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The novel coronavirus stalking America’s nursing homes poses a particular threat to the elderly, ailing and disabled people who live in them.
Those who contract COVID-19, the disease associated with the virus, face “an unnecessary, rapid death due to respiratory issues,” said Joseph Ouslander, a Florida physician and past president of the American Geriatrics Society. “Sometimes people who are infected deteriorate in hours.”
The national toll is mounting. Through March, COVID claimed 35 victims at a Kirkland, Wash., nursing home. The virus then cut a path across the New York metropolitan area, killing 15 in a Brooklyn facility, 19 at a home in Elizabeth, N.J., and 13 veterans 24 miles away in Paramus. The virus also has hit nursing home residents hard in Massachusetts: 10 in Littleton, 21 in Longmeadow, 13 in the leafy Boston suburb of Belmont and dozens of veterans living in state-run “soldiers’ homes” including at least 31 in Holyoke and six more in Chelsea.
That grim trajectory of outbreaks brought the virus to the doors of New Hampshire’s 75 licensed nursing homes, which house nearly 7,000 residents — most of them physically vulnerable, financially stressed and elderly.
“Positive cases are popping up at (long-term care and assisted living facilities) across the state,” Benjamin Chan, the state epidemiologist, warned 300 nursing home operators and others in a Zoom chat Wednesday. “All facilities need to be prepared to identify (i.e. screen for symptoms and test) and isolate individuals positive for COVID-19.”
The virus has already hit here. COVID-19 claimed eight residents of the Hanover Hill Health Care Center, a 124-bed nursing home in Manchester, and six residents of the Huntington at Nashua, an assisted living community. As of Wednesday, 14 of the state’s 32 COVID victims had been seniors living in such facilities. State officials have said that residents of at least 10 homes have been infected.
In Vermont, as of April 15 there had been 12 resident deaths in two nursing homes in the Burlington area and two more deaths at a nearby senior living complex, according to state officials. Cases in these and other congregate living facilities accounted for 14 of Vermont’s 30 COVID deaths.
The COVID-19 pandemic “has created existential challenges for nursing care in both staffing and finding personal protective equipment,” Brendan Williams, chief executive of the New Hampshire Health Care Association, a group of nursing home and assisted living facility operators, said in an April 8 release. The association posted an online appeal for donations of masks, gowns and hand sanitizers which described the scramble for protective equipment as “a competition New Hampshire is too small to win.” The group also called upon Gov. Chris Sununu to provide additional funding to the state’s nursing home operators.
On Tuesday, Sununu responded by announcing that the state would tap the general fund for $30 million a month to underwrite a $300 a week stipend for as many as 25,000 long-term care workers in Medicaid-funded nursing facilities or home-care organizations. “What we’re trying to do is stem the outflow” of care-giving workers, said Sununu, who hopes to see the state reimbursed by federal coronavirus funds.
Lori Shibinette, the commissioner of the Health and Human Services Department, said the state would also partner with ConvenientMD, which would deploy two six-member teams to test 6,600 long-term care workers in Hillsborough and Rockingham counties. The program would last for 20 days and aim to test each employee once, she said.
The Centers for Medicare and Medicaid Services, the federal agency that oversees nursing homes, has also moved to enhance nursing home safeguards. It imposed a ban on all visitors, mandated intensified infection control measures and promised that laboratory tests for COVID-19 would be covered for all residents who are Medicare recipients. CMS has also instructed nursing homes to test and isolate all newly admitted residents and all residents and symptomatic staff in homes where virus transmission has occurred.
The agency also suggested that state and local officials set up separate nursing homes or units within nursing homes for COVID-positive residents and patients.
Last week, Shibinette said that state officials had discussed that suggestion, identified a couple of closed facilities and unused units that might be used to “cohort … together” COVID-positive residents but concluded that there was no current need to activate such facilities.
Meanwhile, long-term care providers still fear shortages of tests and protective gear. New Hampshire’s 11 county-operated nursing homes generally have no more than a 10-day supply of protective equipment, said Howie Chandler, administrator of Carroll County’s public nursing home and president of the nursing home affiliate of the New Hampshire Association of Counties.
