Despite remaining sequestered inside their walls for more than eight months, almost totally isolated from family members and the outside world, residents of long-term care facilities across California now face another dangerous spread of the coronavirus in their midst.
By Thursday evening the number of active COVID-19 cases within skilled nursing facilities reached at least 1,543, more than double the number at the start of this month, according to data published by the state health department.
The surge comes after the number of new cases had largely been on the decline since August and mirrors what’s been happening during the same timeframe throughout most of California’s population.
Health care workers at the nursing facilities also are getting hit — 47 are currently infected with the virus, up from 13 at the beginning of the month.
The picture is just as alarming at assisted living centers, which as nonmedical facilities are regulated by the state Department of Social Services. The combined number of COVID-19 cases among patients and staff there reached 1,437 by Thursday.
Perhaps no group of California residents is more vulnerable to the virus.
The cumulative total of 61,088 cases in skilled nursing and assisted living facilities since the pandemic began is just a small portion of the 1.06 million cases statewide over the same period. But the number of patients and staff who have perished from COVID-19 accounts for 33% of California’s 18,466 coronavirus deaths to date.
Locally, one of the biggest recent outbreaks occurred at San Tomas Convalescent Hospital in San Jose, where 104 residents and 61 health care workers had tested positive for COVID-19, according to state data. By Friday, seven patients still had COVID-19 and one staff member was in isolation, according to a representative at the facility.
State data indicates 20 of San Tomas’ residents who recently had COVID-19 have died.
The facility posted a message on its website noting that its mitigation plan — based on public health guidance — includes isolating residents with COVID-19 and instructing sick employees to stay home.
The Atria Willow Glen assisted living facility in San Jose also had an outbreak in which 33 residents and employees tested positive for COVID-19 and one resident died, according to Atria’s regional vice president, Jason Walthour.
Such outbreaks were common early in the pandemic. Although they became rarer as the number of cases declined between August and November, the latest spike is stirring a new dread.
In a statement, Walthour noted that almost everyone who tested positive didn’t show COVID-19 symptoms, a reality that experts say underlines why regular testing must be a priority for residents and staff of long-term care facilities. Wearing personal protective equipment around residents and maintaining proper infection control practices is also crucial.
And while doctors, administrators and advocates agree that nursing homes are doing a better job of testing, maintaining protective equipment and controlling infections, there’s more room for improvement.
“I’m still not happy with where we are,” said Dr. Michael Wasserman, a geriatrician and former president of the California Association of Long Term Care Medicine. “As long as older adults are dying at a rate higher than normal, we have no business taking victory laps.”
The long-term care industry also has been struggling to keep patients safe while allowing limited visitations to resume. Before the pandemic, many care facilities relied on family members to help their loved ones bathe, eat and stay hydrated during their visits. They also served as an extra set of eyes to make sure patients were OK.
But when the pandemic struck and shelter-in-place orders were issued in mid-March, the facilities effectively shut out all visitors in a desperate bid to prevent vulnerable residents from contracting the disease. For months, not even legally mandated ombudsmen were allowed in nursing facilities, leaving families and advocates with little information.
Ombudsmen have returned, and the state has allowed some visitation from family members or friends under certain guidelines that mostly hinge on counties’ case numbers as well as each facility’s — but visitation is still very limited.
Under state guidelines, visits should take place outdoors or in large communal indoor spaces with physical distancing barriers in place if possible.
Nicole Howell, executive director of Ombudsmen Services of Contra Costa, Alameda and Solano counties, said residents and families are starting to fear that with COVID-19 cases soaring throughout the state, the limited visitations will be rolled back even further.
“That’s going to have some longstanding effects on residents and family,” Howell said. On the other hand, she added, “part of the wariness of setting up visitation is they’re worried about letting the virus into their building. It’s hard on them.”
Before the pandemic, geriatrician Dr. Teresa Palmer would regularly visit her mother at the Jewish Home and Rehab Center in San Francisco. But the pandemic halted that, leaving her to communicate with her mother only through Zoom calls a few times a week.
More recently, she was allowed to physically visit her every three or four weeks, but it’s not nearly enough, Palmer said.
This week she learned her mother had been exposed to an infected staff member a few days ago and was to be tested this weekend.
“The last time this happened, there were two exposures, and she was confined for a month,” Palmer said. “She got very depressed, stopped eating and drinking properly, but has now bounced back.”
“They have been sacrificing by being isolated for the last eight and a half months,” Wasserman said of residents in skilled nursing and assisted living facilities. “For us to say, go back and isolate again, I have a problem with that. I’ve been asking for the last eight and a half months that nursing homes be prioritized, but not prioritized by making them prisons.”
An expert who analyzed data at nursing homes around the country for the Associated Press estimated that for every two people who died from COVID-19 in long-term care, another person died prematurely of other causes, suggesting that care inside facilities was compromised with staffs stretched thin by the virus and its demands.
“The health care system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope,” Stephen Kaye, a professor at the Institute on Health and Aging at UC San Francisco, who conducted the analysis, told the Associated Press. “There are not enough people to look after the nursing home residents.”
And while some changes — like one codified by a new law that forces nursing homes to provide full-time infection prevention specialists — have addressed certain conditions that exacerbated the danger to patients earlier in the pandemic, the chronic understaffing problem has not been fully solved.
Nursing home employees still mostly earn low wages and aren’t always entitled to paid sick leave, and many work at multiple facilities or at other jobs, which means they have a higher risk of getting infected by the virus and spreading it.
So, if you’re an hourly worker and “depend on your job to feed your family, but you’re exhibiting symptoms of COVID, you have every incentive to not call in sick,” said Mike Dark, a staff attorney with California Advocates for Nursing Home Reform.
As a result, Dark and other advocates are urging people to maintain their guard in protecting seniors and other long-term care facility residents from the virus as the winter months loom.
Tragically, Dark added, “many of the most vulnerable are already dead.”
Staff writer Maggie Angst contributed to this story.