Admissions down at some local care homes
For about four months, residents of local nursing homes were unable to meet with family members in person. Visits in front of windows or on tablet screens were all families could do to stay connected to those locked behind nursing home doors. The visitation guidelines likely played a role in a few of the local nursing homes’ lower-than-normal admissions the past 6 months, according to nursing home officials.
Linn Community Nursing Home’s Amy Altwegg said residents there were mostly confined to their rooms in the early weeks of the COVID-19 closures. Now, residents are free to move about the care home but must wear masks. They also must wear masks in their rooms if staff enter their rooms.
After about 4 months of the nursing home being closed to indoor visitations, the inside visits resumed about the first of August, and each resident was allowed two visitors. Washington County’s spike in COVID-19 cases a few weeks ago, though, temporarily ended indoor visits at nursing homes around the county.
While indoor visits are still on hold and it is unknown when they can resume at Linn, the outdoor visitation station remains open. At the outdoor station at Linn, residents and family members can visit in person but with a sheet of plexiglass separating them.
At Centennial Homestead in Washington, residents were allowed to designate one person for face-to-face visits when in-person visits resumed.
“We would have one visitor per resident over the age of 18 to be allowed the faceto-face visit,” said Centennial Homestead’s Haely Ordoyne. “That process would continue for 14 days, and if all went well, we would move on to the next phase where we would add another person per resident, and so on and so forth until we received acknowledgement that we could fully reopen. One requirement of the state is that our reopening plan has to be contingent upon the current status of active cases in our community.”
Like other nursing homes in the county, Centennial Homestead had to close down from face-to-face visits a few weeks ago when the county had a spike in COVID-19 cases.
“We are fortunate with our building layout that we can continue to have window visits in our front entryway where we are separated by glass doors and utilize headsets and telephones for communication,” Ordoyne said. “This along with zoom, facetime, and other forms of video chatting are all currently being utilized.”
“I think it’s worth mentioning the side of the nursing homes in this whole pandemic, too,” she continued. “We hate it just as much, if not more, than everyone else that is seeing this right now. Unfortunately, we don’t get to make the rules in our industry, and we have to receive oversight from and comply with the ever changing rules and regulations that have been placed by CMS, CDC, WHO, KDHE AND KDADS. The frustrating part of this all is that we have to abide by all of these different rules, yet none of them are in agreement of what the rules should be. Personally, I think going into a shut down for our nursing homes poses a bigger risk of death due to depression and mandated isolation from their families. If masks work, then let us open with mask mandates. If they don’t work, then quit the requirements and quit the witch hunt of liability of nursing homes when COVID gets into the homes even after extreme preventative measures.”
Ordoyne said Washington County will have to have 3 active COVID-19 cases or fewer for 14 days in order for Centennial Homestead to open back up to in-person visits. Only one visitor will be allowed per resident. Compassion care visits are allowed under certain circumstances.
Hanover Hospital administrator Brittni Oehmke said long term care visitors are not allowed in the Hanover facility right now, either.
“We have allowed our long term care residents and families to meet outside while following mask and distancing guidelines,” she said.
Lost revenue
Oehmke said she has not noticed a decrease in admissions at Hanover’s long term care facility, but administrators at both Linn and Washington said they have noticed significant decreases.
“Admissions have been impacted,” Ordoyne said of Centennial Homestead. “We were advised to not accept admissions for the longest time, and then updated criteria recommended that we test individuals prior to their admission and then put them into a 14-day quarantine upon their admission. I personally believe that this, plus the mandatory government shutdown, has contributed to a decline in admissions to healthcare facilities in whole.”
Ordoyne said Centennial Homestead was full and had a waiting list before the pandemic began. Now they have two rooms open. She said she thought numbers were down 20 percent from average.
Altwegg said LCNH has lost at least $300,000 worth of revenue in the past 6 months due to lower admissions during the pandemic.
“And that’s probably conservative,” she said.
She said the nursing home has 40 residents now; they usually have 48 to 50. Occupancy at nursing homes is down nationwide, she said, and many nursing homes in this area are “way down” on residents right now, she said.
She said some of the nursing home’s short-term residents are people who are rehabilitating after surgeries, but with fewer surgeries going on right now comes fewer rehabilitation admissions.
Altwegg said LCNH will soon be testing employees and residents for COVID-19 on a regular basis; the nursing home has already received the testing equipment but is waiting for ever-changing information from the state.
She said she thinks COVID-19 will permanently change the way some things are done in nursing homes going forward. One of those things may be the requirement of facemasks for close contact care.
She said that while hand sanitizer was difficult to obtain early in the pandemic, gloves have become the latest thing to be difficult to obtain.
“Everybody is out of gloves,” she said, adding that the cost of gloves has increased from $3 a box to $14 a box.
“We ask everyone to err on the side of caution,” she said. “What happens in the community affects us. Some residents are struggling [with visitation limitations] more than others. It’s hardest on our residents with dementia.”
New testing
Altwegg, who is the administrator at Linn, said things are about to get even more complicated at Linn Community Nursing Home. Washington County has a designation color of yellow, according to the state, which means all of LCNH’s 100 regular employees have to be tested every week for COVID-19. She said Linn Community Nursing Home will spend about $5,000 to $10,000 every week to test employees.
She said that starting on Tuesday of this week, all employees began their weekly tests, which are a rapid antigen test. Both nostrils are swabbed during the test. The nursing home received the machine to run the rapid tests just last week.
If any employee tests positive, a sample will have to be sent to an outside lab, and if that positive is upheld, then all nursing home residents will have to be tested.
She said there are false positives associated with the kind of testing machine that the nursing home was sent.
The costs to run the 100 employee tests each week are significant; one 30-count box of tests costs nearly $1,000, and that’s the cheapest ones. And suppliers are now out of tests, or tests are backordered until mid-October, she said. If or when the nursing home runs out of tests they can run themselves on their machine, they will have to pay at least $100 per test to have a private lab run the tests. She said $100 a test for at least 100 weekly tests will become very expensive, and what if available labs want $200 a test?
“The federal government gave us some money, but we will run out of that money in eight weeks at this rate,” she said.
The frequency with which nursing home employees must be tested is determined by the total case rate of each county. A few weeks ago when Washington County had a spike in COVID-19 cases, Altwegg said the county was listed as a red county. Under a red designation, nursing homes have to test employees two times a week. Fortunately, she said, the nursing homes weren’t required to do inhouse testing yet.
All of Linn’s tests must be reported to the state, Altwegg said, so the advantage of the weekly nursing home tests is that Washington County should have a much higher negative test rate week after week.
Altwegg said she couldn’t remember what the county positive rate must fall below to get a green designation, but if the county were to achieve that designation, employee testing at nursing homes would decrease to about once a month.
Oehmke said Hanover’s long term care unit doesn’t have to do the rigorous testing that Linn does because Hanover is not a licensed adult care home.