Copyright © 2020 Albuquerque Journal
The past nine months have been brutal for residents and employees of nursing homes and assisted living communities throughout the state.
Almost 650 residents have died of COVID-19 out of about 3,400 who have contracted the virus since the pandemic began in March.
That is out of a relatively small population of 12,000 who live in 71 nursing homes and 250 assisted living facilities around the state.
Of the 9,600 employees, more than 2,700 have tested positive for COVID-19 at some point in the past nine months. Five staffers have died of the virus.
As of early December, there were nine nursing homes in Albuquerque, Las Cruces, Santa Fe, Truth or Consequences, Aztec and Farmington in which at least 10 residents had died of the virus.
Residents who have escaped the virus have had their daily routines disrupted, living in isolation from family and even their fellow residents.
“In my 35 years in this business, I have never seen anything as tough as this,” said Gerald Hamilton, owner and operator of five Beehive assisted living facilities in the Albuquerque area. “How sudden it came on. How much we didn’t know.”
Hamilton is a member of an industry group that meets weekly with state officials to discuss what needs to be done and how the state’s health orders directed at the facilities are working.
The residents of Hamilton’s small assisted living homes have gone relatively unscathed during the pandemic. An employee recently tested positive for the virus but didn’t come into contact with residents.
Impact on elderly
Throughout the country, the virus has had a disproportionate impact on the elderly, especially those with underlying conditions like heart and lung disease, diabetes and kidney ailments.
It is little comfort to those who have lost loved ones, but New Mexico has fared better than most of the rest of the country when it comes to the number of deaths in nursing homes and assisted living facilities.
Nationwide, more than one-third of the more than 330,000 deaths attributed to COVID-19 have been in long-term care homes.
In some states, coronavirus deaths in nursing homes and elder care facilities account for more than 40% of the deaths due to the virus.
In New Mexico, that number is around 25%.
Gov. Michelle Lujan Grisham has said she has made the safety of long-term care residents a priority – teaming the Department of Health and the Department of Aging and Long-Term Services to respond to the threat it poses to those in nursing homes and assisted living facilities.
“We are definitely working on it every day,” said Katrina Hotrum-Lopez, secretary of the Aging and Long-Term Services Department.
But one of the most pronounced failures is at the state Veterans Home in TorC, run by the state Department of Health.
The home has had more than 100 residents and 75 staff test positive. Twenty-three residents have died, and some are hospitalized now at other locations. The administrator has been placed on leave.
A nurse at the facility outlined alleged problems in a letter to the governor, and a state inspection team made a finding of “immediate jeopardy” based on infection control practices.
The state says those problems have been remedied but further steps are being taken.
Meanwhile a nursing home in Farmington reported 48 COVID-19 related deaths and now faces 24 wrongful death lawsuits.
The lawsuits were filed in recent months and allege improperly sanitized medical equipment, staff not wearing masks and residents not being properly quarantined after a virus outbreak at the Life Care Center of Farmington in April and May.
The lawsuits also allege that the nursing home was short-staffed and that nurses working with residents who tested positive for the virus were reassigned, spreading COVID-19 to residents in other units.
An attorney for the nursing home vowed to vigorously defend the nursing home against the lawsuits.
‘Staff bringing it in’
Last spring, the state began ordering widespread testing of nursing home residents and employees.
Family members were no longer allowed to visit. Outside contractors, including massage therapists, barbers and hairdressers, were banned.
Even volunteers who investigate allegations of negligence for the Department of Aging and Long-Term Services were not allowed inside nursing homes.
Vicente Vargas, director of New Mexico Healthcare Association, which represents long-term care facilities, said, “We were in uncharted waters.”
Hotrum-Lopez said that after the first few weeks the state began to ease off testing residents.
“We were testing a lot of residents, for the most part they were staying within the facilities,” she said.
“We know the staff is bringing it in. There were asymptomatic (showing no symptoms) staff coming into the facilities,” she said. “That’s who we had to test.”
Department of Health Deputy Secretary Jason Cornwell said, “The correlation is directly reflective of county positivity rates where the facility is located.”
He pointed to the state’s Veterans Home in Truth or Consequences in Sierra County as an example.
“From April through August, the virus positivity rate in the county was low,” Cornwell said.
And there were no cases in the home, which serves more than 100 residents.
He said the surge in cases at the home since August is consistent with the increase in cases in the southern part of the state, including Sierra County.
