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Covid-19 Hits Rural Nursing Homes, Which Are Among Those Least Equipped to Fight It 

Staffers follow recommended precautions, but coronavirus spread like wildfire, administrator said

By: Tom McGinty and Anna Wilde Mathews           Nov. 15, 2020                      Wall Street Journal

 

JSO Comment

This is an article that is hard background into a ‘war’ being raged throughout the senior living community.  Given the data in the article it would be only a small step to understanding the loss in value these rural facilities are experiencing.  It’s not just staffing issues but the purchase and provision of PPP, the loss in occupancy (due to loss of life) with no significant backfill.  Revenues are down, expenses are up and it has to be expected that there will be a long shadow created by the pandemic as to whether residing in one of these communities is safe.  

Covid-19 deaths among vulnerable nursing-home residents are surging again, with the virus increasingly spreading to rural facilities that are struggling with staff shortages and other challenges. 

Nursing homes reported more than 1,900 resident deaths from Covid-19 in the last week of October, as well as more than 32,000 confirmed and suspected cases among staff and residents, according to newly released federal data analyzed by The Wall Street Journal. Those nationwide totals at the facilities were the highest since early August, when states including Texas and Florida were seeing increases.

This time, the virus is infiltrating a far-flung range of facilities, with a growing share of the deaths occurring in rural and small-town communities in states such as Wisconsin, North Dakota and Montana, where case counts have climbed rapidly. The pattern tracks how the virus is spreading more broadly throughout the U.S., hitting regions that had been largely spared earlier in the pandemic.

“Nursing homes are not isolated from what happens in the community,” said Carrie Henning-Smith, an associate professor at the University of Minnesota School of Public Health. “We’re seeing this run rampant through rural communities.”

Facilities in rural counties reported 18% of nursing-home Covid-19 deaths in the week ending Nov. 1, though they housed only 10% of the overall population, according to the Journal’s analysis of weekly survey data from the Centers for Medicare and Medicaid Services. Small-town counties saw 17% of the nursing-home deaths, though facilities there have only 12% of the total residents.

At Lutheran Sunset Home, a 91-bed facility in Grafton, N.D., 55 residents and 46 staffers have been infected since an outbreak started in late October, after Covid-19 infections hit a high rate in the surrounding county. Five residents infected with the coronavirus have died.

Staffers following recommended precautions, but “it still spread like wildfire,” said Trevor Tompkins, the administrator of the nonprofit facility. “To put it bluntly, we’re in hell.”

The trend is a turnaround from the spring, when nursing homes in large cities such as New York were seeing major outbreaks. Facilities in the most urban counties represented around one-third of nursing-home deaths in late May and early June, and only 9% in the most recent week of the data. Rural nursing homes were tied to only 4% of the deaths in late May, compared with their recent share of 18%.

Overall, U.S. long-term-care facilities have been tied to more than 90,000 Covid-19 deaths since the start of the pandemic, according to a Wall Street Journal tally of recent state, local and federal data. Over time, long-term care deaths have tended to represent around 40% of all Covid-19 deaths.

Northern Montana Care Center, in Havre, didn’t have a single case of Covid-19 through the spring and summer, even as the virus devastated facilities on both coasts. But after Covid-19 began spreading in the region, the nursing home saw its first positive test in late September. Eventually, the outbreak spread to 35 of the facility’s 68 residents, killing 16.

“It came into our community and it came strong, and it just found its way into our facility,” said Christen Obresley, the nursing home’s administrator. She said the infection likely arrived through an asymptomatic staff member, though the facility had followed state and federal guidelines on testing and infection control.

The resurgence in nursing-home cases and deaths comes despite new federal requirements that facilities in counties with high Covid-19 rates test staff as often as twice a week, in an effort to detect and stem outbreaks quickly. Many nursing homes have declined to use federally provided rapid-testing equipment, citing concerns including accuracy, yet face delays in getting results from labs. Some facilities have continued to report shortages of protective gear such as N95 masks, a major problem earlier in the pandemic. 

Staffing for many nursing homes outside large metropolitan areas has long been a particular problem, according to researchers and nursing-home administrators. The pandemic has created a crisis for some facilities that can’t find temporary workers to fill in when employees must stay home to quarantine. “The more isolated the community, the harder it is to bring in workforce,” said Shawnda Schroeder, a research associate professor focused on rural health at the University of North Dakota.

Other challenges rural nursing homes face, researchers said, can include smaller buildings that make it hard to isolate infected residents. Rural nursing homes sometimes lack easy access to a hospital or doctor, after closures of many rural hospitals in recent years.

A CMS spokeswoman said the agency has “taken an unprecedented number of public health actions to support nursing homes on Covid-19,” including regulatory moves to ease staffing crunches and allow more use of telehealth, which can help rural facilities that aren’t close to physicians or hospitals.

Guardian Angels Health & Rehabilitation Center in Hibbing, Minn., drew on employees from other facilities owned by the same nonprofit. It put nursing administrators to work in front-line positions and brought in some temporary agency workers, who had to be put up in hotels. Still, in an outbreak that affected 39 residents and 30 employees in September and October, the facility needed help from five National Guard members, who filled in for nine days in early October. Ten residents died.

“Staffing was tight in the first place,” said Scot Allen, a vice president at St. Francis Health Services of Morris, which owns the Hibbing facility. “Then you add in the impact of Covid…It’s very precarious.”

Some rural facilities have been overwhelmed. After an outbreak beginning in early October that sickened all 61 residents, Andbe Home, in Norton, Kan., received an Oct. 26 letter from CMS threatening it with removal from the Medicare program. State and federal regulators found the nursing home’s response to the outbreak, which has led to 20 deaths through Nov. 10, had placed residents in “immediate jeopardy.”

An outside company, Mission Health Communities LLC, is now temporarily overseeing the facility. Cheri Kauset, a Mission Health vice president, said the company is working to help Andbe get back into compliance with regulatory requirements. “We have seen good progress,” she said.

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