I-Team: Nursing home COVID-19 infection rates down, but hampered by other challenges
KALAMAZOO, Mich. — Dorothy French was living at the Clark at Keller Lake Assisted Living Center in Grand Rapids when she contracted COVID-19 in July 2020. Her mother-in-law, Nancy French, said she considered her daughter-in-law lucky.
"She's one of the lucky ones, she didn't have symptoms; but she was scared and affected mentally and many others were impacted," Nancy French said.
Coronavirus infections have devastated nursing home and assisted living communities across Michigan during the COVID-19 pandemic.
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Thousands of COVID-19-related deaths occurred in those communities during the pandemic staffing and protective equipment shortages hampered the nursing homes' ability to control the disease. In the weeks surrounding New Year's Day, the COVID-19 death rate in U.S. nursing homes hit a new high, reveals an AARP analysis of federal data.
As of Feb. 16, 2021, Michigan long-term care facilities had reported 23,905 cases and 5,515 deaths, according to the state's COVID-19 dashboard. Roughly 36% of Michiganders who have died from COVID were nursing home residents.
Nationwide, 162,000 residents and staff of long-term care facilities have died from COVID-19, according to the U.S. Centers for Medicare & Medicaid Services.
Michigan is ranked 16 of 50 states in the nation with 2.12 deaths per 100 residents, according to a Feb. 11 AARP Nursing Home COVID-19 dashboard.
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The state's long-term resident facility death rate peaked in late December 2020, when Michigan had 2.17 deaths per 100 residents.
"The cases in nursing homes have been enormously high, deaths have accounted for a disproportionate number of deaths of COVID," said Marianne Udow-Phillips, director of the Center for Health Research Transformation at the University of Michigan.
The AARP analysis shows that for the first time in months, the national rate of new COVID-19 infections among both residents and staff of nursing homes is coming down.
Personal protective equipment shortages
Early on, experts said long-term facility staffing difficulties and personal protective equipment shortages would make addressing outbreaks a challenge.
Michigan had 34% of facilities reporting only having enough personal protective equipment for one week on June 28, 2020. The state has shown gradual improvement, 16% of facilities reported only having enough personal protective equipment for one week as of Jan 17, 2021.
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"Our state sputtered in the beginning in terms of handling COVID-positive patients coming out of hospitals," said David Herbel, CEO of LeadingAge Michigan, a statewide trade association representing 270 corporations providing senior care.
The University of Michigan health research center staff evaluated the state’s regional nursing home hub strategy and released its findings in September 2020.
"We found policies the state put in place were appropriate. There were opportunities for enhancement as we learned more about COVID and in other states," Udow-Phillips said.
The report found Michigan’s plan to create hubs for nursing home residents with COVID-19 was “logical and appropriate,” and found no significant evidence of transmission of the virus between patients and residents.
"We found you can keep patients safe with COVID as long they are separated from the rest of the population," Udow-Phillips said.
Udow-Phillips said nursing homes weren't prepared at the beginning of the pandemic when COVID hit, due to a shortage of equipment and a lack of staff training. She said the state has made progress since then.
"A lot more attention paid to training, a lot more attention we paid to having supplies for PPE," she said.
Challenges remain
Recent data from the AARP analysis showed 38% of Michigan senior facilities face staff shortages.
- Shortage: The Michigan health department offered staffing options in September 2020 to help with shortages
Udow-Phillips said some nurses in faculties are skeptical about the vaccine.
"Nationally, 27% of nursing home staff have been hesitant to get the vaccine. The nursing home residents have been much more willing," she said.
Vaccinations ramp up
State health officials said every resident at a Michigan's nursing facility who wanted a vaccine has had at least one dose. More than three-quarters got their second dose, according to the state's vaccine dashboard.
- Vaccinations: Long-term care facilities were some of the first to get the COVID-19 vaccine
Dorothy French is prepared to get her final shot the week of Feb. 22, 2021.
"Everything that can be done should be done to protect them," French said.
Seniors face isolation in nursing homes
Advocates of seniors in long-term care facilities in Michigan said the state's visitor restrictions are some of tightest in the nation.
"The visitation guidance proffered by MDHHS, is still too restrictive as compared to the national guidance published by the Centers for Medicare and Medicaid services," Herbel said.
Herbel said the federal guidance was used in Michigan, only two counties with restricted visitation as compared to 38 with the Michigan health department guidance.
The Michigan Department of Health and Human Services visitation order does allow for nursing homes and other long-term care facilities to reopen indoor visitation once they are COVID-free for 14 days, have adequate resources to keep residents safe, and after county risk levels fall below E, deemed the highest risk for COVID spread.
Indoor visitation is not allowed when the county is at risk level E.
From Oct. 23, 2020, until Feb. 13, 2021, the Kalamazoo and Grand Rapids region under the MI Safe Start plan was under Level E.
"They're paying to be in a space that's their home and they're being treated like prisoners in their own home," French said.
Bob Wheaton, spokesperson for the Michigan Department of Health and Human Services said the agency is reaching out to all nursing facilities and associations this week to remind them what’s allowable as far as visitation and to check the county risk levels to determine specifics for their facility.
"At this time we are not relaxing our visitation policy until we get closer to reaching our goal of vaccinating 70% of Michiganders as quickly as possible, or CDC guidelines change." Wheaton said.
