After this week it’s likely that Tom Tobiassen will be able to add pandemic birthday party planner to his resume.
The cyber security professional who spends much of his free time volunteering on local boards and commissions, organizing a cycling group and fiddling with ham radios spent last week organizing a Zoom birthday party for his 94-year-old mother, Eleanor.
Eleanor lives at the Cherry Creek Retirement Village in
Aurora. Guests, like Tobiassen and his family, are limited from visiting Elanor due to the coronavirus pandemic that has hit senior
living facilities particularly hard.
“Having an elderly parent in a senior assisted living facility has been very stressful,” Tobiassen said. “We are on pins and needles constantly. Fortunately mom’s place is free of COVID-19 but we see how easy it could (be) for a facility to be consumed.”
At least six Aurora senior living facilities had reported COVID-19 outbreaks as of April 15, according to new data compiled by the state health department. More than 100 residents and 70 staffers at the half-dozen Aurora facilities with reported outbreaks are believed to have contracted the virus, according to the latest data, which are expected to be updated after press deadline on April 22. Nearly 30 people in the city have died.
Across the country, more than 7,000 people in nursing homes have died because of the virus.
But the true toll among the 1 million mostly frail and elderly people who live in such facilities is likely much higher, experts say, because most state counts don’t include those who died without ever being tested for COVID-19, The Associated Press has reported.
Next door to Eleanor’s retirement village, at the unrelated Cherry Creek Nursing Center, 45 residents have tested positive for the virus and another six people are listed as “probable cases.” Fourteen people have died.
Eleanor was at the nursing center for several weeks after a hip surgery earlier this year. In early February, she was able to return home to the adjacent retirement village, Tobiassen said. “We are so happy that she got out before all of this happened. It was a long recovery,” he said. “She received great care and rehab there. It is so sad what has happened to those poor people. I could not even imagine what life would be like if she was still there.”
This week Eleanor will celebrate her birthday with family and friends over the internet, on a video call. Tobiassen said he set up a laptop with Skype and other video call programs for his mom just before the pandemic prevented in-person visits.
As the COVID-19 death toll in senior living facilities and nursing homes has increased across the country in the past month, so has the call for better working conditions for the health care workers that take care of America’s aging population.
There aren’t enough protections for home health care and nursing home workers and there seems to be even less personal protective equipment, said Melissa Benjamin, the lead organizer for Colorado Care Workers Unite.
Colorado Care Workers Unite represents thousands of health care workers in Colorado that work for private care companies, home health care companies and nursing homes. Typically these workers are paid less and receive fewer benefits, like paid sick leave and health insurance, than staffers employed by more traditional medical entities. They’re issues Benjamin has been working on improving for years.
Amid a global pandemic it’s clear why they’re so important.
“I’ve had some of our members call me at 9 or 10 p.m. crying,” Benjamin said.
One worker told Benjamin she MacGyvered a face mask out of a paper towel, two rubber bands and a few staples. Another couldn’t get medical gloves and resorted to bleaching yellow, rubber cleaning gloves in between clients.
“Basically what we’re seeing is workers without any PPE (personal protective equipment), none at all. Or they’re having to reuse face masks, and they’re having to wear gloves from one room to the next, which is dangerous,” she said. “Not everybody is symptomatic, not everybody is symptomatic in the same way.”
To make matters worse, Benjamin said she often hears that workers are scared to speak up about conditions for fear they might lose their job, which may only pay minimum wage.
Benjamin spent 17 years as a homecare provider before becoming an organizer. It was too hard to make ends meet, she said.
Benjamin said she fears that sentiment will continue. Demand for home health care workers continues to proliferate as Baby Boomers age, with some 10,000 people turning 65 every day.
Government officials estimate another million home workers will be needed by 2026 and the $100 billion home health care industry will swell by at least $73 billion over the next six years.
“These workers do more than just cook a meal and take out the trash,” Benjamin said. “It’s back-breaking work.”
