Community spread of COVID-19 affects nursing homes

Chad Frey
Finding a way to allow visitors to return to nursing homes has been a struggle -- and for homes in communities where there has been community spread of COVID-19 the struggle has become even harder.

This is a difficult time to operate a long-term care facility as the COVID-19 pandemic continues to linger and case numbers continue to rise.

And, according to the American Health Care Association and National Center for Assisted Living, operating a long-term care facility in a community with community spread is even more diffficult. They say COVID-19 cases in a surrounding community is a top factor in outbreaks in nursing homes.

“With the recent major spikes of COVID cases in many states across the country, we were very concerned this trend would lead to an increase in cases in nursing homes and unfortunately it has,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living.

According to a report by the AHCA/NCAL, case numbers dropped steadily from May 31 to June 21 but began rising again starting June 28. The report showed 5,468 cases in U.S. nursing homes June 21, and 8,628 on July 19, the most recent numbers in the report. The report also showed COVID-related deaths in nursing homes had declined significantly but have started to uptick again in recent weeks.

Harvey County received the “community spread” label about a month ago. Community spread means individuals have been infected with COVID-19 in the area, including some who are not sure how or where they became infected.

That announcement came just as some nursing homes were creating plans to open up to limited visitation. And then, for Newton Presbyterian Manor, came the first positive case in a worker — followed by being designated as a cluster for the disease when five staff and one resident tested positive.

It came as a blow to residents and the community.

“It definitely impacts the community. All the steps we were taking to move the community back to status where visitors and family can be welcomed in have to be halted,” said Jeanne Gerstenkorn, vice president for health and wellness of Presbyterian Manors of America. “We want to get our residents and their families together again face to face, so any delay in that is frustrating for us all.”

The Harvey County Health Department identified Presbyterian Manor as a COVID-19 cluster on Aug. 6. The cluster included five staff members and one resident who tested positive for the coronavirus. All of the individuals confirmed to be positive for the virus have been isolated.

A previous COVID-19 cluster was confirmed at the Schowalter Villa retirement facility in Hesston as of July 16, and this week that designation was dropped by the health department — a process that, according to department director Lynnette Redington, requires at least two incubation periods. The incubation period for COVID-19 is 14 days.

At Presbyterian Manor cases were identified through staff and resident testing conducted by Presbyterian Manor and the health department after an employee tested positive. There were 185 combined staff and residents tested, and five staff members and one resident tested positive. At Schowalter Villa, all cases were staff.

Things changed at Presbyterian Manor for residents — more isolation for residents became required. No longer are they only isolated from the outside world, but they are isolated from each other.

“All group activities such as communal dining or social gatherings have to be halted,” Gerstenkorn said.

The cluster designation also meant an increased demand for protective equipment.

“While staff and residents have been using social distancing, good hand hygiene and wearing masks, they now have to wear full PPE — gowns, shoe covers, disposable masks and/or N95 masks, depending on the area of the community they are working in — when providing resident care or when working in close physical proximity to residents,” Gerstenkorn said. “It can be frightening for staff and residents as all want to remain healthy and want things to ’get back to normal.’ ”

And supplies of that gear can be tight. PPE is allocated, and most long-term care facilities, according to Gerstenkorn, did not need to order many gowns, face masks or shoe covers early in the pandemic.

“Thus, our allocated amounts are very small,” Gerstenkorn said. “We have had to go to the open market and use other vendors to find those items. And the items are three to four times the cost. Our glove cost has just gone up and we have been told to expect it to rise more and expect those to be in short supply. It is very frustrating to try to find the items needed and pay such a high cost for items.”

Parkinson and AHCA/NCAL recently sent a letter to the National Governors Association warning states of imminent outbreaks at nursing homes and assisted living facilities given the major spikes in new cases in several states across the U.S., combined with serious PPE shortages and significant delays in getting testing results for long-term care residents and caregivers, which has been taking up to five days or more.

“Given the fact we are several months into the response of this pandemic and the lack of PPE supplies is still an issue is very concerning. We request governors and state public health agencies to help secure and direct more PPE supplies to nursing homes and assisted living communities, especially N95 masks,” Parkinson wrote in the letter.