South Carolina Nursing Homes Grapple With Rising Covid-19 Cases
By Liv Osby
Coronavirus cases are hitting record highs, sparking fears of new outbreaks among vulnerable nursing home residents, who are most susceptible.
Nationally, more than 91,000 nursing home residents and staff had died, according to a Nov. 9 analysis by the Kaiser Family Foundation, up from 84,000 the month before.
And while long-term care facilities account for 8 percent of cases, they have more than 40 percent of all deaths from the virus, Kaiser reports.
As of Nov. 13, there were 7,177 cases among nursing home residents in South Carolina, and 1,500 deaths, state health officials report. There were 3,882 cases and 23 deaths among staff.
Across the nation, Johns Hopkins reports that more than 11 million cases had been confirmed and more than 246,000 people had died of the virus by Nov. 16, when 133,045 cases were confirmed in a single day after more than a week with daily cases topping 100,000.
South Carolina cases are also on the rise, growing from 391 confirmed cases on Sept. 8 to 1,645 on Nov. 13.
The trend has nursing home operators and advocates for the elderly worried.
“More than 1,000 South Carolina nursing home residents and staff have already died of Covid-19 representing about 38 percent of all Covid-19 deaths, and still facilities don’t have the PPE (personal protective equipment) and staffing needed to protect residents,” said Teresa Arnold, executive director of the state chapter of AARP. “This is a tragedy that must be addressed.”
Mark Parkinson, CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represent more than 14,000 facilities nationwide, said the main issue in keeping Covid-19 out of nursing homes is reducing the level of virus in the surrounding community.
“While the support we have received from Congress, the Administration and other public health agencies have helped our facilities fight this battle,” he said, “we could still see another wave of Covid … caused by the sheer volume of rising cases in communities across the U.S. given the asymptomatic and pre-symptomatic spread of this virus.”
Meanwhile, Kaiser reports that Covid is now the third leading cause of death in the U.S., compared with Germany, for example, where it ranks 17th, and that the U.S. has a higher mortality rate than other wealthy countries.
So the AARP Public Policy Institute partnered with the Scripps Gerontology Center at Miami University in Ohio to analyze coronavirus data reported by nursing homes to the Centers for Medicare & Medicaid Services and produce a national and state dashboard in four-week increments.
They looked at five key measures - the number of resident cases per 100 residents, resident deaths per 100 residents, cases among the staff per 100 residents, the percentage of nursing homes without a one-week supply of PPE, and the percentage with staffing shortages.
So far, two reports have been issued.
The first, which covers Aug. 24 to Sept. 20, assigned the highest rate of resident deaths to South Carolina. It also showed that rates for other measures were above the national average, and in some cases significantly above it.
For instance, the Palmetto State had 1.2 deaths per 100 residents – the highest in the nation - compared with 0.48 nationally, and 5.8 cases per 100 residents compared with 2.6 nationally.
But its rates were significantly lower in the Nov. 13 report, in most cases around or just above the national average. The death rate was 0.58, for example, compared with 0.47 nationally.
The initial findings came as a surprise to Arnold.
“I didn’t think we’d be the best in the country, but I thought we were doing a pretty good job,” she told Greenville Business Magazine. “But when our Public Policy Institute started keeping the data … and we jumped to the top of the list – I didn’t expect that.”
The South Carolina Health Care Association, which represents nursing homes in the state, could not be reached for comment.
But the AHCA/NCAL says that the virus “has been the biggest challenge our sector has ever faced” and that “the evidence is clear that we are not out of the woods.”
Arnold said one of the reasons South Carolina appears to be doing better now is that after declining over the summer nationally, cases and deaths have spiked in the Midwest and other parts of the country over the last four weeks.
“Covid-19 is still spreading in the community,” she said. “While nursing home cases and deaths have fallen, continuing shortages of staff and PPE mean these facilities might not be prepared for another wave.”
The AARP dashboard found that nursing homes in every state had a shortage of N95 masks, gowns, gloves and other PPE.