More than anything, Benjamin said she wants more protections for home health care workers and workers in senior living facilities, so that they can speak out about not having proper protective equipment or having to work when they feel sick.
In March, Gov. Jared Polis issued new rules allowing for four days of paid leave to some workers in Colorado, including those who work with the elderly. It’s a start, Benjamin said, but added she thinks more protections should cover the people taking care of the most vulnerable population during this pandemic.
Absent such protections, experts expect the death toll will continue to climb.
Deaths have skyrocketed in long-term care facilities in recent weeks despite steps taken by the federal government in mid-March to bar visitors, cease all group activities, and require that every worker be screened for fever or respiratory symptoms at every shift.
But a recent AP report found that infections were continuing to find their way into nursing homes because such screenings didn’t catch people who were infected but asymptomatic. Several large outbreaks were blamed on such spreaders, including infected health workers who worked at several different nursing home facilities.
Earlier this month, the federal Centers for Medicare and Medicaid Services that regulates nursing homes issued recommendations urging nursing homes to use separate staffing teams for residents, and to designate separate facilities within nursing homes to keep COVID-19 positive residents away from those who have tested negative.
Dr. Deborah Birx, who leads the White House coronavirus response, has suggested that as more COVID-19 tests become available, nursing homes should be a top priority.
“We need to really ensure that nursing homes have sentinel surveillance. And what do I mean by that? That we’re actively testing in nursing homes, both the residents and the workers, at all times,” Birx said.
This week, Polis enlisted the help of the Colorado National Guard to conduct mass testing at three of the state’s largest nursing homes.
“We really need even better planning, better protections to stop the spread of the virus in these facilities, particularly as the stay-at-home order and these severe restrictions in place roll off, we need to really up our game in practice in all the senior care facilities across our state,” he told the AP.
To be sure, infections of all kinds in nursing homes are a chronic problem, killing 380,000 every year. But an AP review of federal inspection records shows some facilities suffering outbreaks were given low “star” rankings for overall quality even before the coronavirus crisis. Three homes in Ohio and Illinois got two out of five stars, as did the one in Gallatin, Tennessee, where an inspector last year found an unsupervised cart in the hall where a resident scooped out ice with her bare hands.
For relatives of those in nursing homes, the visit ban has literally put them on the outside looking in, communicating with parents and grandparents through windows or by smartphones. Their greatest fear is that their loved ones will be left to die alone.
“When someone loses a loved one, you can’t go and give them a hug,” said 80-year-old Rosan Jordan, a resident of a retirement and nursing facility in New Orleans where her husband was among 13 to die of COVID-19 last month.
Even though she was in the same home, Jordan was kept apart from her husband and could only speak with him near the end on FaceTime.
“I should have known that was the last time I’d be talking to him,” she said. “I hope it was some comfort to him to hear my voice.”
Nursing homes hit hardest
The ravages the virus has sown in nursing homes across the country — and the ensuing scramble to quash their spread — have illuminated the fractures in a cash-strapped industry, Kaiser Health News has reported.
Capital Senior Living serves as a prime case study of the new dangers facing the assisted living industry and the people they serve. The Dallas-based company, which owns or operates more than 120 senior communities nationally, told investors on a March 31 conference call that residents at three of its facilities had tested positive for the coronavirus.
Even before those cases struck, though, the company was ailing. Its stock had plummeted 80% since late February. Last week, the company disclosed a 2019 loss of $36 million. Officials said on the conference call they had sold complexes in recent months, even before the surge of COVID-19 cases, to improve the firm’s financial cushion. Recently renegotiated leases will also help, they said.
The pandemic looks poised to exacerbate its finances further, as residents lose their ability to pay amid the faltering economy and costs rise to care for them.
And fragile economics compound the threat of the virus that rages through assisted living facilities, which are much less regulated and medically equipped than nursing homes but serve tens of thousands of America’s most vulnerable elders.
