Coronavirus: Avoiding the much larger crisis; COVID-19 testing at nursing homes is expanding but more is ne – MassLive.com

Posted By on April 17, 2020

While Massachusetts is expanding coronavirus testing across nursing homes and other long-term care facilities, some operators and health care advocates say persistent gaps could lead to more cases and deaths among some of the states most vulnerable residents.

The numbers are sobering. Over 11% of the known COVID-19 cases at long-term care facilities have ended in death, compared to a statewide rate of just over 3%, according to an analysis of data released Tuesday by the Department of Public Health. Nearly half the states 957 reported deaths were at long-term care facilities, and the 3,907 cases reported among residents and employees represents 14% of the state total.

The majority of long-term care facilities in Massachusetts have not detected a case of the coronavirus but health care workers and executives from several operators say testing remains limited a month into the state of emergency.

If we are trying to prevent an outbreak, why wait until we have an outbreak to go and test? said Anne Thomas, president and CEO of the Glenmeadow Retirement Community in Longmeadow. The facility has had one resident test positive for COVID-19, but the majority are independent living residents who do not qualify for testing under the states mobile testing program.

If we are really going to crack this thing, we are going to need to be a lot more proactive, Thomas said.

JGS Lifecare, which operates the Leavitt Family Jewish Home and the Sosin Center for Rehabilitation (JNH) in Longmeadow, sent a letter to families last week saying 21 residents who contracted COVID-19 have died. The company cited limited access to testing and the narrow criteria as barriers to preventing the spread of the virus.

Instead of waiting for testing to become available through channels ordinarily available to nursing facility providers, we proactively contracted with a private lab to begin the process of wide-scale testing of our residents at JNH, the letter reads.

Over half the facilitys 180 residents and over half its 84 employees tested positive, JGS Lifecare said.

Efforts to expand testing at long-term care facilities began March 31, when the Department of Public Health launched a mobile testing program.

The testing was initially approved for nursing homes, but the program expanded to include assisted living facilities and certain group homes. Now those facilities with trained clinical staff can order tests to administer or get the National Guard to test people, as they did at the Holyoke Soldiers Home, if at least one resident has symptoms.

Health and Human Services Secretary Marylou Sudders, director of the states COVID-19 Command Center, said last week that samples collected by the mobile teams would be prioritized for testing by the Broad Institute, with results returned within 48 hours.

In its first week, the National Guard was deployed to 80 nursing homes and rest homes across the state, conducting more than 1,300 tests. On April 6, DPH started letting the facilities with trained clinical staff to order test kits and conduct the tests internally, sending samples to the state lab for testing.

As of Monday, the state has conducted more than 3,700 on-site tests at more than 220 facilities. At least 35 facilities ordered test kits to collect samples on their own, Gov. Charlie Baker said Monday. The state sent out almost 4,500 tests.

Baker said the rollout of the mobile testing program and the quick implementation of no-visitation policies in facilities across the state helped keep the rate of infection relatively low among long-term care facilities that house older residents.

Gov. Charlie Baker speaks during a media availability at the State House to discuss updates relating to COVID-19 on April 13, 2020 in Boston.Staff Photo By Nancy Lane/MediaNews Group/Boston Herald

Speaking from the Massachusetts State House Monday afternoon, Baker touted those two actions as the reason a fraction of the states roughly 1,000 facilities had at least one confirmed COVID-19 case.

The large percentage of facilities without cases is quite a tribute, I think, to a lot of the folks who work in many of those institutions, and we shouldnt forget that, he said.

The states latest figures show 214 long-term care facilities with confirmed cases.

But health care operators argue the number of outbreaks and the severity of COVID-19s impact will only worsen if testing is not more widely available.

Tara M. Gregorio, president of the Massachusetts Senior Care Association, wrote in a letter to Baker and legislative leaders that one model projects thousands of infections and deaths among nursing home residents if there are more delays in widespread, comprehensive testing and access to protective gear.

In the worst case scenario, Gregorio projects up to 19,000 nursing home residents, or half of the resident population, and one-fifth of employees could become infected. Gregorio said the model suggests a death rate of up to 10% of residents.

The most likely scenario, she added, predicts more than one-third of the nursing facility population contracting the virus, killing 3% of residents.

In the letter, Gregorio said the states mobile testing program is well-intentioned but not enough to meet the needs of facilities across the state.

While we appreciate the Command Centers recent and ongoing expansion of mobile testing, the reality is that facilities are still facing significant barriers, including extended wait times for the testing, delayed testing results, as well as inconsistent testing guidance, the letter states.

Gregorio said wider surveillance testing has to happen now to avoid a much larger crisis.

While Massachusetts is among the top states in the U.S. for testing per capita, Baker agreed more needs to be done.

If you were to say to any of us here, are we doing enough testing? We would say no, he said, and if you talk to most other states, they would say the same thing.

Baker said the bulk of his call Monday with Vice President Mike Pence and other governors focused on testing capacity, but it is unclear whether what that means as far as testing among residents in long-term care facilities and the staff.

The Loomis Lakeside at Reeds Landing in Springfield, a 500-resident senior living facility, has had four residents test positive for the coronavirus. All four lived within the facilitys 42-bed skilled nursing unit, said Margaret Mantoni, CEO of Loomis Communities.

"The testing has been extremely limited," she said. "Knowledge is power."

