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Transparency key as care facilities struggle to stay afloat

Topeka Capital Journal - 11/22/2020

As the coronavirus pandemic continues to take its toll on nursing home residents and staff, one long-term care facility in Shawnee County has been more transparent than most.

On Oct. 22, Topeka Presbyterian Manor announced via news release that a resident and staff member there had tested positive for COVID-19, marking the first cases the facility had seen since the beginning of the pandemic.

In the days that followed, TPM announced additional cases of the virus among residents and staff, and on Nov. 10, the care facility lost its first resident to COVID-19.

Since then, TPM has had a total of nine residents die

from the coronavirus. But that number represents a fraction of the 73 deaths attributed to Shawnee County long-term care facilities since March.

According to data provided Thursday by Derik Flerlage, infectious disease division manager for the Shawnee County Health Department, 70% of the county’s coronavirus-related deaths have been associated with long-term care facilities.

And a week-by-week breakdown of deaths, also provided by Flerlage, indicates long-term care facilities in the county had seen 62 deaths related to the coronavirus prior to the week Topeka Presbyterian Manor first announced resident fatalities on its campus.

“It is not for me to say if they are sharing enough information or not,” Flerlage said of local nursing homes’ communication efforts. “I can only comment that this has been very difficult for staff, residents and family members of those residents.”

Losing a loved one

Paxico resident Aleah Mahan is familiar with such loss.

In early September, Mahan lost her mother to COVID-19 about three weeks after she tested positive for the virus.

Her mother resided at Topeka’s Aldersgate Village, where she lived in the memory care unit.

“I didn’t get to see my mom for six months basically before she passed,” Mahan said. “That was supposed to protect her, but she caught COVID from a staff member.”

Mahan said leading up to her mother’s death, Aldersgate failed to effectively communicate with her and other residents’ family members.

“It was really hard to get an update on (my mom),” Mahan said.

She said that after her mother tested positive on Aug. 11, she was transferred to an isolation unit at the care facility where COVID-19 patients were being treated. By Aug. 21, her mother was moved back to her usual room. But Mahan didn’t find that out until more than a day after the move.

“Her social worker called me to say she was back, and she said, ‘I hate to ask you, but did anybody call you to tell you she was being transferred back?’ ” Mahan said. “I said, ‘No.’ She relayed that was what she was hearing from all the families, which is disturbing.”

Aldersgate didn’t respond to multiple requests for comment regarding Mahan’s allegations.

Communication, though, wasn’t Mahan’s only concern. Another concern centered on how her mother’s death was recorded on her death certificate.

Instead of listing “COVID-19” as a cause of death, the medical professional who certified the document listed “coronavirus” as a cause of death, which raised a red flag.

“When I got it and it said just ‘coronavirus,’ when we know that there’s a ton of different coronaviruses, I thought, ‘Hmm, I just wonder what’s up with this?’ ” Mahan said.

She worried her mother’s case might not be included in the state’s count of deaths caused by COVID-19, so she reached out to Lee Norman, secretary of the Kansas Department of Health and Environment, with her concern.

“He basically confirmed it ... that her death would not be counted,” Mahan said. “Even though he agreed that it was COVID related, it could not be counted because of the way that her death certificate read.”

Kristi Zears, director of communications for KDHE, said that when “coronavirus” is listed on a death certificate, staff in the department’s Office of Vital Statistics will reach out to the medical certifier to see if they intended to report “COVID-19.”

“If yes, then the record is reopened so the medical certifier can update the cause of death,” Zears said.

But until Mahan took matters into her own hands, it didn’t appear that her mother’s record had been reopened — even though she had alerted KDHE, through Norman, to the concern.

On Wednesday, Mahan reached out to the Office of Vital Statistics to see about amending the death certificate. She discovered the amendment process had to be initiated by the funeral home that filed the original document.

She spoke with someone at the funeral home that had taken care of services for her mother, and they started the amendment process.

But because the amendment concerned a medical correction and not a personal-information change, Mahan said, she had no idea how long the process might take, meaning there could be a lag time in her mother’s death being included in KDHE’s COVID-19 death summary.

