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Infection Control Problems Persist in Nursing Homes During COVID


The new analysis draws on self-reported data from nursing homes collected by the federal government over four weeks from late August to late September. While some states fared much worse than others, all 50 states and the District of Columbia had one or more nursing homes that reported inadequate PPE supply, staff shortages, staff infections and resident cases. Forty-seven states reported at least one COVID-19 death among residents.

The analysis found that more than 28,000 residents tested positive for COVID-19 during the four-week reporting period, and more than 5,200 residents died, showing that the virus is still raging in nursing homes. More than 84,000 long-term care residents and staff have died since January, and more than 500,000 residents and staff have contracted the disease, according to the Kaiser Family Foundation’s tally, accounting for roughly 40 percent of the national death toll. Long-term care providers include assisted living, adult day care centers and more, while AARP’s new analysis features just nursing home data.

“This is a nationwide crisis, and no state is doing a good job,” says Bill Sweeney, AARP’s senior vice president of government affairs, adding that the results of AARP’s analysis are “profoundly disappointing.”

“While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time,” he says. “These are places where people are vulnerable to infection, whether it’s COVID or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Staff infections nearly match resident infections

For months, providing adequate PPE and developing plans to mitigate staffing shortages have been “core principles” set out by the Centers for Disease Control and Prevention (CDC), for COVID-19 infection control in nursing homes, which generally house older adults with underlying conditions who are at increased risk of infection and severe illness from the disease. PPE stops the transfer of infectious droplets through the air, while adequate staffing ratios mean better care and less person-to-person contact.

Yet in 18 states, more than 30 percent of all nursing homes reported PPE shortages, and in 26 states and the District of Columbia, more than 30 percent of nursing homes are experiencing staff shortages. N95 respirators were the most in-demand PPE item across the country, with 11 percent of all nursing homes reporting shortages. And nursing home aides (certified nursing assistants, nurse aides, medication aides and medication technicians) were the most in-demand staff, with 27 percent of all nursing homes reporting shortages.


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More than 100 N.J. nursing homes have had coronavirus outbreaks since summer as crisis continues

The coronavirus devastated New Jersey’s nursing homes this spring, killing thousands of residents and prompting a raft of measures to better protect the state’s most vulnerable population.

Since that time, long-term care facilities say they have stockpiled personal protective equipment. They’ve developed protocols for testing residents and staff and isolating those who are sickened. Visitors continue to be limited by state regulators, amid fears the virus will be reintroduced as families reunite with their loved ones.

Yet despite those precautions, the coronavirus continues to creep into the state’s nursing homes, assisted-living centers and other senior facilities, even among those that managed to eradicate their original outbreaks, Department of Health data shows.

Across New Jersey, at least 102 long-term care facilities saw new outbreaks this summer or fall after being declared COVID-19 free, according to a review by NJ Advance Media. Included in those were 11 facilities in which residents or staffers died in the new contagions.

That points to a somber reality as New Jersey grapples with a concerning resurgence of coronavirus in recent weeks: Even as nursing homes have had nearly seven months of experience combating the virus, many remain unable to keep it wholly at bay. Still, those outbreaks are proving less deadly and easier to contain than in March or April, when underprepared facilities were floored by a pandemic that caught them, the state and the country flat-footed, flooding New Jersey’s hospitals and morgues.

On Friday, a union that represents 8,000 nursing home workers in New Jersey expressed concerns about a second wave of the disease and the impacts it could carry.

“Nursing home operators need to be taking every precaution, including giving frontline workers access to n95 masks, gowns and surgical masks before, not after, new outbreaks emerge,” said Milly Silva, the executive vice president of 1199SEIU United Healthcare Workers East. “Facilities need also to staff-up now, to prevent the type of short-staffing crisis that we experienced earlier this year.”

James McCracken, who heads a trade association of nonprofit senior care organizations, called preparedness a difference of “night and day” from what it once was. Nursing homes have learned to better protect residents and staff, he said, and have largely secured the personal protective equipment that was in such short supply.

“It’s pretty clear that there’s just a much better understanding of the disease, which no one had in the beginning, which was new to everyone,” said McCracken, the chief executive of LeadingAge New Jersey & Delaware.

