when the state’s restrictions were first announced,” he says. “I’d like to say that they were all consistent with one another, but that would be too much to expect in such an unprecedented environment. We are grateful for the help, but that’s been a challenge.”
St. John’s CEO Runyon wrote in a recent update: “We are following the guidelines of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health to ensure that this continues. All staff members are required to wear masks when within 6 feet of any resident to ensure the safety of both the resident and staff person interacting. For further protection, social distancing is also being practiced within normal work operations when possible.”
St. Ann’s skilled nursing facility is allowing “no visitors, except when our residents are near the end of life such as those in our hospice, the Leo Center for Caring,” McRae says. “That’s hard on residents and puts a special burden on our nursing staff. I’ve been pleased and grateful for the level of cooperation and understanding we’ve experienced with residents and families.”
St. John’s and Jewish Senior Life’s policies mirror those at St. Ann’s. The three organizations include independent and assisted living units as well as multibed skilled nursing facilities. Visitation and social-distancing restrictions are being extended to those facilities as well, officials say.
“(We) continue to enforce the restricted visitation policy that we have been mandated to follow at St. John’s Home, Penfield Green House Homes, and the Hawthorne at St. John’s Meadows, which is our enhanced assisted living community,” Runyon reported in a March 23 update to residents and their family members.
For nursing home residents and residents of lower-level senior housing, including independent assisted living apartment dwellers, the restrictions mean major disruptions of routines.
Residents of Jewish Senior Life’s 350-bed skilled nursing facility must for the foreseeable future abstain from socializing at meal time and can no longer “gather in groups to kibitz,” says King. “It’s hard on them.”
Visitation restrictions are likewise hard on residents’ family members, he adds. Visitors often are children of the Jewish Senior Life’s octogenarian and older residents are themselves in their 50s, 60s or 70s, and are like their parents among those most at risk of suffering serious or fatal consequences from a bout of COVID-19, King notes.
Luckily, says King, as part of a more than $80 million upgrade, Jewish Senior Life has made Wi-Fi available in all its facilities. Residents and families are encouraged to Skype, FaceTime and otherwise connect electronically.
Nursing home restrictions and newly adopted protocols are being adopted toward the same end as the shutdown of non-essential businesses, social distancing and other lockdown steps Cuomo is urging all of us to take—slowing the spread of COVID-19 until the under-prepared public health apparatus can catch up to a pandemic that is now threatening to outdistance our capacity to contain it. Keeping the inevitable spread of the virus to manageable levels until we have better tools to combat it is what public health officials are calling flattening the curve.
“At this stage in the spread of the virus, social distancing is a critically important action that we can all take in order to flatten the curve,” Monroe County Executive Adam Bello urged in a March 24 briefing. “By flattening the curve, we can collectively lessen the impact on our health care providers and ensure that they have the capacity to deal with those individuals most in need of care.”
Dealing with capacity
While area nursing home administrators are confident that steps they are currently taking are sufficient for the moment, whether the virus’s spread will outpace our capacity to deal with it is among their top worries.
“Like other health care facilities, we’re worried that we’ll be short of critical supplies, particularly masks. Without personal protective equipment we’ll be putting our staff at risk—and our patient care staff is everything to us,” McCrae says.
Residents may need to be moved to area hospitals for coronavirus or other needs, Jewish Senior Life’s Aydelotte says. Will already crowded area hospitals be too overburdened to accommodate them?
The two health systems that between them deliver almost all of the Rochester region’s hospitals and other health care, UR Medicine and Rochester Regional Health, are asking state officials to approve a plan to boost local hospital bed capacity by 50 percent, partly by adapting non-hospital settings to health care use, Bello announced at the March 24 briefing. How soon such additional capacity might come on line is not now clear.
And finally, say officials, for area nursing homes, financial viability will be a concern.
Cuomo has warned that the state’s budget is groaning under the weight of coronavirus expenditures. Recently, federal officials declined to extend a multibillion-dollar Medicaid waiver that New York has been using to make its more than $140 billion Medicaid program more efficient. To help fill a $1 billion hole in the state’s 2020-21 budget, Cuomo is asking the Legislature to approve a 1 percent cut in Medicaid funding. What this might mean for Medicaid payments, which account for a substantial slice of nursing home revenues, is not entirely clear, but indications are far from positive,
Says McCrae: “The (extra) cost of responding to the virus—which we’re expecting to be millions of dollars for every quarter this continues—is on top of lost reimbursement we’d already factored into our budget.”
Future Medicaid cutbacks could indeed be a problem, but in the meantime, says King, Jewish Senior Life is already seeing substantial revenue loss from services it is having to shelve until the virus is controlled.
Will Astor is Rochester Beacon senior writer. Kent Gardner is opinion editor.