“All of us are OK as we sit, but that changes immediately when we have a resident (test) positive for COVID,” he said.
The virus complicates everyday tasks. Physicians visiting nursing homes to care for patients must be wary to avoid spreading rather than treating disease. “Our goal is not to vector illness into these facilities,” said Gary Sobelson, a Concord physician and medical director at two large nursing homes.
Tracking the progress of COVID toward and inside long-term care facilities poses a challenge for residents, family members and the public.
New Hampshire, like Vermont, posts daily updates on the number of COVID-19 cases and deaths in the state along with breakouts on the disease spread by victims’ counties of residence, gender and age. But New Hampshire doesn’t regularly disclose the number of cases and deaths among the state’s nearly 7,000 nursing home residents or among the staff of those homes.
Shibinette said the state publicly discloses COVID-19 in nursing and other group homes only when a facility experiences more than one case and some transmission. When a facility has a single positive test, she said, “we don’t feel there’s any reason to come out and talk about that publicly.”
In response to an inquiry, Vermont officials provided an “outbreak situation summary” listing the four nursing homes, lone senior living community and state prison where any residents or staff had tested positive for COVID-19, and the number of cases and deaths in each facility.
On Saturday, the Wall Street Journal reported that 37 states that responded to its inquiries reported 2,300 deaths in nursing homes in their jurisdictions. The other states didn’t respond, according to the report.
Nursing homes constitute the last line of care for elderly and disabled people who require high-level, long-term support. A majority of the funding for the sector comes from the state-federal Medicaid program which covers medical costs for families that meet stringent financial standards.
With New Hampshire’s notoriously low Medicaid payments as the common foundation, a mix of for-profit, nonprofit, religious and county-operated homes offer care.
Nearly a third, or 32 percent, of the state’s skilled nursing beds are in 26 homes owned by Genesis Healthcare Inc., a holding company based in the Philadelphia area that posted $4.6 billion in revenue in 2019 but accumulated $1.3 billion in losses over the last five years. Genesis employs 70,000 people in nearly 400 nursing homes and senior communities nationwide.
In and near the Upper Valley, Genesis owns homes in Lebanon and Claremont as well as Vermont facilities in Springfield and Newport. Nine COVID patients died in a Genesis property in Chittenden County, Burlington Health and Rehab.
In an update posted on the Genesis website on April 8, Chief Medical Officer Richard Feifer said the company was seeking “ways to address unprecedented challenges” in the COVID pandemic. Genesis had “been able to maintain an adequate supply of (personal protective equipment) — standard face masks, gowns, gloves and N95 respirators — by shifting supplies among our facilities and resourceful sourcing” but had also begun to “re-use and extend the use of face masks.” That, Feifer added, “is not a sustainable solution.”
Feifer also called upon “the Federal government and each state’s health department to ensure that testing is available and test results are prioritized in nursing homes.”
Nearly a quarter (24 percent) of New Hampshire nursing home beds are in 11 county-owned facilities.
“Things are going reasonably well” at the Grafton County Nursing Home in North Haverhill, said administrator Craig Labore. About three weeks ago three residents displayed symptoms of viral infections, but all tested negative for COVID. The facility has not done additional testing, but the episode helped planners “identify the need to have a dedicated area” for residents who test positive in the future, he said. Currently, 118 of its 135 beds are occupied even though the home has not admitted any new residents since the second week of March, he said. The facility hopes to resume admitting patients within two weeks, he added.
Craig Roy, a laundry machine operator at the home and chief steward of United Electrical Workers Local 278, said that “everybody’s a little nervous” but that he had received no complaints from workers about the availability of protective equipment or other COVID related issues. “The county’s doing what they can,” he said.
Other nursing homes around the state — “a coalition of the willing,” according to Williams — have continued to admit residents. More extensive and readily available COVID testing would help, he added: “It has been a little bit chaotic.”
Nursing home employees are “the unsung heroes” of the COVID pandemic, Chandler, the Carroll County official, said. “The work is harder than it’s ever been and they’re doing it with great spirit.”
These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.
