State Makes Nursing Home Data Available

An illustration of an elderly man hugging his adult son above the CMS logo

One of the first coronavirus outbreaks in the United States occurred at a nursing home in Washington state.

Currently, nursing homes are supposed to report their infection rates and deaths to their state health departments, but only 33 states require reporting of death rates in those facilities.

Health officials defended the decision as the most efficient way to get a quick handle on what is happening in the homes. More is needed: to contain the spread of the virus we must drive the transmission rate below one.

The COVID-19 death toll at county residential facilities topped 1,000 this week, with the vast majority at nursing homes.

Under President Trump's leadership, we are using CMS's regulatory authority to facilitate residents' care and ensure that long-term care facilities have the guidance they need to prevent the spread of COVID-19.

No nursing home in any state should start to reopen or relax any restrictions until all residents and staff have received a base-line negative test, the guidelines said.

Although the ban on visitors is meant to keep residents safe, Toby Edelman of the Center for Medicare Advocacy said the prolonged isolation could have negative consequences, since family members often act as an extra set of eyes to ensure their loved ones are being properly cared for. That's about a third of the almost 400 facilities in the county.

On May 7, however, Gov. Walz and Minnesota Commissioner of Health Jan Malcolm jointly announced a "five-point battle plan" created to address "COVID-19 challenges for long-term care facilities". That said, McClure added, about 6.3% of Gracedale's population has died of COVID-19, a percentage that "compares very favorably with many much smaller homes".

Still, he said he was not aware of a nursing home that accepted an infected resident despite being unprepared to do so.

"I'm not sure you can practically do testing every day. Well, you can do something about that", Wasserman said. Workers who hadn't had their flu shots were working without masks.

But if you test only a small sample of residents and don't bother to test staff, you are bound to miss positive cases, Wasserman said.

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This reality is likely behind the initial outbreak at the Life Care Center of Kirkland, a nursing home near Seattle.

"In the long range, we will have to have infection control capabilities in nursing homes that are really pristine and really unassailable". Experts say fear of bad publicity and the cost of the tests could have been factors.

Another source of infection entering nursing homes is elderly people who have been discharged from the hospital to nursing homes after things like hip fractures or heart procedures for short rehabilitation stays.

That's a concern for facility owners.

However, other nursing homes have been allowed to admit COVID-19 patients under private arrangements with hospitals. "Unless we test everyone, we're not going to know where it is", said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, a group that advocates for nursing home residents.

Dr. Manuel Eskildsen, who teaches in the Division of Geriatrics at UCLA and works as a clinician for a network of nursing homes, said there has been noticeable progress in testing even in the last week.

One New York nursing home, where a respiratory infection sickened 38 residents, did not maintain a complete and accurate list of those infected, did not isolate residents with symptoms or staff members helping infected patients, and continued allowing residents to eat in the common dining room, according to the report.

That's actually "a triumph", Eskildsen said, because it allowed the home to isolate the cases and control what could have been a huge outbreak without the testing.

Pennsylvania's top prosecutor, Attorney General Josh Shapiro, has opened criminal investigations into several nursing homes.

"It's disgraceful that the county would take a step backward on testing at a time when dozens of nursing home residents are dying from the coronavirus nearly every day", said Michael Connors, a spokesman for California Advocates for Nursing Home Reform.

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