The AHCA/NCAL said in a statement that while the availability of PPE has improved, providers are still struggling because of strains on the supply chain and soaring demand across all sectors.
“We need manufacturers to make more PPE that can be used by long term care, as well as suppliers and state agencies to prioritize our facilities for these supplies,” the statement read.
The organization also said the growing number of cases may drive demand even more. In addition, it said the surge has dramatically increased the cost of PPE.
Moreover, the pandemic has exacerbated an existing workforce shortage because so many staff members have gotten ill or had to quarantine in addition to the increased workloads engendered by the virus, the AHCA/NCAL said.
Arnold said she’s been told by nursing home representatives that staffing is a problem that’s only worsened with Covid because it takes more staff to be able to allow visitation.
AARP says policymakers have taken some steps to address the situation, “such as requiring nursing homes to self-report Covid-19 cases and deaths at the federal level, ordering testing, and providing limited PPE and other resources to nursing homes.”
But it adds that “federal policymakers have been slow to respond” and that “no state has done a good enough job” to stem the loss of life, and that more needs to be done.
Laura Renwick, spokeswoman for the state Department of Health and Environmental Control, said that because staff is still reviewing the AARP data, the agency would have no comment on it. Nonetheless, she said the agency is working closely with nursing homes to ensure proper disease prevention practices are in place to protect residents and staff.
For example, she said, DHEC teams conduct desk reviews or onsite reviews of facilities without active cases to make sure they’re following federal recommendations for preventing exposure to the virus.
In addition, each facility must have a testing plan in place, as well as plans for a Covid unit should a resident test positive, she said. DHEC also makes sure staff are using PPE properly and fully understand the importance of proper disease prevention practices.
Over the summer, she said, DHEC did in-person infection control surveys at all 194 licensed nursing homes in the state to assess whether prevention protocols were being followed properly.
“When we do learn of a case at a facility,” she said, “we immediately reach out to the facility to make sure the required actions are taken for preventing further spread.”
DHEC also issued indoor visitation guidelines on Oct. 9, two days after it ordered facilities to report their visitation status, she said. In addition, other factors, such as the positivity rate of the county, may result in no indoor visitation.
A total of 12 counties, representing about a fifth of the state’s population, has a positivity rate above 10 percent, and thus cannot offer indoor visitation until the rate is 10 percent or lower, she said.
AARP has developed a plan to address nursing home safety that among other things calls for regular testing and adequate PPE for residents, staff and visitors; improved transparency around cases and deaths; and accountability for the state and federal funding they get.
The AHCA/NCAL said nursing homes have used their funding to cover testing, PPE, staff support and other costs associated with fighting the virus.
AARP also calls for ensuring adequate staffing and oversight.
But Arnold said the bottom line is that the report raises a lot of questions about South Carolina nursing homes, and until the cause of the higher rates is known, it’s hard to know how to address them.
“That’s important for us to find out,” she said. “What should we do differently and what can we do to improve?”
AARP will be looking at the data every four weeks in hopes of uncovering a trend that might signal reasons for the state’s rates, such as whether its high rates of diabetes and stroke, or its racial makeup, play a role, Arnold said. African Americans and Hispanics suffer disproportionately from Covid and die at greater rates.
A new Kaiser analysis of 13,982 nursing homes nationwide shows a higher death toll in those with more black or Hispanic residents.
Parkinson said that most of the federal money that providers got in April has already been distributed and that additional funds are needed for the cold and flu season.
“Without adequate funding and resources,” he said, “the U.S. will repeat the same mistakes made during the initial outbreak last spring and the major spike over the summer.”
Noting that South Carolina’s nursing homes have received more than $60 million in federal funds, Arnold said Gov. Henry McMaster has addressed almost every point of the AARP plan.
And though she’s encouraged by the new numbers, she urged caution in the weeks ahead.
“We can be more optimistic that our residents are safer than they were earlier in the fall,” she said. “But everybody should be wearing masks, inside and outside nursing homes, if we want to protect the people we love.”