But seniors and the workers who care for them do continue to be sickened and die, if at rates far lower than at the height of the disease’s sweep. It takes just one positive test for a nursing home to be considered to have a new outbreak, and in many cases, those small-scale infections are not spreading.

The state began publishing an online list of infections and deaths by facility in April after complaints that nursing homes were not being transparent as the disease ripped through New Jersey. But

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Nevada Revokes Halt on Rapid Antigen Testing in Nursing Homes

A week later, however, Admiral Giroir cracked down on Nevada’s “illegal” prohibition on BD’s and Quidel’s tests, which he said had imperiled the residents and staff of nursing homes across the state. “They cannot supersede the PREP Act,” he said.

The false positives that had emerged, Admiral Giroir said, were not only expected but “actually an outstanding result.” No test is perfect, he said.

In the Nevada statement, Dr. Azzam reaffirmed his concerns with the number of false positives that had arisen. “If this laboratory data discrepancy had been reported to Dr. Giroir, we would hope he would have taken the same action as Nevada,” he said. “We too want more testing with rapid turnaround in Nevada, but the results of those tests must be accurate, as they affect clinical care.”

The state’s nursing facilities can resume use of BD’s and Quidel’s products, according to a new Nevada directive issued on Oct. 9. But Nevada’s department of health also recommended that all antigen test results, positive or negative, be confirmed by a laboratory test that relies on a slow but very accurate and reliable technique called polymerase chain reaction, or P.C.R. False negatives, officials noted, risk exposing healthy people in nursing homes to someone who is unknowingly contagious. False positives, on the other hand, could prompt the placement of a person who is well into a unit with sick people, also increasing the chance of infection.

“Both of these scenarios could result in causing harm to a population that we have collectively worked so hard to protect,” the directive said. State health officials, it said, would also continue to investigate the use of BD’s and Quidel’s products.

“We need to better understand the issue before encouraging mass use of such tools among our most vulnerable citizens,” Dr. Azzam said. “We are not saying the tests have no use, we are just saying pause for further review and additional training.”

In a statement, Admiral Giroir said he and his colleagues were “pleased” about Nevada’s reversal. “This serves as a valuable public policy discussion that benefits the public interest by deterring unilateral prohibitions or similar actions in other states or jurisdictions,” he said.

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Advocating for Nursing Home Workers in Pandemic

Nursing home workers face a higher risk for COVID-19 than most Americans, providing essential care in hazardous conditions and at lower pay than they deserve, says David Grabowski, a professor of health care policy at Harvard Medical School. Giving them a living wage, decent benefits and adequate personal protective equipment is not only the right thing to do, it would help keep long-term care residents safer amid the pandemic, too, he says.

Grabowski, whose “day job” is doing research on the U.S. long-term care system, says it’s time to rethink the underlying structure of nursing home reimbursement.

Since the pandemic began, Grabowski has taken on a slew of new roles: serving on a Centers for Medicare & Medicaid Services task force called the Coronavirus Commission on Safety and Quality in Nursing Homes, testifying twice before Congress and writing op-eds aimed at advancing the cause of nursing home workers and residents alike.

Thanks to COVID-19, nursing home workers now have the most dangerous job in America, Grabowski and co-authors declared in a July 28 opinion piece in the Washington Post. Using CMS nursing home data, they determined that more than 200 COVID-19 related fatalities will occur per 100,000 nursing home workers if overall deaths continue at their current pace over a full year.

For their brave and selfless response in continuing to work in an already physically and emotionally demanding job – now with the added danger of coronavirus exposure – nursing home workers like nurses, certified nursing assistants and support staff should receive national hazard pay, Grabowski and co-authors argued.

Direct care staff at nursing homes also need access to good-quality personal protective equipment to prevent virus transmission, free access to coronavirus testing and the ability to make choices about when to stay home when they’re sick without fear of income loss, they added.

Grabowski’s career direction was shaped almost serendipitously when he was a Duke University undergrad in the early 1990s. “I had an adviser who said, ‘We should think about this as a project for your senior thesis,’” he recalls. “To be honest, I really knew nothing about long-term care or nursing homes. I ended up doing the project and it was everything that interested me about economics and public policy – only more so.”

