Residents and long-term care employees have been largely overlooked as the coronavirus pandemic rages on. Read on to learn more about the virus’s impact among our most vulnerable population.
The earliest U.S. coronavirus deaths occurred in late February when residents at a Seattle nursing home began falling ill. Since then, the virus has spread like wildfire through the nation’s nursing homes. On Sunday, April 19th, ABC News reported at least 7,300 long-term care residents, in 19 states, have died during the COVID-19 outbreak. Because only 19 states have reported this data, the number of deaths is likely much higher.
Too Little Too Late
On April 2, 2020, the Center for Disease Control (CDC) issued new recommendations to help slow the spread of the virus among some of our most vulnerable patients and healthcare workers in long term care (LTC). But, COVID-19 continued to surge in LTC facilities across the nation, suggesting the CDC recommendations were not stringent enough or came too late. Here are just a few examples:
Canterbury Rehabilitation & Health Care Center in Richmond, Virginia, reported on April 17th, at least 46 residents died of COVID-19, which is one-fourth of the facilities population. Testing was not available to the facility until March 30th and the state only had an estimated supply of 300 kits.
On April 17th, officials in New York released information showing at least 14 nursing homes in New York City and surrounding suburbs have recorded more than 25 coronavirus deaths. At least 55 deaths are reported at the Cobble Hill Health Center in Brooklyn.
In New Jersey, almost two-thirds of the state’s LTC facilities have reported coronavirus outbreaks and more than 1,500 deaths tied to nursing homes. One of the homes was overwhelmed by the number of resident deaths and an anonymous tip led to 17 bodies being found in the facility’s morgue, which was designed for only 4 bodies.
Both Residents and Workers High Risk
Residents in long term care often require assistance with bathing, feeding, turning and other daily living activities that require close contact with the workers caring for them. The level of personal care needed puts both residents and workers at increased risk for infection. In early April, a McKnight’s Long-Term Care News Flash Survey showed 48% of respondents had workers missing work due to either having COVID-19 or experiencing symptoms. Workers and residents in LTC also face challenges that are both unique and common among all of healthcare.
Chronically understaffed, poor staffing ratios and ill-prepared for staff to be off work after acquiring COVID-19 or coming in close contact with someone who has tested positive.
Many already had a history of safety violations prior to the coronavirus outbreak.
Provide services to residents who are older adults who are immunocompromised due to age or chronic illness/disease.
Late in requiring workers and residents to wear masks.
Some facilities initially required a worker or resident to test positive for COVID-19 before requiring masks.
Poor staff to resident ratios.
LTC facilities designated as lower priority for COVID-19 testing than hospitals.
Difficult to isolate residents with symptoms due to common eating/recreation areas and semi-private rooms with double and triple occupancy.
A combination of these factors, among others, have allowed the spread of COVID-19 despite efforts to slow the spread.
Overlooked Workers
Workers in long-term care have been largely overlooked as COVID-19 plays out. Like other healthcare settings, virus tests and protective gear have been limited in many facilities. Staff in nursing homes are also less likely to receive the same level of training as those working in a hospital. In addition, many employees are poorly paid and work several jobs to make ends meet. As a result, the virus may be spread from one facility to another and even to the worker’s home.
Creative Solution
Park Springs Life Plan Community in Stone Mountain, Georgia, has found a creative way to slow the spread. The facility’s leaders asked staff members to volunteer to live on campus to avoid carrying the virus into the facility from home. Sixty workers took the bold step and volunteered. Only four staff members and one resident at the facility have tested positive for the virus and all have fully recovered.
Let Us Hear from You
Do you work in a long-term care facility or have a loved one that is a resident?
If so, what insight would you like to share on the high rates of COVID-19 in nursing homes?
Specializes in LTC, assisted living, med-surg, psych.
It was bound to happen. Nursing homes are petri dishes full of nasty germs and these elderly folks are sitting ducks. The only good I can see coming from this is hopefully the powers that be won't turn away once this is all over. I hope they will take a good look at these facilities and how they are run (fie, for-profit management companies!!), and make real changes by putting adequate staffing and sanitary practices in place. But I won't hold my breath for it.
