‘Sitting ducks:’ Kentucky nursing homes need help fighting coronavirus
Some of Kentucky’s roughly 280 nursing homes don’t have enough personal protective equipment, access to COVID-19 tests, beds or staff while fighting deadly outbreaks of the highly infectious novel coronavirus. And with a pandemic raging, they’re not sure what to do with new arrivals knocking at their doors.
“We are pretty much sitting ducks if we get someone who is infected in our buildings. I think the state of Kentucky has finally figured that out,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities.
Johnson’s organization is publicly pleading for donations of PPE, including masks, gloves, gowns and protective eye wear. Hospitals have been getting first dibs on protective equipment distributed by local health officials in Kentucky communities, she said Friday. Left on their own, nursing homes employees are sewing home-made masks and reusing what little gear they had on hand, she said.
The U.S. Centers for Disease Control advises nursing home staff to wear PPE when caring for residents during the pandemic, “but that doesn’t account for us being left out of the supply chain,” Johnson said.
“We’ve had staff members reaching out to us this week saying they don’t have the PPE they need to stay safe. They ask, ‘Is there somebody out there working on getting this for us?’” said Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington.
In Kentucky, there have been at least 227 nursing home residents and employees infected — and 18 residents killed — by the coronavirus, spread among 29 facilities, Gov. Andy Beshear said on Friday. At Treyton Oak Towers in Louisville, where five people have died, the Kentucky National Guard helped evacuate 18 infected residents on Thursday, taking them to a local hospital.
In Adair County, health officials confirmed 33 COVID-19 cases Friday among residents and staff at Signature HealthCARE at Summit Manor. In Jackson County, officials reported 34 confirmed cases Friday at Jackson Manor, including 18 residents and 16 staff.
Beshear this week established a Long-Term Care Advisory Task Force to assist state health officials on coordinating with nursing homes as the virus spreads.
“We’re working and planning every day to take care of the most vulnerable during this crisis. Individuals from across the Cabinet for Health and Family Services are working together to address the complexities of responding to COVID-19, in a manner that is in the best interests of residents and the capabilities of individual health care facilities and systems,” Beshear spokeswoman Crystal Staley said Friday in a prepared statement.
‘We’re asking for widespread testing’
Culp, a member of the task force, said nursing homes are struggling to deal with the crisis and need all the help they can get. For one thing, Culp said, most nursing homes don’t have enough access to tests that confirm if residents and employees are infected with the coronavirus.
“I don’t think there has been a wide availability on testing unless someone who works or lives in a facility is actively showing symptoms,” Culp said.
Johnson said that when nursing homes cannot reach an arrangement with their local health departments on testing, they have been forced to seek out deals with expensive out-of-state labs. The alternative is not knowing if the virus has arrived or if it’s already passing from person to person, she said.
“We’re asking for widespread testing,” Johnson said. “This is a virus that can be asymptomatic for a period of time, so you need to be checking everyone in the facility — residents and staff — on a regular basis. It can spread like wildfire once it gets in there.”
Four sites opening for nursing home patients with COVID-19
The state Department of Public Health has taken steps in recent days to relieve the pressure on nursing homes in two areas: beds and staff.
To help nursing homes relocate residents sickened by COVID-19, the state is in the process of opening four dedicated “alternative sites,” three of them in Louisville and one in Winchester, with 100 beds between them. These will be portions of existing care facilities that will be entirely cordoned off, with their own entrances and staff, dedicated to coronavirus patients from nursing homes.
Residents who are sickened will transfer first to a hospital for acute care and then to one of the alternative sites, under the plan. They will not return to their original nursing home until they are well again and test negative for the virus.
On staffing, federal and state regulatory officials temporarily have waived certain training requirements for personal care attendants “to address work increases and staffing shortages caused by the COVID-19 pandemic.” In extreme cases, such as River’s Bend Retirement Community in Lyon County, where a viral outbreak is sickening residents, the Department of Public Health dispatched a small team of medical students to assist the facility’s overtaxed staff, Commissioner Steven Stack said Thursday.
Nursing homes still accepting new patients
One unresolved problem is how tightly nursing homes should lock their front doors.
Beshear ordered the facilities closed to almost all visitors a month ago. Only essential staff members are supposed to be coming and going.
But the Kentucky Cabinet for Health and Family Services “has communicated that it is absolutely imperative during this time that facilities continue to accept admissions from the community and transfers (from hospitals) in order to keep acute beds open for those who absolutely need them,” Johnson’s organization tells its members on its website.
The problem is, every new arrival during a pandemic could be carrying the virus, Johnson said. It’s impossible to know for certain without universal testing. Her group advises members to screen newly admitted residents as they would anyone else, checking for fever and other symptoms, but that’s not a foolproof system, she acknowledged.
Culp related a story from recent days: A male resident of a Western Kentucky nursing home fell, broke his hip and was admitted to the local hospital. After a brief hospitalization and a short period in a rehabilitation center, the man tried to return to his nursing home. But the facility blocked his return because the rehab center had had a positive coronavirus case, she said.
“Some facilities are saying they don’t want to take someone who is positive or who may have been exposed to someone who is positive,” Culp said. “I suppose you could try testing people before you take them, but in reality, they’ve not been able to test anyone unless they’re already showing symptoms.”
This story was originally published April 10, 2020 at 5:01 PM.
