Dr. Prasuna Madireddy, medical director for Koester Pavilion and SpringMeade Health Center, said as the first nursing home outbreak in Ohio, others have looked to them for guidance amid the ever changing pandemic.
“When we took our first leap into this unknowingly, there was not a whole lot of guidance out there,” she said.
The Centers for Disease Control and Prevention, the Ohio Department of Health and Miami County Public Health provided the nursing homes guidance and support, Madireddy said.
The outbreak is controlled but it’s not considered officially over by public health officials until there is a 28-day gap without a positive test. Some asymptotic residents are still testing positive, Madireddy.
Increased testing, including testing for antibodies, has helped contain the spread, Madireddy said.
This outbreak speaks to the challenges nursing homes and assisted living facilities everywhere face as they struggling to keep the virus out, keep spirits up, source enough protective supplies and hold on to staff.
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Nursing home residents are less than a half percent of the U.S. population but are at least one-third of COVID-19 deaths in the U.S., according to a May 12 publication in Health Affairs.
About 70,000 Ohioans live in nursing homes and 42,000 live in various kinds of assisted living environments. More than 500 of them have died from COVID-19, more than 4,000 have tested positive for the virus since April 15 and more than 1,800 positive cases have been reported among staff.
Since the state health department started collecting data April 15, the department has reported there have been 82 cumulative residents with cases at Koester and 59 at SpringMeade as of May 14. Koester also has had 25 cumulative staff cases and SpringMeade 24 cumulative staff, according to the state.
It is not possible to compare cases between nursing homes because testing was initially limited, and results were not formally collected and posted prior to April 15. Some facilities’ data also could be skewed higher because they have dedicated COVID-19 wings or have done mass testing that leads to increased case counts.
Testing is important with the new coronavirus, because it can be the only way workers without symptoms will know they need to stay home and isolate to prevent nursing home residents from getting sick.
Ohio has more testing capabilities now, Madireddy said, and turnaround times are decreasing.
“So the capability of widespread testing is slowly increasing, not to the point where we want it yet, but slowly skilled nursing facilities are trying to test their residents more often than before,” Madireddy said.
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The Miami County nursing homes also have been doing antibody testing through resources with Premier.
“We’re in a much better position because we know what we have within our facilities with the extra layer of antibody testing,” said India Williams, regional vice president of operations for AdCare Health Systems, which operates the Premier Health-affiliated nursing homes.
Emotional toll
The Miami County nursing homes received an outpouring of community support, Williams said, from letters to flowers to restaurants delivering ice cream.
She said they also tried to provide psycho-social and emotional support to their staff through this time.
“A lot of them saw a lot of deaths or dying, declining residents,” Williams said.
Resident isolation has been a challenge with visitor restrictions, and group activities and community dining stopped. Technology like FaceTime has helped, Williams said, as has taking residents outside more as the weather gets warmer.
One patient faced spending her 69th wedding anniversary apart from her husband for the first time ever. The care center arranged a special luncheon for the couple that also kept them safe.
“They sat between a window and they each had their favorite meal. She blew him a kiss when they saw each other. You have to say, ‘This is still their lives. And this is still memories and events that we have to celebrate, so how can we do that safely?’” Williams said.
Ohio Medicaid Director Maureen Corcoran
said Tuesday at the state’s regular briefing that the state is working on a plan to be more aggressive on testing in long-term care centers. At first, nursing home testing was not ranked on the same priority level as hospital testing, but the state gave a higher priority to nursing home testing in late April.
“This is not a sprint, this is a marathon. And we’re building structures and scaffolding to provide the kind of both clinical support, as well as other support for the staff who work in these environments,” Corcoran said.
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COVID-19 risks increase in congregated living communities and for people with underlying health problems — and nursing homes have both of these factors.
Mary Sutton's mother Vera Gudorf died at SpringMeade Health Center on April 8. Many residents live for playing cards and getting out of their rooms, Sutton said, those small highlights they can't have any more.
She understands why banning visitors and restricting group activities was necessary, but said she also worries about the isolation of residents.
“I can see why they would want to clamp down because when people come in from the outside that’s the contamination. So that would be a tough call,” Sutton said.
Oversight limited
Chip Wilkins, long-term care ombudsman for the Dayton region, said his team commonly helps residents with issues like delays in call-light response, or getting enough time and assistance with eating dinner.
But now with the visitor restrictions, the watchdog agency can’t go in and provide that advocacy across Ohio. He said the staff and volunteers are worried about problems building up at some places.
“This is the most frustrated that I have been as an ombudsman because I can’t get in to observe first hand what is going on,” Wilkins said.
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For now, he said they have a team of about 40 volunteers who have a call list of the family contacts for all area nursing home residents. They are calling every family to see how they are doing and what communication they’ve had with the nursing home.
“We are reassuring them that this is absolutely the safest thing for their loved ones, but we do want to know if their family member is having any issue and we have generated a lot of information that way,” Wilkins said.
Family members can reach the area ombudsman's office — serving Montgomery, Preble, Greene, Clark, Miami, Darke, Logan, Shelby, and Champaign counties — at 1-800-395-8267 or ombudsman@dayton-ombudsman.org. The office is also accepting volunteers.
Ongoing supply challenges
Terry Spitznagel, chief growth officer for United Church Homes, which has several area locations, said a call to action was when they heard about a nursing home in a different region where they had a positive case and then no one came into work that night. After that, they started doing practice COVID-19 case exercises.
“It started off as a way to make sure we knew how to use our PPE and it was properly secured and available, but then it became something else, which was a way for us to be supportive of each other and know that this is as much of an emotional and anxiety-ridden challenge as it is a health care challenge,” she said.
Spitznagel said when the pandemic started, scammers called nursing homes saying they were selling desperately needed supplies, including fake testing supplies. Other facilities had suppliers tell them they couldn’t deliver supplies until summer, she said.
For many of the personal protective equipment suppliers, she said prices are higher and quantities are limited, with nursing homes rationed to buy only 40% of what they ordered in the fourth quarter of 2019.
“So if you didn’t need anything in the fourth quarter of last year, you can order 40% of nothing,” Spitznagel said.
Widows Home director of nursing Tracey Behm said they received a donation of masks from Dayton Children’s Hospital at the beginning that helped them have what they need while they figured out how to get more supplies.
“We actually made our own face shields — literally with a staple gun, and foam and elastic,” Behm said.
They have the supplies they need at the moment, she said, but they have to constantly plan ahead because it’s not as simple as ordering more boxes when they start to run low.
“I’ve been a nurse for 30 years and I’ve never encountered this type of situation by far,” Behm said.
By the numbers: COVID-19 and long-term care
4,091: Ohio long term care COVID-19 reported cases, April 15 to May 14
70,000: Ohioans living in nursing homes
42,000: Ohioans in assisted living
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