Why did Gov. Cuomo require nursing homes to take back positive residents?
Why couldn't they stay at the hospital?
We are not equipped to care for Covid patients.
Because there isn't room at hospitals for all the people who are covid+, but do not need acute care.
I'm outside NY, and our med-surg COVID units are pretty full. They aren't bursting at the seams the way they were a week or two ago, when another patient would almost immediately fill a vacated room, but there is definitely not room for stable patients to hang around for weeks. Hospitals are intended for quick turn around, not long term residents. If those patients remained in the hospital, others who are sicker and need hospital level care could not be admitted.
CT and MA have designated nursing homes for COVID+ patients, but I'm not sure when those will be up and running. In the meantime, many residents are returning to their previous nursing homes, and many COVID+ patients are going for inpatient rehab for the first time because they're so deconditioned from long periods of intubation.
The truth is that most nursing homes have or will have COVID+ patients. This virus isn't going away, and we're at least a year away from a vaccine. Especially when some of the stay at home orders expire, we'll see more community transmission. All facilities are going to have to come up with a plan for dealing with COVID+ residents. At least if you get them from the hospital, you KNOW they are positive, and can take precautions.
How are you going to deal with demented residents who refuse to stay in their rooms? Are we going to go back to restraints? Are nursing homes just going to build Covid19 units? Out of the thin air?
We are gated with over 600 resident in independent, assisted and healthcare. We are lucky. No cases within our LTC. A few of our independent residents were + and they have already recovered. Sufficient staffing, good attitudes (for the most part). Only three staff were +. Also all recovered. Everyone taking appropriate precautions. Could not ask for better. (We are East Coast with plenty of infection around us.)
However the healthcare residents are declining due to social isolation. Hard to see them sad and lonely.
How are you going to deal with demented residents who refuse to stay in their rooms? Are we going to go back to restraints? Are nursing homes just going to build Covid19 units? Out of the thin air?
Most have Covid 19 floors. Mine just placed about 10 on one floor. The non positive residents were moved to the non Covid floor.
I work at a subacute/LTC facility in NJ and things have been rough to say the least. I do want to point out that this facility has had a good reputation and has done very well during state inspections. That being said though, COVID-19 hit us hard, and it often appeared as though no one knew what they were doing, which is stressful and frightening. Administration states that regulations keep changing from day to day, even hour to hour, and I'm sure that's true, but there is such a lack of communication, and it's scary going in to work not knowing what you will be facing. One day it's "No one is allowed to wear masks" and the next day it's "Everyone MUST wear masks!" That of course, was very early on in the game before we had our first positive case. That seems like forever ago, but it's only been about a month. So much has happened and so much has changed...
I can't keep track of the number of positive cases we have, but I remember the "official" number from last week was 56. No one knows the real numbers though, because 2-3 weeks ago (I can't keep track of time anymore), the local hospital, who does all our labs, refused to give us any more tests. During that time, residents kept getting sick... and kept dying. I believe the death count is at least 20 now, but I've honestly lost count.
Early on, they emptied out our 2 subacute units, one of which was my regular unit, so I was initially bounced around and then worked regularly on the dementia unit after the nurse there became sick. Employees were dropping like flies, and others just didn't come to work, so we were working dangerously short on a daily basis. This of course, put us remaining few even more at risk, because being stressed and overworked made us more susceptible to getting sick from this virus. A little over a week ago, I began working on my unit again, because it was reopened and turned into the "COVID Unit." This unit was set up because the DOH stated that COVID+ residents must be separated from the residents that are "well." To me, that's a joke, because no one knows who is "sick" and who is "well" anymore! Not without testing!! Our facility did manage to contract a different lab that has supplied us with more tests. I believe the vast majority, if not all, of the new tests we have sent out have come back positive. The dementia unit had actually managed to stay "clean" for so long, even while the other 2 LTC units were in their peaks. However, this virus is completely taking over that unit right now. I have no doubt in my mind that literally every resident there is infected. Unfortunately, we cannot test everyone, so many residents will remain "presumed COVID-positive."