“The virus is everywhere now,” he said.
Testing requirements established by the state Department of Health are:
⋄ If the positivity rate in the county is below 5% then 25% of staff must be tested once a week on a rotating basis.
⋄ If the positivity rate in the county is between 5% and 10% then all staff and residents who leave the facility for medical treatments such as dialysis are tested once a week.
⋄ If the positivity rate in the county is greater than 10% then all staff and residents who regularly leave the facility are tested twice a week.
If an employee or resident tests positive, then all residents and staff are tested and a track-and-trace is initiated by the state to determine who may have been in contact with the person testing positive.
Facilities with residents who have tested positive for COVID-19 have to be separated into three zones: a red zone for residents who have tested positive; a yellow zone for patients who may have been in close contact with staff or a resident who has tested positive; and a green zone for residents who have tested negative and have not been in close contact with someone who has tested positive.
Staff not at fault
State officials and industry executives don’t believe the employees who test positive are at fault.
“These are people who leave work and have to go out into the community and buy groceries, get gas and go home to their loved ones who may also be working,” Vargas said.
“They are not in a position to isolate themselves,” he said.
Hotrum-Lopez said that asymptomatic spread is the major factor in COVID-19 outbreaks in facilities.
“People going to work without knowing they have the virus is the major issue,” she said. “It correlates to high county positivity rates.”
She said state officials looked at other factors in nursing homes to see if there was a correlation to COVID-19 outbreaks and came up empty.
“The only correlation was to the spread of the virus in the surrounding community,” she said. “We had facilities with no positive tests until the community began showing positive tests.”
Hamilton said he has found his employees take precautions when they leave work and act responsibly.
“But asymptomatic spread is definitely an issue all facilities face,” he said.
PPE ongoing issue
Throughout the pandemic, nursing homes have struggled to get enough protective gear for employees working directly with residents.
The requirements for employees in close contact with residents – closer than 3 feet for more than three minutes – include N-95 masks, gloves, and gowns.
The facilities must obtain gear on their own from private suppliers.
If there are problems getting gear on the open market, the state has set up a warehouse that can supply it.
Early in the pandemic obtaining equipment was difficult and facilities relied on the state. There have been periodic shortages since then, and prices have climbed.
“PPE (personal protective gear) has been an ongoing issue,” Hamilton said. “An N-95 mask cost 35 to 50 cents before the pandemic; now we buy them for $5 each.”
Vargas and Hamilton said that getting tests and timely results is also an issue for facilities around the state.
“The state has been understanding if a facility can only test 20% of employees because the tests aren’t available,” Vargas said.
He also said there have been times that getting test results back has been a problem.
“The labs have been overwhelmed at times and they have problems obtaining the chemicals used to run the tests,” Vargas said.
Dim financial future
In addition to the challenge of keeping residents and staff safe in a COVID-19 environment, nursing homes nationally are facing dim financial prospects.
The Wall Street Journal reported last week that nursing home occupancy was down 15%, or about 195,000 residents, due to deaths and a COVID-inspired push in favor of home care whenever possible.
The nation’s biggest nursing home operator, Genesis, has told investors it might not to be able to continue as a going concern. Its stock was languishing at less than $1.
Vargas said about 70% of nursing home residents are paid for through Medicaid.
“Medicaid traditionally underpays for nursing home residents,” Vargas said.
The industry also is concerned about the possibility of a spate of new lawsuits.
“Lawsuits were at the forefront of concerns,” Vargas said. “But we haven’t seen that nationally, yet.”
The light at the end of the tunnel, of course, is a vaccine.
The Department of Aging and Long-Term Services announced the vaccinations will begin today and continue Monday. In all, residents and staff at eight nursing homes are scheduled for vaccinations today and Monday.
Nursing home employees and residents are in line to be the first to receive the Moderna two-shot vaccine that was authorized last week by the federal Food and Drug Administration.
The Moderna vaccine protects individuals from contracting the virus or developing symptoms, but people receiving the vaccine can still be carriers and transmit the virus to others, according to state officials.
The state and the nursing home association have been working to get homes and assisted living communities signed up in the Federal Pharmacy Management Program.
Walgreens and CVS pharmacies will be delivering vaccinations under the program.
“We’ve been working to get facilities signed up,” said Zack Quintero, ombudsman for the Aging and Long-Term Services Department.
He said, “We ask all the time, and it is now at the point where if a facility isn’t signed up, we sign them up.”