High-risk, large-scale, low-income nursing homes with a surge in COVID-19 in California, experts say

When Sharon Kimball arrived at the Arden Post Acute Rehabilitation Center in March, her first thought was that it was much larger than she had expected.

“It’s a big place,” she said. “There are all these holes … 500 holes.”

The 75-year-old was transferred to a Sacramento facility in March and recovered from post-hospital pneumonia.

Arden’s home takes care of people who have recovered from a fall, stroke, or surgery. The State Department of Health has identified it as a skilled nursing facility, and according to their data, there have been 83 positive COVID-19 cases among residents in the home since the onset of the pandemic.

As of November 12, Kimball is one of them.

“I don’t know who gave it to me or anything,” she said. “I realized I was positive and was put into the room.”

As of December 4, there were a total of 11 COVID-19 cases of facility residents. According to the state database.

Since the beginning of the pandemic, skilled care facilities have been a major source of dissemination.Nursing home residents make up 0.5% of California’s population, while 26% of COVID-19 deaths This month’s report From the University of California, San Francisco, IBM Watson Health, California Health Care Foundation.

According to the analysis, the number of deaths at these facilities is increasing. In May, one-quarter of the 800 nursing homes surveyed had more than one COVID-19 resident, and at least one in 16% died. By August, 66% of facilities had COVID-19 and 37% had at least one resident dying from COVID-19, according to the report.

Christoph Stremikis, director of market analysis at the California Healthcare Foundation, said the problem is the current surge, with more than half of care facilities experiencing COVID-19-related resident deaths, according to the latest data. ..

“It’s really, really popular, and very deadly in that setting … you need to be careful,” Stremikis said.

Many beds, few workers

The report found that there are several risk factors that increase the likelihood that COVID-19 will spread to skilled care facilities. This includes the size of the house, the level of staff, and the racial and economic composition of the occupants.

Nursing homes with 99 or more beds had a 55% or more higher case rate than nursing homes with 68 or less beds, and even larger homes had a higher mortality rate. According to a survey, there were 177 beds in Ardenpost acute rehabilitation when Kimball became ill as of August.

Arden Post Acute Rehab did not respond to a request for comment on Friday.

DeAnn Walters is Director of Clinical Issues and Quality Improvement at the California Health Facility Association and represents nursing homes and other collective care environments.

“During May-August, when the community continued to deal with COVID … it entered the doors of even more facilities,” she said. “As the virus spreads throughout the state, it’s not surprising that more facilities will be affected by the virus.”

According to the report, nursing homes that do not meet the state’s recommended staff level are about twice the case rate of homes that exceed the threshold, and nursing homes that have suitable registered nurses on staff have less nursing time. We found that there were 50% fewer cases of COVID-19 than. Per resident per day.

Staffing has been a long-standing problem, Walters said, and the industry has yet to find a solution.

“Unfortunately, as the pandemic progresses, we continue to realize that taking people to health care is very scary,” she said. “Daily appearances in an environment exposed to deadly viruses can be a real sacrifice. People are really tired.”

The authors of the report said that nursing homes reduce staff turnover by reducing the number of residents in large facilities, increasing the use of private rooms, increasing Medi-Cal refunds for services, or making other payment adjustments. It is recommended.

Residents of the most endangered colors

According to the report, the case rate of COVID-19 was disproportionately high in nursing homes with a high proportion of black or Latino residents. According to August data, the incidence of nursing homes, where more than 26% of residents are Latin, was 50% higher. Less than 6% of the residents were of Latin descent.

“Unfortunately, that’s not surprising,” said Stremikis of the California Healthcare Foundation. “We have seen this pandemic having a disproportionate impact on a particular population in California in other situations throughout the healthcare system.”

According to the report, who owns a nursing home is also a factor in whether an outbreak occurs and how deadly it is. According to their data, the COVID-19 infection rate of commercial nursing homes is 5-6 times higher than that of non-profit and government-run nursing homes, which applies to both independent nursing homes and nursing homes that are part of the chain. It was.

Researchers recommend that the California Public Health Service have weekly COVID-19 institutional testing staff and request training in infection control and culturally sensitive care at least annually. They also urge the state to prioritize residents and staff of the highest-risk facilities when it comes to vaccine distribution.

Information gap

Kimball recovered from mild COVID-19 symptoms, but as of Friday, he was kept in a special ward with other residents who tested positive.

She says she likes her home staff, but she doesn’t fill in as much about the outbreak of COVID-19 as she wanted.

“I think they really pulled us out,” she said. “But what was important to me was that the information might have been a little better. More information about what’s happening in general and how many people are getting it. I should have been able to get it. “

She states that she has not been retested since the positive test and does not know how long she has been quarantined from other COVID-positive residents.

Walters, in collaboration with the California Association of Health Facilities, is most likely to bring the virus into the facility, so the protocol frequently tests nursing home staff and only tests patients if someone is symptomatic. It states that it is.

She said that if the patient’s test result is positive, the protocol is to move the patient to the “red zone”, 14 days after the onset of symptoms, until no fever, no other COVID-19 Say you are with a positive patient. Use of antipyretic.

“They are cohorted together to stop the spread,” Walters said. “Usually, the CDC recommends a time-based strategy rather than a test-based strategy, so if the first positive, there are no additional tests.”

She said these guidelines are public and the facility is doing its best to inform the family of their family status in the event of an outbreak, but it can be difficult to stay in touch when working on an outbreak. say.

Still, some senior care advocates say the lack of transparency from these facilities is frustrating for families.

“The disaster happening in nursing homes isn’t surprising at all,” said Patricia McGuinnis, secretary-general of California’s advocates for nursing home reform earlier this year. “No one has come to see it. It was absolutely traumatic for both the inhabitants and their families. They can’t talk to anyone.”

Sharon’s daughter, Mary Kimball, said she didn’t know what her mother would do next or how to know when she would return home.

“We were a little worried that she would get COVID, she got COVID, but no one called us,” she said. “It’s all a big, gloomy deal.”

Some nursing homes Use technology to increase communication between residents and loved ones -Especially Given the risk of mental deterioration due to loneliness —But he argues that more effort is needed as the pandemic continues.

CapRadio is supported by the California Health Care Foundation.