There are more than 25,000 assisted living facilities across the country, and the median monthly cost to live in one is $4,000, according to the National Center for Assisted Living. Residents, more than half 85 or older and often with arthritis, memory problems and depression, need help with daily tasks but receive less medical attention than in a nursing home. That’s because assisted living staffs are typically smaller and the workers have less health care training than those at nursing homes. And fewer than half the states have minimum staffing regulations for assisted living communities.
Sheryl Zimmerman, a professor in the School of Social Work at the University of North Carolina at Chapel Hill, said only about half have a nurse on staff, and many workers are personal care aides, not certified nursing assistants. Staffers don’t receive as much training about things like the use of gloves and masks as do nursing home workers, even though they often help residents with eating, bathing or using the toilet.
“It’s not a health care workforce,” she said. “In general, they do not have the level of infection prevention you would hope to see.”
As Capital Senior Living’s stock price has fallen to a few dimes, investors fear a possible bankruptcy filing, financial analysts said in interviews. They are worried new residents will stop moving in as others leave or die, hurting revenue. More than half its communities are below 90% occupancy, according to an executive on the conference call. Analysts say that level is roughly the minimum needed for profitability.
“I have confidence in our ability to continue delivering great service and a warm, caring environment to our residents,” Brandon Ribar, the company’s chief operating officer, told stock analysts on the call.
The company declined to make executives available to KHN for an interview but said it is “exercising extreme caution” and “following strict disinfecting and sanitizing guidelines.” Among the safeguards are screening anybody entering a facility and quarantining new residents for their first 14 days.
But one analyst raised a dire scenario if the pandemic worsens: the theoretical closure of facilities.
“Is there a certain rule of thumb, where if occupancy hits a certain point you just say, ‘Hey, let’s just shut down this facility, because we’re just going to lose too much money?’” Steven Valiquette, of Barclays Capital, asked executives on the conference call.
CEO Kimberly Lody, who was brought into the company last year, dismissed the concern, saying Capital Senior Living has “strong flexibility” to reduce staff and other costs if the number of residents decreases substantially at particular facilities.
Nationally, a scourge erupts with 10,000 nursing home deaths
After two months and more than 10,000 deaths that have made the nation’s nursing homes some of the most terrifying places to be during the coronavirus crisis, most of them still don’t have access to enough tests to help control outbreaks among their frail, elderly residents.
Neither the federal government nor the leader in nursing home deaths, New York, has mandated testing for all residents and staff. An industry group says only about a third of the 15,000 nursing homes in the U.S. have ready access to tests that can help isolate the sick and stop the spread. And homes that do manage to get a hold of tests often rely on luck and contacts.
“It just shows that the longer that states lapse in universal testing of all residents and staff, we’re going to see these kinds of stories for a very long time,” said Brian Lee of the advocacy group Families for Better Care. “Once it’s in, there’s no stopping it and by the time you’re aware with testing, too many people have it. And bodies keep piling up.”
That became clear in some of the nation’s biggest nursing home outbreaks. After a home in Brooklyn reported 55 coronavirus deaths last week, its CEO acknowledged it was based entirely on symptoms and educated guesses the dead had COVID-19 because they were unable to actually test any of the residents or staff.
At a nursing home in suburban Richmond, Virginia, that has so far seen 49 deaths, the medical director said testing of all residents was delayed nearly two weeks because of a shortage of testing supplies and bureaucratic requirements. By the time they did, the spread was out of control, with 92 residents positive.
Mark Parkinson, CEO of the American Health Care Association, which represents long-term care facilities, says “only a very small percentage” of residents and staff have been tested because the federal and state governments have not made nursing homes the top priority.
“We feel like we’ve been ignored,” Parkinson said. “Certainly now that the emphasis has gone away from hospitals to where the real battle is taking place in nursing homes, we should be at a priority level one.”
Two-thirds of U.S. nursing homes still don’t have “easy access to test kits” and are struggling to obtain sufficient resources, said Chris Laxton, executive director of The Society for Post-Acute and Long-Term Care Medicine.
