Long-term care again in spotlight amid new COVID wave

DOWNSTATE — Amid warning of another nationwide spike and call for additional congressional funding, COVID-19’s resurgence has sparked increased awareness in Delaware following outbreaks in three long-term care centers last month and a fourth this past week.

Those sites, three in Wilmington and one in Greenwood, saw a few additional positive cases of COVID among staff members in the last week, the state said Friday.

It also announced that two more residents of long-term care centers in Delaware had died from the virus.

As of Thursday, Delaware’s Division of Public Health recorded the following positive cases:

• Kentmere Rehabilitation and Health Care Center in Wilmington; 54 residents and 42 staff members;

• Cadia Healthcare Silverside in Wilmington; 44 residents and 32 staff members;

• Country Rest Home in Greenwood; 31 residents and 18 staff members;

• Newly added: Regency Healthcare and Rehabilitation Center in Wilmington; 38 residents and 15 staff.

Delaware Department of Health & Social Services Secretary Molly Magarik announced the three long-term care center outbreaks in late September. DHSS notes that “staff members” may include health care and non-health care personnel, such as facility vendors or other individuals working in the long-term care facility who may not be full-time facility employees.

As for long-term care deaths, through 6 p.m. Thursday, DHSS reported 395 residents of LTC facilities have died from complications related to COVID-19. Harrison House Senior Living in Georgetown has had 41 COVID-related deaths followed by Milford Center/Genesis Healthcare (36) and Brandywine Nursing and Rehabilitation Center, Wilmington (34), according to DHSS.

Meanwhile, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 nursing homes and assisted living communities across the country that provide care to approximately 5 million people each year, released a report Oct. 19 showing nursing homes in the U.S. could see a third spike of increasing new COVID cases due to the community spread among the general population.

According to AHCA/NCAL, recent data released by John Hopkins and the Centers for Medicare & Medicaid Services (CMS) show that with the recent spike in new COVID cases in the general U.S. population, weekly nursing home cases rose in late September for the first time in seven weeks after new cases dropped significantly throughout August and early September.

The report also showed COVID-related deaths in nursing homes had declined significantly, but industry leaders remain concerned about the recent uptick in new COVID cases in facilities, the AHCA/NCAL reported.

Mark Parkinson, president and CEO of AHCA/NCAL, said with new COVID cases now rising in the general population of 38 states, Congress needs to end its partisan logjam and prioritize frontline health care workers and residents, particularly vulnerable elderly populations.

Most of the $175 billion Provider Relief Fund provided by the CARES Act back in April has already been distributed and Parkinson said health care providers, including long-term care facilities, will need additional funds to continue their response to the COVID pandemic heading into the cold and flu season, which provides new challenges.

“Without replenishing funds for federal and state agencies, health care facilities, including nursing homes and assisted living communities, could find themselves less than completely prepared for the challenges of the upcoming winter season, which could inevitably result in an uptick in new COVID cases,” Mr. Parkinson said. “Without adequate funding and resources, the U.S. will repeat the same mistakes made during the initial outbreak last spring and the major spike over the summer. We need Congress to prioritize our vulnerable seniors and their caregivers in nursing homes and assisted living communities, by passing another COVID funding package before they leave town for the elections.”

Availability of PPE (personal protective equipment) is paramount in dealing with the coronavirus pandemic.

According to DHSS’s My Healthy Community site — de.gov/healthycommunity — Delaware’s current PPE inventory status as of Friday appears sufficient, with the exception of gloves.

The DHSS site lists at least two-plus weeks’ worth of all supplies available (fluid resistant gowns and isolation gowns; glasses and goggles; isolation and procedural ear loop masks; surgical masks; face shields; and N95 masks) while there is a one-to-two-week supply of gloves.

“Gloves are the one thing that hospitals and nursing homes … go through more than anything else,” said DHSS communications director Jill Fredel. “You have to change gloves every time you see a patient or a resident, because you can obviously carry an infection from one person to another. You have to change gloves.”

My Healthy Delaware site, as of Thursday, lists Delaware’s Healthcare System Status, as “stable,” with:

• 75 percent or less ICU beds occupied;

• 75 percent or less ventilators occupied;

• 5-hour hospital ED wait times; and

• Hospital census/capacity at 96 percent. Hospitals typically function at 95 to 98 percent capacity; increases to 100 to 105 percent for short periods of time are not a significant concern, however, sustained operation at that capacity is problematic.
As experts have repeatedly noted, COVID-19 cases in a surrounding community is a top factor in outbreaks in nursing homes.

