By Chris Caraveo
Twitter: @ChrisCaraveo31

Nursing home and assisted living officials continue to plead for more resources as facilities combat COVID-19.

Earlier this week, the American Health Care Association and National Center for Assisted Living released a report showing nursing homes in the United States have experienced an alarming spike in new coronavirus cases because of community spread among the general population, according to recent data from the Centers for Medicare & Medicaid Services.

CMS data shows cases in nursing homes significantly increased during July after having dropped significantly throughout June. The most recent data was submitted the week ending Aug. 2. As of then, there were 177,129 cases of COVID-19 in nursing homes, with another 109,253 suspected cases. Nearly 46,000 residents have died.

“According to preliminary research presented, larger facilities located in urban areas with large populations, particularly in counties with a higher prevalence of COVID-19 cases, were more likely to have reported cases,” stated Dr. David Grabowski, professor of Health Care Policy, Harvard Medical School.

In a check of Arizona nursing homes, the top 10 affected facilities added few cases between the weeks ending in July 26 and Aug. 2. As of the latter week, only nine of 146 nursing home facilities in Arizona have not submitted data to CMS. That includes Sun Health La Loma Care Center in Litchfield Park, Weyrich Health Care Center of Westminster Village in Scottsdale and Allegiant Healthcare of Mesa.

Arizona nursing homes are reporting a total of 2,340 confirmed cases and 481 deaths, according to CMS. Keep in mind, CMS only gathers data on nursing homes, not all long-term care facilities such as assisted living. For all long-term care facilities, the Maricopa County Department of Public Health reported 3,430 cases and 850 deaths among 367 facilities in the county as of Friday.

“What we understand now about all of COVID is that community spread plays a big part in it,” David Voepel, CEO of the Arizona Health Care Association, told the Daily Independent. “If your community has no COVID — typically the rural areas may not have any —  you’re not going to get as much spread. Especially on the long-term care side. We have a lot of folks in our workforce that work two or three different jobs. They come in and out of the nursing center. And if you have community spread, they bring it in and you don’t even know because they’re asymptomatic. It tends to lend itself to more COVID in the buildings in the urban areas than anywhere else.”

When asked about whether visitations play a role in spread into nursing homes, Mr. Voepel said skilled nursing sites are not open to visitations. However, assisted living is a different animal.

“They’re not open as well, but assisted living has a little more latitude,” he said. “So you might get some spread there with some caregivers, compassionate caregivers or some other family members that are their caregivers might come in and bring it with them unknowingly. That could happen. But typically on the skilled nursing side, the family’s restricted and visitation’s restricted as well.”

According to CMS data, Arizona ranks No. 7 in most cases per 1,000 residents — 249.8 — and No. 13 in most deaths per 1,000 residents — 47.8.

Providence Place at Glencroft is reporting the most COVID-19 deaths among Valley nursing homes with 30, according to CMS data. The two places in the Valley with the second most deaths are in Goodyear and Peoria.

Twenty-two facilities reported three or more confirmed or suspected cases during the week ending Aug. 2, per CMS. Four were in Scottsdale, three in Glendale, two in Peoria and one in Sun City.

“Which really go back to the last week in July,” Mr. Voepel said. “That’s when Maricopa County and Pima County were huge hotspots. Since then, our numbers have trended down. And even in the long-term care side, it really wasn’t in long-term care. Long-term care had a lot of COVID in it starting back probably around mid-late March, more into April and then the first part of May, and that bubble kind of died down. And then you saw the 20-44 year olds that started to pick up with this last bubble where it went up. Now granted, that’s a lot of our workers, that’s in that workforce of skilled nursing, but it tended to impact more urban areas and not so much on the skilled nursing side. That’s not to say we didn’t see a rise in COVID. We did. But we were more adaptable, able to take care of it and more restricted. So, it wasn’t as big. And so right now we’re seeing our numbers trending down. It’s looking pretty good.”

Mark Parkinson, president and CEO of the AHCA/NCAL, recently sent a letter to the National Governors Association warning states of imminent outbreaks at nursing homes and assisted living facilities given major spikes in new cases in several states across the nation, combined with PPE shortages and delays in getting testing results for long-term care residents and caregivers — which has been taking up to five days or more.

“This is especially troubling since many nursing homes and other long-term care facilities are still unable to acquire the personal protective equipment and testing they need to fully combat this virus,” Mr. Parkinson stated.

CMS data also appears to indicate many nursing homes still face significant PPE supply shortages, mainly N95 masks and gowns.

However, nationwide issue doesn’t appear to be as big in Arizona. Ten facilities in the state reported a lack of N-95 masks, per CMS data. But only four reported more than 10 cases of COVID-19, including Estrella Center in Avondale — 35 — and La Estancia Nursing and Rehabilitation in Phoenix — 30. Those two also report no supply of surgical masks, hand sanitizer, gowns and eye protection.

Fortunately, Mr. Voepel says Arizona’s supply chain has decreased its time to get PPE to skilled nursing homes as the months have passed.

“But it’s still difficult depending on the item,” Mr. Voepel said. “For instance, just a month ago, gloves were hard to get for some reason. I have no idea why but they were put on back order and next thing you know you get them in 10 days.

“Skilled nursing has learned ‘Okay, before I get down to my last case of gloves, I need to reorder.’ And now we’re kind of starting to push to get stockpile before flu season starts.”

On the other hand, Mr. Voepel says assisted living facilities continue to struggle getting PPE.

“They didn’t have the supply chain in place. In other words, they don’t have big orders for PPE to begin with,” he said. “So they might not have a contract with [sic], McKesson or some of the big suppliers. They might even go to Costco and get their supplies. Well, that all dried up and when you don’t have those supply chains already in place, that makes it very much more difficult coming in as a new customer. So, it’s still nip and tuck for assisted living. Right now, in Maricopa County, the county is helping out a lot in getting folks emergency amounts of PPE. So that helps out quite a bunch.”

The AHCA/NCAL is calling on public health officials to take immediate steps to protect nursing homes and assisted living communities, especially in areas with significant increases in new cases.

Mr. Parkinson is also urging Congress for an additional $100 billion for the U.S. Department of Health and Human Services Provider Relief Fund and that a sizable portion of the fund be dedicated to helping nursing homes and assisted living communities acquire resources, including constant testing, PPE and staff support.

“Without adequate funding and resources, the U.S. will end up repeating the same mistakes from several months ago,” Mr. Parkinson stated. “We need Congress to prioritize our vulnerable seniors and their caregivers in nursing homes and assisted living communities in this upcoming legislation.”

Meanwhile, Mr. Parkinson says members of the public to do their part to help reduce spread by wearing a mask in public and continuing to practice social distancing.

“We all have a duty to defend our nation’s greatest generation and their essential caregivers,” he stated.