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?
I find it appalling. I worked in an LTC when the pandemic hit. The "powers that be" decided that with new admissions, they would place them on 7 days "isolation". We had ample empty rooms. They placed new admissions in the same room with other new admissions and would not allow staff to use proper PPE in the "isolation" rooms. During a meeting, I advised them that since most patients are not in the hospital that long, they should place each new admission on a full 14 day isolation, and treat them as if they were COVID +. They stated they could always re-evaluate this issue as time went on, but stood strong on not using N95's, etc, with new admits. Luckily, I had already given my notice and was out of there before 45 of the 85 patients tested positive, and multiple patients passed. There should have been guidelines on both ends - test the patient prior to release from the hospital, keep them on isolation, test them again in 14 days if no symptoms, then they could come off iso. And, proper PPE for the staff. I heard of 2 different LTCs/SARs that refused to test patients that were having symptoms. They did not want to have to report cases to the state because they were afraid of getting shut down, or having the state show up. I know they got hit hard and fast. But there were ways they could have handled this with a better outcome. It's a shame.
I work in a LTC facility. We have been in lockdown for over 2 months. Absolutely no visitors except for end of life with the resident actively dying. No hospice personnel may come in either even though we have several who are on hospice. We have been monitoring all staff prior to the beginning of shift by taking temps and filling out questionnaire. We monitor all residents every day for s/s of Covid. All staff, every single one, wears a mask at all times and all direct care staff also wear a face shield. We have not had one single case of infection, neither staff nor residents. The facility I work at is going everything possible to ensure we all are as safe as possible. I am proud to be working in my LTC facility!!
I work in a LTC facility. We have been in lockdown for over 2 months. Absolutely no visitors except for end of life with the resident actively dying. No hospice personnel may come in either even though we have several who are on hospice. We have been monitoring all staff prior to the beginning of shift by taking temps and filling out questionnaire. We monitor all residents every day for s/s of Covid. All staff, every single one, wears a mask at all times and all direct care staff also wear a face shield. We have not had one single case of infection, neither staff nor residents. The facility I work at is going everything possible to ensure we all are as safe as possible. I am proud to be working in my LTC facility!!
We don't have any agency nurses in my facility. However, most of the LTC facilities in my area do utilize agencies. I haven't heard of any in positive cases in my immediate area. But I live in a rural area. In the bigger cities which are about an hour away from me, have had cases.
My coworkers and I have worked harder and under more stress than every before keeping this *** away from our little old people.
Between them not being allowed to see their families and now not even leaving their rooms, the issues we are facing are compounded with the result of so much isolation and deprivation from human contact.
Most of my patients aren't confused, although some are - and even the oriented ones are struggling with the loneliness and fear. On top of that the ones who are confused see us in masks and gowns and the fear only gets worse.
We don't get to choose to stay out sick because we're worried or our jobs aren't doing enough to protect us (most aren't) - if we do that, these people suffer for it and that's not right in any scenario.
To add fuel to the fire anyone we do have to send out comes back worse than when they left us because of how overwhelmed the hospital is right now. Then they have to go on a 14 day isolation period which is even more stringent than our new normal.
Oh and because our census is lower than usual as we try to limit admissions to keep the virus out, our staff is getting cut. People who would normally eat in a dining room with supervision from one or two staff members are in their rooms, so meal time takes so much longer and there just isn't enough time in a day.
Specializes in Mental Health, Gerontology, Palliative.
Some of the biggest clusters in NZ were from two rest homes.
The places are like ginormous big petrie dishes. I have seen it happen with norovirus, unless we put units into isolation, it goes from one end of the home to the next
There is some controversy here at the moment because the MOH is refusing to test patients moving out from acute hospitals to long term care. Which is dumb given that one infected patient could make for many more.
I worked in one place that got shut down due to one patient with norovirus, admitted from an acute hospital ward that had noro. The acute hospital didn't tell the rest home and lo and behold it spread like wildfire
beachlover
10 Posts
I find it appalling. I worked in an LTC when the pandemic hit. The "powers that be" decided that with new admissions, they would place them on 7 days "isolation". We had ample empty rooms. They placed new admissions in the same room with other new admissions and would not allow staff to use proper PPE in the "isolation" rooms. During a meeting, I advised them that since most patients are not in the hospital that long, they should place each new admission on a full 14 day isolation, and treat them as if they were COVID +. They stated they could always re-evaluate this issue as time went on, but stood strong on not using N95's, etc, with new admits. Luckily, I had already given my notice and was out of there before 45 of the 85 patients tested positive, and multiple patients passed. There should have been guidelines on both ends - test the patient prior to release from the hospital, keep them on isolation, test them again in 14 days if no symptoms, then they could come off iso. And, proper PPE for the staff. I heard of 2 different LTCs/SARs that refused to test patients that were having symptoms. They did not want to have to report cases to the state because they were afraid of getting shut down, or having the state show up. I know they got hit hard and fast. But there were ways they could have handled this with a better outcome. It's a shame.