Amid Hundreds of Coronavirus Deaths in California Nursing Homes, It's Still Not Clear How State Is Monitoring

California is now monitoring nearly 200 nursing homes where coronavirus has spread among thousands of care workers and patients, Gov. Gavin Newsom said Tuesday.

It’s still not clear what monitoring means or how exactly it’s helping slow the spread in long-term care facilities. Where assisted living and nursing homes report problems, like with shortages of protective gear or staff, county public health departments have varied responses and levels of resources to fill the gaps. The governor says testing is a priority, but it’s not required where outbreaks are reported, either by state or local order.

Over 40% of COVID-19 deaths have been people who lived or worked in elder care facilities.

"I don't feel very monitored," says 85-year-old Davlyn Jones, who has been recovering from a stroke at the Mountain View Healthcare Center in Santa Clara County. Looking out her window and across a patio, she can see  into the wing where nurses have told her that COVID-19 patients live.

As of April 28, the skilled nursing facility reports at least one case of coronavirus. Jones says her caregivers reported the presence of the virus there to her only after she asked about what she was seeing.

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“Occasionally I'll see the nurses and doctors coming out fully clothed in protective gear, not just face masks, but everything,” she says. “So it's close.”

Jones needs a walker; she has lost some control of movement in the left side of her body. But she's also pretty buoyant; she says that she's healthy, considering her age, and the risks inherent to a pandemic.

“I’m scared to death. [But] other than that, yeah,” she laughs.

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Jones, a longtime feminist and founder of hundreds of chapters of the National Organization of Women, is also assertive. She says that helped her push for her own COVID-19 test.

After two months that included hospitalization for a stroke and time in skilled nursing, Jones is returning home today, to her two-bedroom residence in San Jose’s Winchester Ranch Mobile Home Park. In order to contract with in-home support services as she continues to recuperate, Jones says she needed to prove she had not been infected with the coronavirus.

Initially, she says, her doctor told her she wouldn't get a test.

Mountain View Healthcare administrators didn’t respond to emailed and telephone questions about testing, though an operator who answered the phone Wednesday confirmed a COVID case.

Santa Clara County health officials say they "have tested large numbers of patients and staff both on-site and via drive through testing, helping to contain any potential outbreaks."

No Testing Requirements

No state rule or guidance requires testing for long-term care home residents or workers who appear well. In the absence of a statewide plan, local health authorities have wide leeway, resulting in divergent methods for how they counsel facilities about tests.

In part, testing availability appears to be driving those decisions.

"If you test everyone in a facility and say there's 500 people, first, you have to have those resources and then you have to decide, OK, I've tested them now (and) they don't have symptoms. And then do I test them every week, every two weeks?" says Dr. Erica Pan, medical officer for Alameda County. "It just becomes like a very big operational logistical challenge with limited resources when we might have another facility that has 10 symptomatic people that we need to test."

Pan says the utility of testing is also a factor. "I only want to order a test that I know what I'm going to do with information," she said. Since workers and residents will continue to interact in a high-risk environment, Pan says the test may mislead them into false confidence or fear about not having or having the virus.

In Los Angeles, Mayor Eric Garcetti has doubled the number of teams available to test in long-term care facilities and ordered nursing homes to test workers monthly going forward. The governor has also said that testing is a priority and there needs to be more: “A lot more, it’s not enough, that’s the honest truth.”

Jones says she’s worried about the nurses and care workers at the facility too. Over the last month, she says, it appears that fewer staffers have to work harder now, caring for patients separately, COVID-19 positive or not.

Mountain View Healthcare Center also did not respond to questions about staffing. In Santa Clara County, health officials say they've supplemented staffing at facilities with larger outbreaks, using county workers and workplace registry lists.

In Alameda County, medical officer Pan says "there have been some really difficult situations where the staffing was at very concerning levels" during an outbreak. As a result, health officials "have gotten creative" when responding to staffing requests, including by working with EMTs.

But Pan says it's hard to meet all of the need. "The very unique situation about being in a pandemic is we can't ask for mutual aid in the same way you can when you have a local disaster, because everyone is experiencing the same situation," she says.

The state has created a database of potential volunteers to supplement pandemic health care needs, though it's not clear how many volunteers have gone to assisted living or nursing homes.

More generally, monitoring, at the state and county level, is done remotely. In Santa Clara, the emergency operations center sends a  survey every day to all congregate living and long-term care facilities in the county. The California Department of Public Health says it calls facilities daily, using its cadre of 600 health facility evaluation nurses who conduct inspections and surveys in nonpandemic times.

Jones is happy she has tested negative for COVID-19. But she remains worried, both for her neighbors in the mobile home park, with whom she has agreed to take strict precautions to limit exposure, and for the care workers at the skilled nursing facility she is now leaving behind.

“The nurses are nice,” she says. “And I worry about them getting the disease and dying. Too many people have died from this thing.”

 

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