COVID-19 has taken a toll on staff as well. Honestly, it feels like there are more who are/were sick than those who are not. This includes employees of ALL ages, young and old. I work 11-7, and three of the nurses, several CNAs, and most recently the supervisor on my shift have all gotten sick, with one ending up in the ICU. Fortunately, she is recovering at home now. There are many more employees on other shifts who have also become sick. One has been in the hospital for at least 3 weeks now with no end in sight... And sadly, another has passed away...
That being said, I am grateful for the fact that I've managed to dodge this virus so far, and I'm not even sure how. I do believe in "mind over matter," which is why I go into work every day telling myself, "You are fine... You are healthy... You are F-ING IMMUNE to this S***!!" (I apologize if you were expecting rainbows and butterflies, but I'm just keeping it real here!). Don't get me wrong, I wear my PPE and wash my hands like a champ, but so has everyone else here who has gotten sick. I strongly believe that in addition to taking proper care of yourself and following the necessary precautions, you have to put yourself in a positive mindset and remain focused in order to stay healthy. There are definitely times when this is easier said than done, but I do my best not to allow myself to be consumed by fear and negativity.
I’m a Director Of Nursing for long term care/ rehab in Houston, TX. I have worked in several places as DON. I can tell you, the facility is as strong and in compliance as those in charge. I have never allowed my facility to provide mediocre care to my patients/residents and appreciated staff. I can tell you right now , we have been following CMS and HHSC regulatory rules as they apply to COVID-19 and have strict infection control process that follows the CDC. I’m a certified Infection Preventionist and I’m constantly on my staff and resident to follow the systems in place. We have PPE that we count on a daily basis, and we get shipments from our corporate office as we need them. Not all nursing homes and they are not all the same. I strictly enforce the rules. I look for caring and compassionate staff to hire , but the turn over is high just like a lot of other health care settings. This Covid-19 is another hurdle for us that we will overcome and get through it together. Thank believe what I preach.
How are you going to deal with demented residents who refuse to stay in their rooms? Are we going to go back to restraints? Are nursing homes just going to build Covid19 units? Out of the thin air?
Exactly what I was thinking. I worked LTC for 25 years so I can say from experience with previous flu related isolation's it's darn near impossible to keep an ambulatory person with dementia contained.
Keeping them isolated to their respective units is a little easier by creating physical barriers like closing fire doors or hanging curtains across the end of the hall if there isn't a door conveniently placed.
Creating an entire unit Covid unit would be a logistical nightmare if the facility is anywhere near census capacity. There's just not the room to move all the residents while keeping the symptomatic and symptom free completely separated.
Then there are the issues with staffing. If there is any way to plan for the staff that work with the possible or confirmed cases to not have any contact with the residents that are not considered infected I'd love to see it. Staff move from unit to unit all the time. Many facilities, especially on the night shift some staff work on more than one unit. Plus when staff call out somebody is either called in to work, somebody already there is mandated to stay or somebody is pulled from another unit to fill that hole. Few facilities have enough staff available to add extra staff per shift to minimize contact between units. There's a daily struggle to get enough staff in the building even without Covid in play. Not to mention it's not unusual for LTC staff to work in multiple facilities increasing that risk of cross contamination even more.
Then there are the kitchen, maintenance, laundry and housekeeping staff that move throughout the building. Not to mention management. Every isolation we endured they were rounding the entire building checking in.
I *do* work in an LTC that’s adequately staffed (an oxymoron yes I know), but because of the configuration of our floors and the issues of our residents, we simply weren’t able to create a dedicated floor.
But thinking back to some of the places I went when I was doing agency work I just shudder . They were on the brink of disaster even in the best of circumstances.
