Nursing homes hit hardest by fatalities

They account for more than half of the state’s deaths during pandemic

Nursing homes in Maryland account for just over half of the deaths caused by the coronavirus pandemic, according to new data released Tuesday evening by the Maryland Department of Health.

There were 4,406 coronavirus cases in the state’s nursing homes Tuesday, and the facilities account for 471 of Maryland’s coronavirus deaths. That means more than one in five of the state’s 20,113 confirmed cases as of Tuesday are attributed to nursing homes. The state’s total confirmed deaths related to the COVID-19 illness caused by the virus stand at 929.

As Maryland released the data after repeated public calls for the information, nursing homes already were demanding more action to protect their vulnerable residents.

The extent of the outbreak in nursing homes suggests the facilities should get more of the supplies, testing and attention that have gone to hospitals, said Kevin Heffner, CEO of the LifeSpan Network, which represents long-term care facilities in Maryland and Washington.

“If anyone takes an honest look at the data that exists about where the COVID patients are, it’s overwhelming that they’re in nursing homes, they’re in assisted living,” he said. “It’s really time to start devoting some of the state’s resources to nursing homes. That’s where the need is."

In the first weeks of the coronavirus

pandemic, state officials rushed to prepare hospitals and ready space for an eventual influx of COVID-19 patients. But nursing home industry leaders say that, while they have gotten some help from state and local health officials, they haven’t received the same level of attention and resources as hospitals even as cases and deaths in their facilities have mounted.

For weeks, Maryland had resisted requests for detailed breakdowns of coronavirus case counts and death tolls at nursing homes, and had even directed local health departments to stop providing information on specific outbreaks that had been released in spurts. The state told The Baltimore Sun that disclosing a list of nursing homes dealing with COVID-19 outbreaks would serve “no public health purpose.”

But state officials reversed course Monday, saying they decided that public demand for the information overrides what they called legal concerns over patient privacy. The state health department said it would begin posting data related to COVID-19 cases and deaths associated with nursing homes, assisted living centers and other “congregate living” facilities this week.

Until Tuesday, the state was among 15 in the country not reporting any specifics on nursing home cases or deaths, according to the Kaiser Family Foundation.

The data revealed many large outbreaks around the state, including several that have been reported publicly and have continued to expand.

The death toll at Pleasant View Nursing Home in Mount Airy has reached 29, with 129 positive tests. At FutureCare Lochearn in Baltimore, where a rare effort by the operator to test all residents and staff revealed 170 infections earlier this month, the case count has surged to 220, and 10 people have died. At Genesis Loch Raven, seven people have died out of more than 80 who tested positive there.

Before the state released the data, it was already clear that there was a significant toll in nursing homes. People aged 70 and older account for nearly two-thirds of the 929 confirmed COVID-19 deaths in the state as of Tuesday.

Data that county officials shared with The Sun shows that nursing home residents represent 54% of coronavirus-related deaths in Howard County, 67% in Baltimore County, 71% in Anne Arundel County and more than 90% in Carroll County.

Across the country, similar clusters of nursing home deaths are being reported. More than 10,000 residents of long-term care have died of COVID-19 in 23 states that are reporting those numbers, according to the foundation. That represents 27% of coronavirus deaths in those states.

Maryland officials have raised alarm about the potential dangers of coronavirus spread in nursing homes since early on in the pandemic, after concerns about a major outbreak at a nursing facility near Seattle. Actions to protect nursing homes were among Gov. Larry Hogan’s first executive orders under a declared state of emergency last month.

He demanded facilities restrict visitor access to reduce potential exposure to residents in early March. When it became clear that staff were bringing the virus in earlier this month, he ordered all staff to begin wearing masks, gowns and face shields when interacting with nursing home residents and patients.

And as infections spread and the death toll rose at facilities such as Pleasant View in Mount Airy, the state began launching what Hogan called “strike teams” to help nursing home administrators triage outbreaks.

But nursing home administrators say they nonetheless still are struggling to keep up with the pace of infection. They say those teams provide some help with protective equipment and testing, but not enough to help the facilities manage outbreaks in the long term.

They face shortages in staffing, exacerbated by illness and fears about the virus; in space for quarantining COVID-positive residents from others; and in protective supplies for staff to comply with Hogan’s order.

While they have received small quantities of protective equipment from a national emergency stockpile, they otherwise have had to scramble for supplies through private vendors and other organizations.

Many hospitals, on the other hand, have established COVID-19 units with dedicated staff, reducing the risk of those caregivers spreading the virus to COVID-negative patients. And, apart from emergency care, they are otherwise keeping beds free by canceling elective procedures.

Bob Atlas, CEO of the Maryland Hospital Association, said it’s “not accurate” to suggest there has not been a coronavirusrelated surge in patients at the state’s acute and emergency care centers. About 80% of 7,500 hospital beds across the state are occupied, and a quarter of those patients have tested positive for COVID-19, a fraction Atlas said is growing.

Hospitals have readied space for an additional 2,000 beds, and Atlas said that includes enough capacity for any coronavirus patients in nursing homes whose condition requires a higher level of care. But they also are facing similar protective equipment shortages and staffing issues.

Hospitals also face an economic crisis as elective procedures remain on hold and people avoid care out of coronavirus fears. Emergency room traffic, even, is at a third of its normal level, and the state association predicts state hospitals’ revenue will decline by 20% in the three months from April through June, by $1 billion collectively.

The reduced business already has forced layoffs and other cuts, including the furlough of 1,000 employees at Anne Arundel Medical Center last week.

But nursing home industry leaders say, given that the coronavirus is hitting their facilities hardest, some hospital resources should be shifted.

“If hospitals are laying off people, the need doesn’t exist there, and meanwhile in nursing homes and assisted living, it’s exploded and we can’t get the resources we need,” Heffner said. “It’s all been devoted to hospitals.”

Heffner said nursing homes are pressing the state to do more testing, including of all nursing home patients and staff and any patient being transferred from a hospital to a nursing home. And they are asking for more help building inventories of protective equipment.

Mike Ricci, a spokesman for Hogan, said meeting with nursing home industry officials, including Heffner, was “one of the first things the governor did after declaring a state of emergency." That meeting, he said, was followed by “a wave of aggressive actions.”

“Governor Hogan has and will continue to take whatever actions are necessary to protect Marylanders in long-term and continuing care facilities," Ricci said.

Some state lawmakers are meanwhile taking a closer look at nursing homes’ concerns. Several members of the House of Delegates met by teleconference with nursing home industry leaders Tuesday to discuss problems and potential solutions.

Del. Joseline A. Peña-Melnyk, a Democrat who represents Anne Arundel and Prince George’s counties, was among them, and said lawmakers left the briefing concerned that some facilities are turning away the state’s strike teams. She said she wants Hogan to amend his executive order to require facilities to accept the teams.

“Those are the most vulnerable people,” Peña-Melnyk said. “We should be testing them frequently, stabilizing those places and providing them with PPE. The virus is attacking people who are medically compromised with preexisting conditions. It’s attacking black and brown people who have disparities in our communities. We need to do more for the most vulnerable in particular.”

Sen. Paul Pinsky, a Prince George’s County Democrat who was not on the teleconference, said he thinks that with such a crisis in so many nursing homes, the state should do whatever it can to help them, including expanded testing and more space to quarantine patients.

“We don’t want more people to die; that’s as simple as it is," Pinsky said. "If we need more isolation, that’s what we need.”