Nursing homes across the country have been stranded for weeks under federal orders to protect their frail and elderly residents from the coronavirus, but a wave of deadly epidemics almost every day since suggests measures, including a ban Staff visits and daily health checks either came too late or were not rigorous enough.
Recent epidemics in Tennessee, New Jersey, Ohio, West Virginia and Maryland have increased the number of deaths in retirement homes across the country to at least 450, highlighting the biggest gap: Screenings for doctors, nurses, aides and other workers do not involve actual tests but taking temperatures or asking health questions that still allow infected and asymptomatic people to pass.
“It’s always like Swiss cheese with people coming in and out of it, so you have these explosions in facilities for the aged,” said John BaRoss of Long Valley, New Jersey, who recently removed his mother 85 years old. of an assisted living center for fear of infection.
After an epidemic of 100 infections and four deaths at the Gallatin Center for Rehabilitation and Healing outside Nashville, Tennessee – where the National Guard was called to help evacuate the facility – Sumner County mayor Anthony Holt, blamed staff members who came to work despite symptoms for COVID-19 and “exposed a large number of patients. “
“Things have gotten out of hand,” Holt told The Associated Press. “Once the employees became symptomatic, they should have asked them to go home immediately and called the health service. I don’t think it happened. ”
After an epidemic near Dayton, Ohio, which killed six people and infected nearly 50 people in a pair of nursing homes within 10 miles of each other, health officials said started to examine medical specialists such as phlebotomists and respiratory therapists who work in several facilities per day. One of these health workers who visited the two houses tested positive for COVID-19.
In Maryland, Governor Larry Hogan said an epidemic that had spread like wildfire in a Mount Airy nursing home, killing five and infecting 77, had apparently started with an agent asymptomatic health worker who had passed a temperature test and “infected the population”. ”
Family members of Sundale Nursing Home in Morgantown, West Virginia, where 29 residents and staff have tested positive, say more should have been done to prevent the coronavirus before federal restrictions take effect effect in mid-March.
“The day before the stop, we entered anywhere. There was no connection. There was nothing, “said Courtney Templeton of her last visit to her 69-year-old mother.
Templeton also blamed the house for failing to test residents quickly enough and for not separating those in good health from those who had just returned from a nearby hospital with symptoms of COVID-19, including his roommate mother.
“She came back coughing and had a fever,” said Templeton of a visit two weeks ago, after which she started begging at home to protect her mother. “Can’t you separate the new patients? Can’t you keep them in quarantine for 14 days? ”
Last week, Templeton learned that the roommate and her mother had the disease.
Although the federal government has not released its own tally, an AP count of media and state health reports indicates that at least 450 deaths and nearly 2,000 infections have been linked to coronavirus outbreaks in nursing homes and long-term care facilities nationwide.
And for more than 15,000 of these facilities and the one million people who live there, experts estimate that the situation could worsen before improving.
They say the crisis has only exacerbated a chronic shortage of staff in retirement homes because more workers are quarantining themselves or staying home with their children. There are still no comprehensive staff or patient tests, and shortages of masks and other protective equipment persist.
“This is an emergency, and it is just completely overlooked in all national politics,” said Charlene Harrington, professor emeritus at the University of California at San Francisco and former public health official . “They don’t focus on the fact that they are the most vulnerable people across the country. “
And even more disturbing, overcrowding in hospitals has some states seeking to force nursing homes to take patients recovering from COVID-19, raising fears that they will spread it to residents inside .
Last week, New York released a statewide notice prohibiting nursing homes from denying admission to residents “solely on the basis of a confirmed or suspected diagnosis of COVID-19”. California has told its nursing homes to make similar preparations. Massachusetts has announced plans to designate specific nursing homes as care centers for patients with COVID-19 – a decision that sets it apart from other states
“Sending inpatients who are likely to be carriers of the virus to nursing homes that do not have the appropriate units, equipment and staff to accept COVID-19 patients is recipe for disaster,” a said Mark Parkinson, president of the American Health Care Association.
Federal guidelines for preventing coronaviruses in nursing homes followed the country’s largest epidemic in one place, killing 40 people in the Life Care Center nursing home near Seattle. A government inspection found that infections in and around the home were likely caused in part by employees working during their illness.
A March 13 order from the Centers for Medicare and Medicaid Services states that nursing homes should immediately arrest visitors and non-essential workers, cancel joint meals and group activities, and actively seek residents and staff for fever and respiratory symptoms.
But the order did not impose regular testing of staff members, which nursing providers and advocates say it is not possible or practical due to the limited availability of tests and delays in the results.
“In an ideal world, would everyone have been screened with COVID tests? Of course. But that’s all we can do, “said Kathleen Hill O’Neill, nursing home consultant and trainer at the University of Pennsylvania.
The restrictions have done little to slow the daily rate of new infections.
In New Jersey, an entire nursing home relocated residents after two dozen were confirmed to be infected and the rest were believed to be. Seven died and more than 40 were infected in a nursing home on the outskirts of Richmond, Virginia. Two died and at least 57 were infected in a nursing home east of Los Angeles. And on New York’s Long Island, a retirement community has so far killed eight people in two weeks.
“The coronavirus in a nursing home is like fire in the dry grass,” New York Governor Andrew Cuomo said this week.
Certainly, infections of all kinds in retirement homes are a chronic problem, killing 380,000 people each year. But an AP review of federal inspection records shows that some facilities with epidemics received a low “star” rating for overall quality even before the coronavirus crisis. Three Ohio and Illinois homes received two out of five stars, as did Gallatin, Tennessee, where an inspector found an unattended cart last year in the lobby where a resident picked up ice with bare hands.
For those close to those who live in retirement homes, the visiting ban literally put them outside by looking at them, communicating with parents and grandparents through windows or smartphones. Their greatest fear is to let their loved ones die alone.
“When someone loses a loved one, you can’t go and hug them,” said Rosan Jordan, 80, a resident of a retirement and nursing home in New Orleans, where her husband was among the 13 to die from COVID. -19 last month.
Even though she was in the same house, Jordan was kept away from her husband and could not speak to her until late on FaceTime.
“I should have known it was the last time I spoke to her,” she said. “I hope it comforted him to hear my voice.”
Randy Herschaft, AP investigative information researcher, and journalists John Seewer in Toledo, Ohio, Michael Kunzelman in College Park, Maryland and Sarah Rankin in Richmond contributed to this report.