LINCOLN — The coronavirus pandemic has reached more than one in 10 Nebraska nursing homes and assisted living facilities, causing sickness and death among some of the state’s most vulnerable residents.
At least that’s the best estimate from an industry representative.
Official tallies are unavailable from the Nebraska Department of Health and Human Services, including the number of affected facilities, number of cases among residents and staff, and number of deaths. Unlike some states, Nebraska also does not make public the names of facilities with infections.
An HHS spokeswoman said officials are “currently compiling and analyzing data” and “hope to have that available in the future.”
But Heath Boddy, president and CEO of the Nebraska Health Care Association, which represents both nursing homes and assisted living facilities, said long-term care homes are struggling to control outbreaks, maintain staffing levels and find enough protective equipment for workers.
“It’s still an awful fight, a war of sorts with the virus,” he said. “I think we are north of 50 buildings that have been affected.”
Nationally, the coronavirus has killed more than 11,000 nursing home residents, according to various sources. That’s out of more than 50,000 deaths in the United States.
Among them were at least 37 people associated with the Life Care Center of Kirkland, Washington, a nursing home that gained infamy as an early virus hot spot. The home now faces sanctions from Medicare for failing to meet federal care standards.
No known Nebraska outbreak has reached that level. But Carter Place, an assisted living center in Blair, went into lockdown in mid-March and later temporarily closed after 13 residents and six staff members tested positive for the disease. One resident, Darrell Dibben, died of the disease at age 90.
At least 22 infections have been tied to the Gold Crest Retirement Center in Adams, Nebraska. The infections, identified in late March and early April, killed three residents.
News reports have identified some of the others. Among them are cases connected to the Central Nebraska Veterans' Home in Kearney, Douglas County Health Center in Omaha and Callaway Good Life Center in Callaway, Nebraska.
Michelle Chaffee, who heads the Nebraska Office of Public Guardian, raised an alarm about the rates of infection and death in Nebraska long-term care facilities. In a letter to state policymakers, she called for testing all residents and staff of a facility once a case is confirmed in the facility.
Based on her office’s experience with wards in long-term care facilities, she said there has been confusion and inconsistency in how facilities are handling coronavirus cases.
In one example, she said the public guardian was told that a ward would not be tested unless the person showed symptoms. After symptoms appeared, the person was tested but was not sent to the hospital even after his fever rose to 103 degrees. The ward finally made it to the hospital after the guardian insisted.
In another facility, she said, X-rays showed that a ward’s lungs were affected and that he had a constant cough but no fever. The facility refused to test him, saying that it had only two tests available and that those were being saved for people with most symptoms.
“As long as you’re only testing people when they have symptoms, you’re simply treating the results, you’re not treating the spread,” Chaffee said.
On Friday, Mark Parkinson, head of the American Health Care Association and National Center for Assisted Living, also called for more testing in long-term care homes, saying the true extent of infections cannot be known without adequate testing. He said facilities that have done expanded testing have found a high number of residents and staff who have the virus but show no symptoms.
“Lack of timely testing in long-term care has forced providers to rely on a symptoms-based approach, which ... will not prevent the spread of COVID-19,” he said.
In Nebraska, Boddy agreed, saying homes would appreciate being able to find out the full extent of infection.
Nebraska, however, does not have enough tests available to test all residents and staff at facilities with infections, according to Dr. Gary Anthone, the state’s chief medical officer and head of HHS’s public health division.
Health officials instead focus on testing residents and workers who show symptoms of coronavirus, such as a fever, dry cough and shortness of breath. Once someone tests positive, officials investigate to find out who might have been exposed to the person and may need testing.
“We do not test individuals without symptoms, as they could test negative one day and then contract the virus in the following days,” said HHS spokeswoman Leah Bucco-White, noting that the state is following current guidelines from the federal Centers for Disease Control and Prevention.
To help facilities, she said state public health officials have been working closely with local health officials, long-term care facilities and others on strengthening infection control policies and practices. State officials have provided training for staff and administrators on such topics as the proper use of personal protective equipment.
If a facility has an outbreak, Bucco-White said an infection prevention expert from Nebraska Medicine’s infection control assessment program, along with one of the HHS physician epidemiologists and local health officials, will work with administrators on controlling spread and ensuring safety for residents and staff.
“Care for residents in long-term facilities is a top priority,” Bucco-White said.
But getting supplies of protective equipment, such as masks, gloves and gowns, for proper infection control has been a struggle for long-term care facilities. Parkison’s group reported recently that more than 70% of providers have been unable to get enough equipment.
Jenifer Acierno, CEO of LeadingAge Nebraska, a network of nonprofit long-term care facilities, said homes have been forced to reuse equipment if they did not have a big stockpile on hand or access to someone who could sew homemade masks and gowns.
She said federal and state guidance has recognized the realities facing long-term care homes. For example, guidelines put out by the state and the Nebraska Medicine infection control program allow employees who have been exposed to coronavirus to continue working as long as they wear masks and are actively monitored for symptoms.
Acierno said that provision helps facilities that could see severe staff shortages if all exposed workers were forced to quarantine themselves.
“I think our members are doing the best they can,” she said.