Lack of transparency

Mahan remains troubled by the seeming lack of both internal and external transparency during the pandemic when it comes to the roughly 20 long-term care facilities that operate in Shawnee County.

“This lack of transparency is alarming and greatly impacts the families of current or prospective residents in the Topeka nursing home communities,” she said.

According to Kevin Sundbye, a Stormont Vail physician who serves as medical director at Topeka Presbyterian Manor and several other long-term care facilities in Shawnee County, the transparency exhibited by TPM is an anomaly.

“My experience with their transparency is, unfortunately, very unique,” Sundbye said. “Their reaction to an outbreak was unique and very appreciated from a medical standpoint.”

TPM is one of several different long-term care communities in Shawnee County that have made it onto KDHE’s list of coronavirus cluster sites — but it was the only local facility to release information to the public that provided context about the cluster of cases there.

Other local facilities listed as cluster sites earlier this month included Aldersgate Village, Homestead of Topeka, Lexington Park Health and Rehabilitation, McCrite Plaza, Plaza West Healthcare and Rehab Center, and The Legacy on 10th Avenue. A handful of those facilities remained on the cluster site list this past week and were joined by Brighton Place West and Lexington Park Assisted Living.

Flerlage, the infectious disease division manager for the health department, told Shawnee County commissioners late last month that the health department had seen about 25 COVID-19 clusters in local long-term care facilities up to that point. One of those clusters, he said, involved more than 125 positive cases among residents and staff.

Karen Harriman, senior vice president of communications and public relations for Presbyterian Manors of Mid-America, TPM’s parent organization, said the size and history of that network of care homes makes frequent communication with the public more feasible.

“Our system’s a pretty good-sized system,” Harriman said. “With all the number of people that trust us with their loved ones, the only thing we can do is be transparent, be upfront. ... That’s the way we operate, and that’s the way we believe you should operate.”

Still, Harriman doesn’t blame the smaller systems or independent care homes for not communicating as readily about new cases and deaths in their facilities.

“I think everyone’s so afraid of what this virus can do — it’s like trying to take a tiger by the tail — that they just don’t know how to communicate it,” she said.

The coronavirus struck long-term care facilities hard in the beginning, she added, and has been relentless since.

“I think a lot of them probably are just trying to keep their heads above water,” Harriman said.

‘Community spread is nursing home spread’

According to Flerlage, COVID-19 cases in nursing homes tend to increase when cases in the general community spike.

“Community spread is nursing home spread,” he said. “It is important to note that spread in our (long-term care) community was limited until community spread reached its highest points.”

Flerlage noted during a presentation before the Shawnee County Commission late last month that nursing home deaths began to increase significantly in August and September — and they haven’t slowed since. According to data Flerlage shared, long-term care facilities saw a record number of weekly deaths late last month.

Linda MowBray, president and CEO of the Kansas Health Care Association, which represents more than 260 long-term care providers in Kansas, said if more members of the general public took the coronavirus seriously, nursing homes might not be in the situation they are in.

“(Nursing home staff’s) actions and behaviors outside the building have a correlation with COVID coming in the building, but by the same token, it’s all of us. It’s all of our behaviors,” MowBray said. “As long as we continue to not wear masks and gather and be around people that we haven’t cohorted with, that makes it even harder for the nursing home workers.

“They have to go to the grocery store, too. They have to go to Walmart. And with the community spread so high, their chances of getting it and inadvertently walking it into a facility are much, much higher.”

Much like hospital workers, nursing home staff have been fighting this pandemic for months, MowBray added, and they are “exhausted.”

“It is therefore our obligation as Shawnee County residents,” Flerlage said, “to make sure that we are following the recommended mitigation strategies to help slow the spread.”

He said late last month that “deaths are often a lagging indicator, so they take a while to reflect cases.” That means the surge in COVID-19 cases and hospitalizations Shawnee County is experiencing now could take weeks to be fully realized.

India Yarborough, The Topeka Capital-Journal

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