Coronavirus in Ohio nursing homes: What you need to know

Coronavirus preparation at local nursing homes: what you need to know

As cases of COVID-19, the disease caused by the novel coronavirus, increase in Ohio, skilled nursing and assisted living facilities are restricting visitors and outings in an effort to prevent the disease's spread among their residents, who are at the highest risk for severe illness and death.

CLEVELAND, Ohio —The first few people to test positive for the novel coronavirus in Northeast Ohio are all in their 50s. But as infection spreads in the community, public health officials are most concerned about the impact on older adults.

Dr. Frank. Esper, an infectious disease expert at Cleveland Clinic Children’s, said long-term care and nursing facilities have reason to be cautious: it’s still unclear why, but COVID-19 is most deadly for people over the age of 70, and for those with underlying health conditions such as heart disease, COPD and emphysema.

Nursing facilities, where residents live in close quarters and staff frequently move from room to room, are ideal locations for infections to spread, he said. Add to that many residents have difficulty washing their hands and maintaining their own hygiene, and it’s a recipe for an outbreak.

An outbreak in a nursing facility in Kirkland, Washington, which began undetected about three weeks ago, has now killed 19 residents and infected at least 31, according to health officials there. It’s still unclear how the first resident came into contact with the virus.

The Centers for Medicare and Medicaid Services on Monday announced updated guidance for long-term care facilities and nursing homes advising no visitation in areas with community spread of the virus, and limited visitation in counties where people have tested positive for the virus. In those counties, and the ones adjacent to them, visitation should be limited to end-of-life situations and when emotionally essential to the patient.

In Northeast Ohio, most facilities began following these guidelines after the Cuyahoga County cases were announced, with many also canceling events and outings or screening employees and residents for symptoms of the disease, known as COVID-19.

On Tuesday, the Department of Veteran Affairs announced it is indefinitely suspending visitation and new admissions at its 134 nursing homes nationwide. Visitors will still be allowed to see hospice patients.

As of Wednesday, all nursing homes and assisted living facilities in the state were directed to follow suit when Gov. Mike DeWine issued an order limiting the number of visitors to one person per resident, per day. The order also requires the facilities to screen visitors for fever and keep a log of everyone admitted.

The Life Care Center in Washington has been criticized for its slow response to the cluster of cases there, in part due to inadequate staffing and infection control procedures.

Esper said the situation there was a “worst case scenario” that has “sounded the alarm” about the coronavirus in long-term care facilities. “Over the past several weeks everybody has been looking at their infection control policies.”

Ohio facilities respond

There are 950 skilled nursing facilities and 700 assisted living facilities in Ohio, which house and take care of 120,000 people, said Peter Van Runkle, executive director of the Ohio Health Care Association, a trade association representing skilled nursing, assisted living, home care and hospice.

“We are taking care of a very vulnerable population,” Van Runkle said.

Ohio facilities are following Centers for Disease Control and Prevention (CDC) guidelines, he said, which include:

  • Screening visitors when they enter these facilities to be sure they are not sick, haven’t come in contact with an ill person or traveled to a place where COVID-19 is prevalent;
  • Monitoring staff members for symptoms of COVID-19 and sending them home if ill;
  • Alerting hospitals and/or public health authorities when transporting a patient or resident who has symptoms of COVID-19; and
  • Isolating patients or residents with respiratory symptoms or fever in their rooms.

Delivery people at these facilities also will be screened if they come into contact with patients, Van Runkle said.

The Weils, a non-profit assisted living senior community in Chagrin Falls owned and operated by Montefiore, is restricting all visitors per CMS guidelines, according to a message sent on Tuesday to family members of residents by Adminstrator Ari Hyman.

The Weils also has canceled all outside group events and activities, as well as resident outings and is monitoring employees for symptoms at every shift, according to the letter.

Toledo-based HCR ManorCare, which operates more than 200 skilled nursing and more than 50 assisted living facilities across the country, is taking the additional step of taking the temperature of visitors, according to a statement posted on its website. The CDC has not released guidelines on how high a fever must be to cause concern, but screening for fever has been used in airports and other locations since the early days of the outbreak.

At Judson Services, Inc., a not-for-profit organization that operates continuing care retirement communities, as well as home care and hospice, staff are cleaning and disinfecting “high touch” surfaces in the facilities such as doorknobs, faucets and communal areas, said Cindy Struk, vice president of health services.

Judson has been providing education on infection prevention for residents and staff this week, Struk said, and has set up a website for updated information. Resident trips haven’t been canceled, she said, but will continue to be evaluated as local conditions change.

Questions to ask

If you have a loved one in a long-term care facility and haven’t yet seen any communication about the disease, Esper suggests contacting the administrator or ombudsman to ask for a plan or policy.

“You are absolutely within your rights to ask if there’s a policy in place for this outbreak,” Esper said.

Judson’s Struk said facilities should be able to describe their plan and potential impacts of the virus, as well as “how they are prepared for staffing or resource/supply challenges in the event of a widespread outbreak.”

Charlene Harrington, director of the UCSF National Center for Personal Assistance Services, said family members should ask if their loved one’s nursing or assisted living facility has enough nursing staff, and the ratio of residents per aide.

“There is a high correlation between inadequate staffing levels and infections,” Harrington said in an email. While nursing homes are supposed to provide training for staff and have an infectious disease expert on staff, “it is doubtful that nursing homes are following this guideline... most are so short on staffing they fail to do basic hand washing between residents and have very poor sanitation control procedures too.”

It may also be worth asking if a loved one’s facility has equipment on hand to respond in case of an outbreak: Some Ohio long-term care facilities have expressed concern about having enough personal protective equipment, such as masks, gloves and gowns, said Van Runkle. The state has an emergency supply of this equipment, but it has not yet made it available to healthcare facilities, he said.

Plain Dealer reporter Julie Washington contributed to this story.

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