Pandemic Raging in Nursing Homes

Wisconsin has been working to try to keep nursing homes safe from COVID-19. But as the pandemic has surged across the state this autumn, it has hit nursing home residents and employees hard, too.

Just how hard was made clear by a new analysis from the American Association of Retired Persons (AARP), which every four weeks collects federal data on nursing home infections and deaths in the pandemic.

In the four weeks that ended Nov. 15, there were 2.11 deaths per 100 nursing home residents from COVID-19 — seven times the rate for the previous four-week period that ended Oct. 18, the report found. New cases rose more than threefold, with 13.4 per 100 residents.

Staff cases doubled, with 15.9 employees per 100 residents testing positive for the coronavirus. Reports of staff shortages — exacerbated by employees who had to miss work because of illness or because they were in quarantine after they were exposed to the virus — rose, as did reports of shortages of personal protective equipment (PPE).

The data comes from the nursing homes themselves, who report it to the federal Centers for Medicare & Medicaid Services (CMS). The AARP collects it in a dashboard that the AARP Public Policy Institute developed in collaboration with the Scripps Gerontology Center at Miami University in Ohio, reporting at four-week intervals.

Those alarming numbers come even as Wisconsin has been passing money through to pay for nursing home PPE and more testing for the virus in residents and employees, as well as to help nursing homes pay their employees more.

“We are certainly aware of a number of the interventions that have been taken by the state of Wisconsin” to promote nursing home safety during the pandemic, says Sam Wilson, the Wisconsin AARP state director.

“That being said, the interventions to date, if we were to look at the data, do not correlate to a higher level of safety for the residents, or the staff themselves — because the staff numbers [of infections] are increasing as well,” says Wilson. “All we know is that what has been tried has not been effective to date. And as a result, as community spread rises in Wisconsin, it’s leaking its way into nursing homes as well.”

The Wisconsin Department of Health Services (DHS) posts data on nursing home COVID-19 outbreaks. “Nursing home employees live in our communities,”  says Jennifer Miller, a DHS spokesperson. “As long as we have high levels of community transmission, we will have high levels of cases in our skilled nursing homes, assisted living facilities, and other long term care facilities.”

The AARP report doesn’t address assisted living communities, where there are more people living than in nursing homes, but there hasn’t been any nationally reported data on the pandemic in assisted living. “So what we have is a very narrow picture of a very big issue,” says Wilson.

With Wyoming, Montana, and North and South Dakota, Wisconsin is among the worst five states in the AARP dashboard for nursing home COVID-19 cases and other impacts, with rates twice the national average. Other states appear to have effectively tamped down the virus, achieving “a very flat trajectory for cases within nursing homes,” he adds. “The data would suggest that in some places [available strategies] have been very, very effective.”

For the last decade, Wisconsin nursing homes, rural and urban alike, have been “struggling,” says Wilson, to enlist enough frontline caregivers, including certified nursing assistants and others. “The pandemic has now laid all of that bare, where we had sort of duct-taped it all together.”

In response, the AARP’s policy arm has launched the LTSS Choices project, which proposes new state resources, new regulations for long-term care providers, and investments in pay, health benefits and sick leave for industry employees, among other changes.

The last time the state Legislature met, when it passed the state’s only coronavirus relief bill in April, the legislation included changes to streamline training requirements for certified nursing assistants (CNAs). It also enabled the state to collect $1.9 billion under the federal Coronavirus Aid, Relief and Economic Security (CARES) Act.

Funds from the act have been used to support testing for nursing home employees and residents. The state is also spending $50 million in direct payments to homes and another $30 million to help homes take patients discharged from hospitals, which have experienced a backlog in patient discharges as staff shortages from the pandemic have made it difficult for homes to take new patients.

Last month, the Evers administration announced an $80 million infusion to nursing homes to hire more workers. Altogether, state aid to nursing homes during the pandemic has reached an estimated $200 million, according to AARP calculations. The federal government, through CMS, has also spent about $21 billion nationally to help nursing homes, Wilson says.

Despite those investments, however, the latest data show “we’re at the highest levels now” when it comes to virus spread, infection and deaths.

“We want to support them — we know that nursing homes play a critical role in our long-term care delivery system,” Wilson says. “But there’s just a lot of questions about how resources were spent — and what did that translate into if we’re still seeing so many challenges in our long-term care facilities for residents?”

With the promise of a vaccine soon — and with nursing home workers and residents at the front of the line for the shot once it is available — “we’re hoping that that doesn’t lead to complacency, because it may still be several months” before all nursing home residents can get the vaccine, he says.

Meanwhile, recent numbers of confirmed cases of COVID-19 are down from a month ago. There might be some hope that the next four-week period in the AARP’s data will look better, but Wilson is cautious on that front. Death rate trends are still high, and are about four weeks behind transmission trends, so a decline on that measure might take longer to show up.

At the same time, though, he adds, “we’re really concerned about what the numbers are going to look like when we look at the November-to-December data.”

Reprinted with permission of Wisconsin Examiner.