Dr. David Grabowski, professor of Health Care Policy, Harvard Medical School recently stated, “The strongest predictor of whether or not we’ll see cases in [a particular setting] is community spread.”

“The number one factor in keeping COVID out of our nursing homes … is reducing the level of the virus in the surrounding community,” Mr. Parkinson said. “While the support we have received from Congress, the administration and other public health agencies have helped our facilities fight this battle, we could still see another wave of COVID cases caused by the sheer volume of rising cases in communities across the U.S.”

The report showed new COVID cases in nursing homes had declined significantly from 10,125 cases the week of July 26 —when the country experienced a growing number of cases in the Sun Belt states — but saw an uptick in new cases in the final week of September.

The pandemic has impacted in-person visitation at nursing homes and long-term care centers. One in particular, the Delaware Veterans Home in Milford, garnered the spotlight amid complaints from families who claimed they were denied visitation by DVH administration when the veterans home met CMS standards that would allow for outdoor visitation as early as June.

Except for compassionate care visits in near-death cases, in-person visitation was not permitted through June, July and August at the DVH, then under administrative leadership of Tina Foskey.

In early October, Delaware Secretary of State Jeffrey Bullock announced Ms. Foskey was leaving her administrative position at DVH.

One of the outspoken family members was military veteran Gene Thornton. Her husband of 42 years, Lt. Col. Donovan Jagger was a resident at the DVH until his passing on Aug. 24.

“They are in phase 3 but for some reason they tell us they are phase 1 and that is the puzzlement there,” said Ms. Thornton. “If you read the federal guidance which is being ignored by the state, we should be able to visit. Other Delaware nursing homes are allowing visits on their porches or outside or in parking lots …”

According to DHSS, in early September a reopening plan was released and went into effect Sept. 8 at 8 a.m. This plan allowed LTC facilities to apply for indoor visitation and activities, such as communal dining and group activities, if the facility met certain criteria.

The Delaware Veterans Home submitted its plan for outdoor visitation on Sept. 3, according to DHSS.

Any visitation plan must be approved by the state’s Division of Health Care Quality, which oversees nursing homes in Delaware and other long-term care facilities, DHSS said.

“But again, they had to meet certain requirements, and one of the requirements that still stands today is (that) you cannot have had a positive case for the past 14 days,” said DHSS spokeswoman Jill Fredel.

According to CMS data — https://inthefirststate.com/CMSData/ — DVH had one confirmed COVID positive resident for the week ending Aug. 2, and one staff COVID positive during the week ending Sept. 27.

Provided by DHSS, DVH’s reopening plan/visitation timeline was:

• Approximately one month prior to Sept. 3, Division of Health Care Quality staff answered many questions for the Delaware Veterans Home related to outdoor/window visits and reviewed a draft plan for window visits.

• On Sept. 3, DHCQ received the first proposal for outdoor visitation, reviewed the proposal and sent an approval to the facility.

• On Sept. 4, DVH resubmitted their plan with a “clarification.”

• On Sept. 10, DHCQ approved the amendment.

According to DHSS, in reference to the amendment, the Delaware Veterans Home changed the timeframes in which visitation could occur and added language to allow visits to be arranged as staffing and space permits. The Division of Health Care Quality subsequently approved the plan.

Secretary Magarik said in an email that between March and May/June, the availability of personal protective equipment (PPE) and testing supplies was a national issue, as the availability varied and there were extreme shortages throughout the US. Due to these issues, and to help mitigate and prevent the spread of COVID-19, visitor restrictions were implemented in long-term care (LTC) facilities throughout the US in mid-March 2020.

“Over the course of the pandemic, the Department (DHSS) has worked with all LTC facilities to provide education and support as well as testing and the supplies necessary to protect and care for LTC residents. In addition, the DHCQ has visited all of LTC facilities, including DVH, to conduct focused infection control surveys,” Secretary Magarik said.

“This has been an extremely challenging time for LTC residents and their loved ones. DHCQ is working diligently with LTC facilities to balance the social/emotional needs of residents with the fact that this is a medically vulnerable population.”

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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