The challenges faced by long-term care facilities, residents and caregivers soon captured Grabowski’s attention. “I ended up doing my dissertation on Medicaid payment and nursing home quality,” he says, Since then, he adds, “Basically, I’ve been doing this research on this area without realizing we would ever have this kind of pandemic and this kind of situation.”

Location – of the nursing home itself and where workers live in the surrounding area – plays an important role in the COVID-19 outbreaks, according to studies conducted nationwide. That includes findings on Cleveland, Detroit and New York City from Grabowski and colleagues, published June 24 in JAMA.

In June, Grabowski was named to the CMS task force to help

Federal Official Threatens Nevada for Halting Rapid Tests in Nursing Homes

The leader of the nation’s coronavirus testing efforts condemned Nevada’s health department on Friday for ordering nursing homes to discontinue two brands of government-issued rapid coronavirus tests that the state had found to be inaccurate.

“Bottom line, the recommendations in the Nevada letter are unjustified and not scientifically valid,” Adm. Brett Giroir, an assistant secretary of Health and Human Services, said in a call with reporters on Friday. The state’s actions, he said, were “unwise, uninformed and unlawful” and could provoke unspecified swift punitive action from the federal government if not reversed.

The rapid tests, which were distributed to nursing homes around the country in August by the federal government, were supposed to address the months of delays and equipment shortages that had stymied laboratory-based tests.

“The important issue is to keep seniors safe,” Admiral Giroir said in an interview on Friday. Antigen tests, he added, were “lifesaving instruments” that had been called “godsends” by some nursing home representatives. About 40 percent of the country’s known Covid-19 deaths came from nursing homes, according to a New York Times analysis.

But Nevada officials had discovered a rash of false positives among two types of rapid tests, manufactured by Quidel and Becton, Dickinson and Company, that had been used in the state’s nursing homes. Both tests look for antigens, or bits of coronavirus proteins, and had been advertised as producing no false positives.

Among a sample of 39 positive test results collected from nursing homes across the state, 23 turned out to be false positives, the state reported. (The bulletin did not specify whether negative results from the antigen tests, of which there were thousands, had been confirmed, leaving the number of false negatives unknown.)

“I would consider that to be a significant number of false positives,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.

Admiral Giroir contended that such rates of false positives are to be expected, and are “actually an outstanding result.” No test is perfect, he said.

He also said that the federal government expected the state to promptly rescind its unilateral prohibition, which he described as a violation of the Public Readiness and Emergency Preparedness Act.

An Aug. 31 guidance from Admiral Giroir’s office stipulated that PREP Act coverage “preempts” states from blocking the use of coronavirus tests that have been authorized by the Food and Drug Administration on people in congregate settings, like nursing facilities.

What Nevada has done is “illegal,” he said. “They cannot supersede the PREP Act.”

The federal government’s formal response to Nevada’s health department, dated Oct. 8 and signed by Admiral Giroir, portrayed the state’s officials as scientifically incompetent and their actions as “improper” under federal law. “Your letter can only be based on a lack of knowledge or bias, and will endanger the lives of our most vulnerable,” Admiral Giroir wrote.

Should the state hold its ground, “there can be penalties from the federal side,” he said in an interview on Friday, but declined to provide details.

Coronavirus relief funds for nursing homes dry up, raising fears for elderly, vulnerable

As drafts of a renewed coronavirus relief package continue to be debated in and around the White House, the many millions left languishing in nursing homes and elderly care facilities – along with their loved ones forced to communicate with them from afar – are urging swift action.

According to the American Health Care Association (AHCA), almost all the initial $175 billion U.S. Department of Health and Human Services (HHS) funds from the CARES Act – which was signed into law by President Trump in late March – has been spent, and yet coronavirus – officially termed COVID-19 – cases in at least 22 states continues to ascend, ahead of the already daunting cold and flu season.

