June 4, 2021

Why are nursing homes still experiencing Covid-19 outbreaks?

Daily Briefing

    Although nursing homes have made substantial progress against Covid-19 since the vaccination rollout began, the facilities are still routinely experiencing small outbreaks of the coronavirus—driven in large part by unvaccinated staff members, Susan Haigh writes for the Associated Press.

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    Outbreaks continue among nursing homes

    According to Haigh, recent outbreaks at nursing homes are generally "much smaller, less frequent, and less severe" than they were at the height of the pandemic—but they are still consistent enough to account for "hundreds of deaths" each week. For instance, Haigh reports, 472 nursing home deaths were related to Covid-19 in the first two weeks of May, compared with 10,675 such deaths in the first two weeks of January.

    These outbreaks—and the resulting shutdowns for given facilities—have "jolted" the family members and loved ones of those being cared for in nursing homes, many of whom "were just starting to enjoy in-person visits" again, Haigh writes.

    For instance, Jeannie Wells, who was finally able to visit her mother in a nursing home in early April—after nearly a year of no in-person contact amid the pandemic—said the reunion was cut short after a staff member tested positive for Covid-19. The facility suspended in-person visits for six weeks. Many communal activities, such as shared dining and hairdressing services, are still on hold.

    As a result, Wells said that although in-person visits have resumed, it's been so long since she was able to interact with her mother that she no longer recognizes Wells.

    Risks posed by new residents, unvaccinated staff

    Experts have cited two key factors behind the continuing outbreaks, Haigh reports: incoming residents who are not yet vaccinated and the low rate of vaccination among nursing home staff.

    For instance, David Gifford, CMO of the American Health Care Association, said it would be a "perilous mistake" to assume that because "vaccines were administered in long-term care, … we're done." He explained, "Nursing homes and assisted living communities have a constant flow of new residents, whether coming from the hospital or the community, and many of them haven’t been vaccinated yet."

    Separately, CDC also cited the risk posed by the low rate of vaccination among health care workers at skilled nursing facilities.

    For instance, a recent report by CDC highlighted an outbreak at a Kentucky nursing home stemming from one infected, unvaccinated staff member that resulted in 46 cases—including 22 "breakthrough" cases among 18 residents and four staff members who were fully vaccinated. And although most of the cases among vaccinated people were asymptomatic, one vaccinated resident passed way.

    How is the issue being addressed?

    As a result of these issues, according to Connecticut Gov. Ned Lamont (D), trying to keep the coronavirus out of nursing homes is akin to trying to fix "leaky boats."

    The Connecticut Department of Public Health established Operation Matchmaker to pair up nursing homes and pharmacies to make sure that new residents and staff are vaccinated. In addition, hospitals are trying to ensure that patients are vaccinated before they are moved to a nursing facility.

    However, Vivian Leung, director the Healthcare Associated Infections Program of the Connecticut Department of Health, said leaders are stopping short of mandating vaccination among nursing home staff because of staffing shortages across the nation. Nonetheless, Leung said the state is "working with the long-term care industry to really increase the pressure on getting those staff vaccinated."

    Separately, Tim Brown, director of marketing and communications at Athena Health Care Systems, a system of 48 nursing facilities in Connecticut, Rhode Island, and Massachusetts, estimated that between 50% and 60% of staff are vaccinated so far. "Throughout our network, we are seeing [outbreaks of one or two people], mostly with employees, though, [who] have not been vaccinated," he said. "That's really where we're seeing them."

    Brown added that when a staff member tests positive, the network will put the facility on quarantine and suspend in-person visits until staff are re-tested. "If there are no other cases, or if the employee did not work on a specific wing, then we allow visitation for that wing or for … the wings that are not affected by the positive employee," he said.

    And for its part, Connecticut is also trying to minimize how these safety measures affect nursing home residents and families' ability to interact, Haigh reports. Mairead Painter, Connecticut's ombudsman for long-term care, said the state has recently released guidance on how nursing facilities should handle these smaller outbreaks so as to reduce the negative impact on residents and their loved ones (Haigh, Associated Press, 6/1).

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