I work at a subacute/LTC facility in NJ and things have been rough to say the least. I do want to point out that this facility has had a good reputation and has done very well during state inspections. That being said though, COVID-19 hit us hard, and it often appeared as though no one knew what they were doing, which is stressful and frightening. Administration states that regulations keep changing from day to day, even hour to hour, and I'm sure that's true, but there is such a lack of communication, and it's scary going in to work not knowing what you will be facing. One day it's "No one is allowed to wear masks" and the next day it's "Everyone MUST wear masks!" That of course, was very early on in the game before we had our first positive case. That seems like forever ago, but it's only been about a month. So much has happened and so much has changed...
I can't keep track of the number of positive cases we have, but I remember the "official" number from last week was 56. No one knows the real numbers though, because 2-3 weeks ago (I can't keep track of time anymore), the local hospital, who does all our labs, refused to give us any more tests. During that time, residents kept getting sick... and kept dying. I believe the death count is at least 20 now, but I've honestly lost count.
Early on, they emptied out our 2 subacute units, one of which was my regular unit, so I was initially bounced around and then worked regularly on the dementia unit after the nurse there became sick. Employees were dropping like flies, and others just didn't come to work, so we were working dangerously short on a daily basis. This of course, put us remaining few even more at risk, because being stressed and overworked made us more susceptible to getting sick from this virus. A little over a week ago, I began working on my unit again, because it was reopened and turned into the "COVID Unit." This unit was set up because the DOH stated that COVID+ residents must be separated from the residents that are "well." To me, that's a joke, because no one knows who is "sick" and who is "well" anymore! Not without testing!! Our facility did manage to contract a different lab that has supplied us with more tests. I believe the vast majority, if not all, of the new tests we have sent out have come back positive. The dementia unit had actually managed to stay "clean" for so long, even while the other 2 LTC units were in their peaks. However, this virus is completely taking over that unit right now. I have no doubt in my mind that literally every resident there is infected. Unfortunately, we cannot test everyone, so many residents will remain "presumed COVID-positive."
COVID-19 has taken a toll on staff as well. Honestly, it feels like there are more who are/were sick than those who are not. This includes employees of ALL ages, young and old. I work 11-7, and three of the nurses, several CNAs, and most recently the supervisor on my shift have all gotten sick, with one ending up in the ICU. Fortunately, she is recovering at home now. There are many more employees on other shifts who have also become sick. One has been in the hospital for at least 3 weeks now with no end in sight... And sadly, another has passed away...
That being said, I am grateful for the fact that I've managed to dodge this virus so far, and I'm not even sure how. I do believe in "mind over matter," which is why I go into work every day telling myself, "You are fine... You are healthy... You are F-ING IMMUNE to this S***!!" (I apologize if you were expecting rainbows and butterflies, but I'm just keeping it real here!). Don't get me wrong, I wear my PPE and wash my hands like a champ, but so has everyone else here who has gotten sick. I strongly believe that in addition to taking proper care of yourself and following the necessary precautions, you have to put yourself in a positive mindset and remain focused in order to stay healthy. There are definitely times when this is easier said than done, but I do my best not to allow myself to be consumed by fear and negativity.
Do not know what to say. Please take care yourself and stay safe, my fellow nurse.?❤️
I’m a Director Of Nursing for long term care/ rehab in Houston, TX. I have worked in several places as DON. I can tell you, the facility is as strong and in compliance as those in charge. I have never allowed my facility to provide mediocre care to my patients/residents and appreciated staff. I can tell you right now , we have been following CMS and HHSC regulatory rules as they apply to COVID-19 and have strict infection control process that follows the CDC. I’m a certified Infection Preventionist and I’m constantly on my staff and resident to follow the systems in place. We have PPE that we count on a daily basis, and we get shipments from our corporate office as we need them. Not all nursing homes and they are not all the same. I strictly enforce the rules. I look for caring and compassionate staff to hire , but the turn over is high just like a lot of other health care settings. This Covid-19 is another hurdle for us that we will overcome and get through it together. Thank believe what I preach.
I'm curious to know your nurse to patient ratio and your CNA to patient ratio. As well as the average pay for both positions.
guest1143647
163 Posts
Why did Gov. Cuomo require nursing homes to take back positive residents?
Why couldn't they stay at the hospital?
We are not equipped to care for Covid patients.