“HHS has announced distribution plans for 80 percent of the $175 billion Provider Relief Fund created by the CARES Act. Health care providers, including nursing homes, will need additional resources to continue its response to the COVID pandemic heading into the cold and flu season, which provides new challenges,” Mark Parkinson, president and CEO of American Health Care Association and National Center for Assisted Living (AHCA/NCAL), told Fox News. “COVID-19 disproportionately impacts the elderly – many of whom already have preexisting health conditions and chronic diseases – and the dedicated staff who care for them.”

AMID CORONAVIRUS, 1 IN 4 AMERICANS ARE FAILING TO WASH THEIR HANDS: CDC

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has thus requested an additional $100 billion from the HHS Provider Relief Fund, which is accessible for all health care providers impacted by the novel pathogen, and asked “that a sizeable portion of the fund be dedicated to helping nursing homes and assisted living communities to acquire resources associated with protecting vulnerable residents and staff from the virus, including constant testing, personal protective equipment (PPE) and staff support.”

Parkinson is urging Congress to provide the additional billions to protect the most susceptible. As of Friday, the notion of further stimulus and relief funding was still the topic of political fodder in Washington.

Parkinson emphasized that the PPE supply shortages and delays in obtaining test results in the first six months of the pandemic “put nursing homes at a serious disadvantage” in keeping COVID out of their facilities.

 “Funding from HHS has helped nursing homes pay for additional staffing, secure vital PPE equipment, and conduct regular testing of residents and staff in response to the COVID pandemic,” he lamented. “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.”

Indeed, a prominent portion of coronavirus deaths have occurred in nursing homes and assisted living facilities nationwide – a chilling consequence of the disease, which is known to be especially lethal to adults over the age of 60, and with underlying health ailments. Furthermore, it can rapidly tear through converging, indoor dwellings and be passed on by workers who move from room and room.

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Dozens infected, nine dead in COVID-19 outbreak at a Santa Cruz County nursing home

Coronavirus has infected dozens of residents, with nine dead, at a nursing home in Watsonville, Calif., in Santa Cruz County.
Coronavirus has infected dozens of residents, with nine dead, at a nursing home in Watsonville, Calif., in Santa Cruz County.

A skilled nursing home in Santa Cruz County is suffering a severe outbreak of COVID-19, with 61 people having tested positive and nine dead, a county health spokeswoman said Thursday.

Of the 61 infected at the Watsonville Post-Acute Center, nine were staff. All those who died were residents and ranged in age from their early 70s to 90s, said Corinne Hyland, a public information officer for the county Department of Public Health. The facility is licensed for 95 beds.

Hyland said the facility had been following state guidelines for employee testing, which exposed the outbreak. The center reported the outbreak to the county on Sept. 17 after a resident tested positive. An outbreak at a nursing home is defined as an infection in one resident. Visitors have been barred during the pandemic, she said.

“It spread pretty quickly,” Hyland said. “Unfortunately, this is a very vulnerable population.”

Dr. David Ghilarducci, deputy health officer for Santa Cruz County, said the county’s public health staff was working closely with the facility to control the outbreak.

Santa Cruz County health officials have been visiting the facility daily to review protocols on isolation, quarantine, testing and screening, and to respond to requests for more resources.

Officials from the California Department of Public Health have made multiple visits to the facility to assess the situation and make recommendations, and the California National Guard also is providing help, the county said.

Because many nursing home employees work in more than one facility, the county immediately alerted other homes of the outbreak, Hyland said. She added that the county was tracing the contacts of the infected.

“This is really a large outbreak,” Hyland said. “We haven’t seen this sort of thing in our county until now.”

The Watsonville center’s website has reported previous infections in the past but in small numbers. The website indicates that past infections have been among employees.

Gerald E. Hunter, the facility’s administrator, said on the website there were 23 residents and four staff members who were positive for the virus on Oct. 5. He said the county’s numbers reflected the total infected since the outbreak started.

“Each day we evaluate all of our residents following CDPH and County of Santa Cruz guidelines to determine whom meets the criteria to be transferred out of the unit,” said Hunter on the website. He did not immediately respond to a request for an interview.

This story originally appeared in Los Angeles Times.

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Nevada Halts Use of Rapid Coronavirus Tests in Nursing Homes, Citing Inaccuracies

Kristen Cardillo, BD’s vice president of global communication, said the company was aware of the situation in Nevada and was “conducting thorough investigations.” She added that “based on the information in the directive and the total tests performed, we believe the rate of reported false positives is well within what we would expect for the BD Veritor System.”

