Nursing homes still struggling to get protective gear and quick tests


In one of the largest nursing home chains in the United States, 45,000 beds, Genesis Healthcare, the shortage of protective gowns for workers and the lack of rapid tests forced it to catch up with a rate of Raging infection, even if other supplies have become more accessible in the past few weeks.

“This is not a problem that is far from being resolved,” Genesis Healthcare CEO George Hager Jr. said last week.

The nursing home system recorded more than 1,100 cases of coronavirus among staff and more than 2,700 cases among its residents, more than 500 deaths Monday.

In recent weeks, attention to supply shortages has focused mainly on the availability of face masks and the supply of hospitals. Nursing homes, where severe cases of the virus are particularly easy to spread, have received more help in recent weeks, according to the state. But they are still facing a catastrophic situation.

“We, as a company, were very aggressive. We got on with it pretty quickly, “Hager told CNN of how his nursing homes were able to get all employees wearing face protection by the week of March 26. “I would have liked to have gone (to all employees using masks and goggles) earlier, but we just didn’t have adequate supplies. “

Now, Genesis staff reuse or launder the dresses if they can.

Normally, each of the company’s 400 nursing homes uses an average of four to eight isolation gowns per day. With the epidemic raging, each establishment needs 140 dresses per day.

“We are talking about 20 (times) of usage. Every day, ”said Hager. “When you see the hospital worker in the garbage bag – it’s the replacement of the isolation gown, unfortunately. “

On Monday, the Centers for Medicare and Medicaid Services insisted on more transparency in the number of cases in nursing homes and gave advice on how homes should reduce flare-ups. The agency demanded that nursing homes tell patients, their families and the Centers for Disease Control and Prevention the extent of coronavirus cases in their facilities.

“Nursing homes are stalled for Covid-19,” CMS administrator Seema Verma said, calling the new reporting requirement “critical” to monitor the spread of the virus and reopen the country.

Earlier this month, federal officials promised that “nursing homes have been a major target for the Trump administration in its aggressive efforts to fight the virus.”

But tracking cases in nursing homes would only be a start. Failures in nursing home systems to obtain the necessary supplies prevented them from limiting the spread of the virus.

So far, the Federal Emergency Management Agency is working on a plan to get more supplies to nursing homes, Verma said on Sunday.

Last week, the American Geriatrics Society urged the Trump administration’s coronavirus task force to prioritize protective equipment and test supply shortages in nursing homes, long-term care facilities and other collective living spaces.

Joe DeMattos, head of the Health Facilities Association of Maryland, which represents health care providers in nursing homes, said that while most facilities today have adequate personal protective equipment, he intends to always desperate calls for medical gowns. “It’s really cyclical,” he said, and the need will continue.

A day ago, an assisted living center called DeMattos requested medical gowns, he said. “They had tried all government sources for the dresses, the county, the state – and they had failed,” he said. DeMattos obtained a handful of robes for the nursing home from a nearby hospital.

Government response

While the Trump administration has promised to step up efforts to help nursing homes, states like Maryland and Virginia have set up special response teams.

More than half of the coronavirus outbreaks in Virginia come from long-term care facilities, according to data from the state health department. About 15 percent of the state’s 300 deaths have been reported by a single facility, the Canterbury Rehabilitation & Healthcare Center in Richmond, according to health officials.

“It’s a battle that we sometimes feel like losing. It’s a battle we waged, day and night, seven days a week, “said Dr. James Wright, medical director of Canterbury Nursing Home, in recent news. conference. “It’s traumatic. It’s traumatic for everyone. “

Virginia Democratic Governor Ralph Northam, pressed by a reporter at a press conference last week, said that personal protective equipment remained a serious challenge for the state – even as Virginia sends aid retirement homes to avoid shortages.

Dr. Danny Avula, director of the health districts of the City of Richmond and Henrico County, where the Canterbury facility is located, explained that seniors’ care facilities continue to be severely affected because testing , among others, were not available. The entire state of Virginia only had access to 300 test kits in early March, he said.

“There is no doubt,” the shortage of protective equipment has also exacerbated the spread of the virus inside retirement homes, Avula told CNN. “But not because health workers are doing something wrong and not wearing PPE when they see an infected patient. More likely because they don’t wear PPE when they see what they think is an uninfected patient, “he said. said.

These nursing and assisted living homes are particularly vulnerable to the spread of Covid-19 for several reasons, Fran Phillips, Maryland assistant secretary of public health, told CNN.

“Covid is so contagious that we have seen that epidemics in this elderly population can really accelerate incredibly quickly,” said Phillips. “It is the vulnerability of the elderly to fight the virus. She added that the outbreaks are also due to asymptomatic transmission, which makes localization very difficult.

In response, said Phillips, the Maryland Department of Health was trying to identify and address the spread of Covid-19 among Maryland care facilities with what it called “starter teams.”

Teams, made up of National Guard members along with local and national health departments and health professionals, have already responded to epidemics in more than 30 assisted care facilities, Republican Governor Larry Hogan told reporters at a press conference last week. Teams are expected to assess problems that nursing homes face, such as lack of protective supplies, testing, or more general infection control practices.

No more tests needed

One of the Maryland teams working on tests for nursing homes guarantees results within 24 hours for residents and potentially infected staff.

Maryland’s response has been hailed nationally, with governors having consulted with Hogan on their own struggles to contain the virus in assisted care facilities, and Vice President Mike Pence identifying Maryland as a leader on the issue during a call to the governors on Monday.

But the situation inside the houses is still dire. In Genesis nursing homes, screening for coronavirus still has a delay of three to four days. Waiting for the results was up to a week before.

“We couldn’t test people entering the hospital admissions. We could not test people leaving our facility for basic needs, such as chemotherapy or dialysis. We couldn’t test our employees who go home and run three works a day at work, “said Hager, said the CEO of Genesis, about the first weeks of the pandemic in the United States.

He noted how nursing homes met the screening needs of hospitals. Yet even leaders in the hospital and laboratory industry have raised alarms over the past few days about supply chain issues that prevent widespread detection of the virus in the United States.

“We were all shouting to raise our priority level. The practical reality was that there was no testing capacity, period, “said Hager.

Tami Luhby contributed to this story.


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