The Loomis properties include the senior communities Applewood in Amherst and Loomis Village in South Hadley. Applewoods independent living community would not qualify for the mobile testing program. Some of the residents and staff at Loomis Village, which has both independent and assisted living, could qualify.

Lori Mayer, a spokeswoman for Genesis Health Care, which owns Heritage Hall in Agawam, said access to testing at the nursing homes is improving since the mobile testing program launched.

So far at Heritage Hall West, 57 residents and 12 staff have tested positive. There have been four deaths, she said. The disease has not been found in the other Agawam Heritage Hall facilities.

We are now able to get results within 24 hours and can test entire buildings if needed, Mayer wrote. "At the end of the day, we cant fight what we cant see. Thats why testing is so critical for nursing home patients, residents and those caring for them. "

Lisa Gaudet, vice president of communications for Berkshire Healthcare, said dealing with a set of state responses that change every day is part of the challenge. Berkshire Healthcare has 15 skilled nursing facilities and three senior housing communities. Its operations include the newly opened East Longmeadow Skilled Nursing Facility, Day Brook Village in Holyoke and Linda Manor in Northampton.

Berkshire Healthcare is testing residents when, under DPH guidelines, there is a resident with symptoms, Gaudet said.

I hope we are keeping up with it, she said. We are all learning, and we are learning every day.

Gov. Charlie Baker listens as Health and Human Services Secretary Marylou Sudders speaks during a media availability at the State House to discuss updates relating to COVID-19 on April 13, 2020 in Boston.Staff Photo By Nancy Lane/MediaNews Group/Boston Herald

AdviniaCare, a residential care facility in Wilmington, was designated to become a treatment facility for only COVID-19 patients until social workers and other officials convinced the state to test the residents and staff.

Fifty-one of the 98 residents who were set to be moved tested positive for the virus, prompting the state to halt its plans, WBUR reported last week.

In doing that testing, more than half of individuals who were asymptomatic tested positive, Sudders told reporters Monday.

The state changed course and selected multiple decommissioned or otherwise empty nursing homes to be converted into COVID-19 treatment facilities, adding 986 beds for COVID-19 patients.

The testing at AdviniaCare may serve as a lesson for why testing asymptomatic residents is crucial to preventing the spread of the coronavirus but most long-term care facilities across Massachusetts do not have that option.

It would be wonderful to have the ability for the city to be able to test congregate populations like those individuals who are living in shelters so we can rule out COVID-19 or rule in COVID-19 and monitor those individuals in shelter facilities, as well as long-term care and nursing facilities, said Helen R. Caulton-Harris, Springfields health commissioner.

Caulton-Harris is tracking multiple clusters of cases at nursing homes and long-term care facilities, Including the outbreak at Chapin Center that has infected at least 43 people and killed one resident.

When multiple cases are identified, local health officials follow up with those who tested positive to check if they have good personal hygiene habits and find out who they might have exposed. Health officials then have to track down the exposed individuals, warning them to self-quarantine, as part of a process called contact tracing.

The Chapin Center in Springfield.

If a facility sees a rise in cases, the state sends an epidemiologist to make sure the facilitys staff and residents are practicing social distancing and washing their hands regularly, Caulton-Harris said.

The role of local public health is then to follow up with that facility and to make sure that they are doing everything they can to keep the residents safe by social distancing and just monitoring the symptoms of the residents there, Caulton-Harris said.

In some cases, the state could order increased testing and order all residents to be tested, but the state is in charge of providing those test kits, she said.

The kits are not widely available to test people in congregate settings, including nursing homes where there may be asymptomatic residents and employees. Springfield has been asking for test kits, but has not received them, Caulton-Harris said.

Sudders said the state is taking steps to test more asymptomatic people. She said the Executive Office of Health and Human Services reviewed the needs of various nursing homes over the weekend, including staffing, protective equipment supplies and infection control.

Sudders also said she hopes the creation of COVID-19 wings and non-COVID-19 areas within long-term care facilities could help reduce the spread, in addition to additional testing in these locations. Her comments come a week after the state announced $30 million in funding for COVID-19 treatment within nursing homes, and another $50 million in funding for all nursing homes across the state.

Its another thing to check temperature, but people may be asymptomatic, Sudders said.

We continue to try to respond," she added. We understand that individuals who are the most vulnerable are people who are in those 24/7 congregate care facilities.

Some health care operators say the parameters for mobile testing are too stringent. Independent living communities, which house people in their 50s or 60s or older, are not eligible for tests under the program, according to the states overview.

Thomas, the Glenmeadow executive, said proactive testing means being able to check every resident and employee, including employees who recently switched from a facility that had an outbreak and residents in independent living centers.

The Longmeadow community has 250 employees and 160 residents, including 33 residents in assisted living.

The state added assisted living centers to the list of those eligible for the mobile testing program. But Thomas said she worries about the rest of the Glenmeadow residents, who may be presumed healthier than their counterparts in higher levels of care. Given what state officials have said about transmission among people with no symptoms, Thomas said waiting for symptoms in an assisted living or independent living facility is like sitting on a powder keg with a lit fuse.

What I need is enough tests to test all the staff and all the residents here, Thomas said. We cant test if there are no symptoms.

The facilitys one case, a 97-year-old resident who tested positive after experiencing symptoms, was able to get a test after it was ordered by a physician, Thomas said. That resident is being treated outside of Glenmeadow and is stable.

Our average age is 88. They have all the same frailties as residents of nursing homes, Thomas said. We absolutely want to keep people out of Baystate Medical Center.

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