“Those nursing home leaders who have developed good relationships with their local hospitals and health departments seem to have better luck,” said Laxton, whose organization represents more than 50,000 long-term care professionals. “Those that are not at the table must fend for themselves.”
Public health officials have long argued that current measures like temperature checks aren’t sufficient. They can’t stop workers with the virus who aren’t showing signs from walking in the front door, and they don’t catch such asymptomatic carriers among residents either. What is needed is rigorous and frequent testing — “sentinel surveillance,” White House virus chief Deborah Birx calls it — to find these hidden carriers, isolate them and stop the spread.
The U.S. is currently testing roughly 150,000 people daily, for a total of 4.5 million results reported, according to data compiled by the COVID Tracking Project. Public health experts say that needs to be much higher. “We need likely millions of tests a day,” said Dr. Ashish Jha, director of the Harvard Global Health Institute.
The federal Health & Human Services Department told The Associated Press that ”there are plenty of tests and capability for all” priority categories and that all should be tested. The agency also noted one of President Donald Trump’s briefings this week in which he underscored the states’ role in coordinating testing.
Only one governor, West Virginia’s Jim Justice, appears to be mandating testing for all nursing homes without conditions. Detroit Mayor Mike Duggan ordered tests at all 26 nursing in the city, using new kits that can spew out results in 15 minutes. Massachusetts abruptly halted a program to send test kits directly to nursing homes this week after 4,000 of them turned out to be faulty. New Hampshire teamed with an urgent-care company to test care workers. Several states including Colorado, Florida, Maryland, Tennessee and Wisconsin have dispatched National Guard testing strike teams.
“It’s a snapshot,” New Hampshire Health Care Association President Brendan Williams said of the national piecemeal approach. “We need a motion picture.”
While the federal government promised this week to start tracking and publicly releasing nursing home infections and deaths, which could help identify hotspots, that work was only beginning. In the meantime, The AP’s own tally from state health departments and media reports put the count at 10,652 deaths from outbreaks in nursing homes and long-term care facilities nationwide. About a third of those are in New York.
New York Gov. Andrew Cuomo, who has described COVID-19 in nursing homes as “fire through dry grass,” said he would ideally like to see any resident, staffer or visitor seeking to enter a nursing home take a rapid test that would come back in 20 minutes. But, he said, “that’s millions of tests.”
Dr. Roy Goldberg, medical director of a nursing home in the Bronx that reported 45 deaths, said his facility still can’t test asymptomatic patients because of shortages that have limited testing to those showing fever or a cough.
“This isn’t what anyone signed up for,” Goldberg said. “It just breaks my heart that the long-term care industry is going to end up being totally scapegoated on this.”
Amid the tragedies have emerged hopeful cases in which early and aggressive testing has made huge difference.
After the first of two deaths at a Sheboygan, Wisconsin, nursing home and other residents and staffers started falling ill, administrator Colinda Nappa got on the phone and pleaded with state officials: “I got to know what is going on.”
A 65-member National Guard testing unit soon showed up, donned head-to-toe protective suits and quickly tested nearly 100 residents and 150 staffers.
In all, 19 residents and staffers tested positive and all are either now housed in a special section of the building or quarantined at home. There have been no more deaths.
In the Seattle area, which had the nation’s first major nursing home outbreak that eventually claimed 43 lives, health officials are targeting their testing efforts on homes that have shown little sign of the disease.
Their plans for testing at 19 such facilities are aimed at trying to head off hotspots by quickly identifying and containing cases. In conjunction with ramped-up capacity for tracing contacts of patients, it’s considered an important prerequisite to reopening he economy.
This past week, medical professionals led by the University of Washington’s Dr. Thuan Ong went room by room through a nursing home in a highly orchestrated ballet of swabbing and bagging. In all, 115 residents were tested and results came back the next day as all negative — a development that drew cheers from the facility’s staff.
“One of the greatest values,” Ong said, “is to catch it before it spreads.”