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As nursing home deaths mount, California says they must test for COVID-19

San Jose Mercury News - 5/28/2020

May 28--As COVID-19-related deaths and the number of infections in California nursing homes continue to climb, the state has issued new instructions to facilities to test all patients and staff.

Senior care facilities have been among the communities most hard hit by the coronavirus, accounting for 52 percent of all recorded COVID-19 deaths in California, according to the state's latest available data.

Geriatricians and patient advocates have been pressuring the state for months to do more testing of those in skilled nursing facilities and the non-medical assisted living facilities for the elderly, noting that the best way to stop the spread is to identify those who have the virus and isolate them. While the public health department had issued guidance previously for counties to prioritize congregate care facilities such as nursing homes, its latest guidance is more specific..

In a letter issued to facilities last week, the state instructs skilled nursing facilities to -- besides testing those who have symptoms or have been exposed to the virus -- do baseline testing of all residents and staff in facilities that do not have a confirmed case of COVID-19. It also requires that facilities must test resident transfers from the hospital prior or upon admission to the nursing home.

In facilities without a positive case, the state is instructing them to test 25 percent of the staff weekly and ensure 100 percent of the staff are tested each month, although local health officials may change the frequency depending how widespread the virus is in the community, the letter notes. If one or more people do test positive, the letter instructs the facility to test all the patients who test negative every seven days until no new cases are confirmed after two rounds of testing.

Staff who test positive and are asymptomatic can still work, the state's letter says, as long as they are only caring for residents who are positive and "maintain separation" from other staff "as much as possible." They also must wear masks.

Experts have said COVID-19 has frequently spread from asymptomatic staff members. While facilities shut their doors to visitors in March, health care workers -- many of whom work across multiple facilities and are paid low wages -- were free to come and go.

Statewide data released Wednesday show nearly 1,700 staff and patients in nursing homes across California have died of coronavirus, including almost 350 in a recent 10-day period.

Overall, at least 1,693 people have died from cases that originated in nursing homes, including 342 between May 15 and May 25, according to the data released by the state Department of Public Health.

The data also show that:

-- Deaths at East Bay Post Acute, a Castro Valley nursing home, have climbed to 16 -- just two less than the Gateway Care and Rehabilitation Center in Hayward, which has 18. The Redwood Springs Healthcare Center in Tulare County leads the state list with 29 COVID-related patient deaths.

-- The Bel Tooren Villa Convalescent Hospital in Bellflower, Los Angeles County, leads the state with 200 total patient infections. Less than 11 of those patients have died.

-- A total of 9,028 patients and 5,245 staff statewide have contracted the virus.

The state has not released data showing the number of nursing home patients and staff that have been tested for the virus.

The order for universal testing at nursing homes does not extend to residential care facilities for the elderly -- which includes assisted living facilities with memory care units and much smaller board-and-care homes -- said Scott Murray, a spokesman for the state's Department of Social Services which oversees those facilities.

But, Murray said, "California has been working hard to ramp up testing capacity, with over 40,000 tests being conducted on a daily basis. The availability of these additional tests is allowing Californians in many settings to get tested as needed".

San Mateo, Contra Costa and Santa Clara counties' health officials have indicated in recent weeks they are working on plans to test periodically in congregate-living facilities, such as nursing homes and assisted living facilities.

Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine, said in a telephone interview late Wednesday that while people in care facilities are still getting sick, more testing is needed to fully understand the problem and how to solve it.

"If you don't test, you don't know," Wasserman said. "At the start of this, it was easier to say, 'no one has COVID' because there was no one testing. Unless you know how many people have been tested, you don't have any context."

Wasserman said he expects more cases to be identified, but for now the numbers of COVID cases and deaths in long-term care facilities is likely undercounted.

"I continue to predict, when we finally get the data figured out, it's going to be tragic," he said.

Wasserman said facilities need more support when it come to testing. "Facilities are saying, how do we do that?"

It's not enough to get everyone tested, he added -- the laboratories need to prioritize results for nursing home residents and staff, so that measures can be taken quickly to isolate or quarantine if necessary.

The Trump administration called for increased national testing in nursing homes earlier this month. But the head of the elder-care advocacy group Leading Age said in a statement Tuesday it was not enough, and that the administration has failed nursing homes.

"Despite guidelines that nursing home staff be tested weekly, thousands of nursing homes and other aging-services providers still do not have access to testing or resources to pay for it," Katie Smith Sloan, the group's president and CEO, said in a statement.

"The sad truth is this: The country has little more than a patchwork plan for protecting older lives," she said. "Our leaders in Washington, DC did not listen, did not plan, and did not prioritize the health and lives of older adults. Now our most vulnerable Americans are paying the price."

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