Representatives for the Department of Health and Human Services did not respond to requests for comment.

Concerns have also been raised about the ability of antigen tests to accurately pinpoint infections, especially if administered during a period when a person harbors low levels of the coronavirus. BD’s test is advertised as having a false negative rate of 16 percent. Quidel’s is just above 3 percent. The directive from Nevada’s department of health did not report whether the negative antigen test results from nursing homes — there were nearly 3,700 such results — had been confirmed by P.C.R.

In a call with LeadingAge members on Monday, Adm. Brett Giroir, who has been leading the nation’s testing efforts, said antigen tests were “clearly a lifesaving option,” and for many facilities the best test available, given the delays, expenses and shortages that had plagued P.C.R. tests.

“It is perfectly acceptable for congregate care, particularly nursing homes, to use an antigen test, even if they are, quote, off-label,” Dr. Giroir said in the interview. “Just because they don’t have an authorization doesn’t mean they’re not good for it.”

In response to questions about false positives, Dr. Giroir reminded LeadingAge members that in places where the coronavirus is scarce, false positives should be expected to outnumber true positives and do not necessarily invalidate the usefulness of a test. “That’s a function of the way life is,” Dr. Giroir said.

The halt to antigen testing in Nevada’s nursing homes comes just days after health experts criticized the White House, which is now in the midst of a coronavirus outbreak, for a misguided overreliance on rapid testing. For months, officials used two products made by Abbott Laboratories, the ID NOW and the BinaxNOW, to test people without symptoms — another off-label use — while eschewing masks and physical distancing. In September, the White House also began distributing millions of BinaxNOW tests to communities across the country, including nursing homes around the country.

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Relaxed regulations have calming effect on Cy-Fair area nursing homes

After a heart-breaking five months of isolation, seniors in area nursing homes and assisted living centers have some new options for seeing their loved ones.

At a press conference on Sept. 17, Gov. Greg Abbott announced a new visitation guidance for eligible nursing homes, assisted living facilities, intermediate care facilities, home and community-based service providers, and inpatient hospice effective Thursday, Sept. 24.

“I certainly applaud Gov. Abbott and the HHSC (Health and Human Services Commission) on working to reduce and relieve some of the restrictions with visitation,” said Derek Prince, CEO HMG Healthcare who manages Park Manor of CyFair.


“We value the psycho and social well-being and family relationships,” he said. “It’s been extremely trying for our patient population and our families. We’re excited to be able to put this stuff together,” he said.

With the relief comes a bit of grief as well.

“They are also burdensome and duplicitous from the guidance we received from CMS (Centers for Medicaid and Medicare Services). It’s somewhat confusing at times,” he said.

“Slowly but surely we’re getting our arms around it and hopefully making a difference” the CEO said.

Prince described the visits under two categories: a regular visitor policy and an essential care worker designation.

Under the regular visitor policy, they are based on county positivity rates whether they are designated as indoor or outdoor visits. They can consist of outdoor no contact visits, open window visits, or indoor visitation with the use of plexiglass safety barriers, all attempts at preventing the spread of the coronavirus. There can be no physical contact between residents and visitors.

“Those can be scheduled by any loved one on our website with the Schedule A Visit button at an appropriate time,” he said.

The visits are allowed seven days a week and they allow for cleaning between each visit.

The potential is there for those visits to be taken away in the event of a breakout with patients or even staff.

The second category is an essential care worker designation. A resident or responsible party can designate two essential caregivers for each resident. They’re not required to adhere to social distancing. There can be contact and touch and can be in a patient’s room. Staff and other residents are still required to socially distance with the visitors.

“On the front end we have to provide training for all of the essential caregivers on facility policies and procedures regarding infection control, PPE, and hand hygiene. They still have to go through testing protocols to make sure they are safe,” Prince said.

Only one caregiver can visit a resident at a time. Some facilities place a time requirement on that from 30 minutes to an hour. Proper PPE must be used at all times during these scheduled visits, and the caregiver must test negative for COVID-19 within the previous 14 days