2 more deaths at senior care facility show how quickly virus spreads
Two more hospice residents of an Ozaukee County long-term care facility for seniors have died after testing positive for COVID-19 — reinforcing how quickly and devastating the virus’ spread can be among vulnerable populations.
The patients were residents of Village Pointe Commons in Grafton, where a 91-year-old man died a week ago after contracting the coronavirus.
The two residents were an 87-yearold man and an 82-year-old woman in an end-of-life memory care unit, according to Kirsten Johnson, the director of the Washington Ozaukee Public Health Department.
One of those two was the first resident in the facility to test positive for the virus, while the other tested positive a few days before dying, Johnson said.
Village Pointe Commons is home to 230 people, but the outbreak of at least 13 staff and residents who tested positive appears to be contained within the memory care hospice unit, which has about a dozen residents, Johnson said.
The health department ordered a lockdown of all long-term care facilities in both Washington and Ozaukee counties after the first patient’s death. A medical unit with the National Guard had been assisting with staffing at Village Pointe Commons since last week.
“I don’t think this is the fault of this facility,” Johnson said. “We have made a targeted effort of testing more people within these facilities, so we’re finding them.”
She added: “We would not have been alerted to what’s happening at Village Pointe Commons if they had not called us.”
The Washington Ozaukee department has confirmed five facilities across the two counties have outbreaks, defined as one resident or two staff members testing positive.
“I hope others are learning from what we have learned or taking what we’ve learned to heart, because as I said, we’re not the only ones,” Johnson said.
A spokesman for Capri Communities, the company that owns Village Pointe Commons, told the Journal Sentinel earlier this week that extra staff had been added; that all local, state and federal guidelines are being followed; and that residents and staff are being closely monitored. All employees are screened for symptoms and have their temperature checked before they start work.
What does it mean to do a contact investigation?
The Washington Ozaukee Public Health Department has tracked cases through contact investigations.
Once health officials learn someone has tested positive for COVID-19, they track down everyone the person had contact with during the two days before
becoming symptomatic. Then, they reach out to all of those individuals.
“If any single one of their contacts is a health care worker or a first responder that is symptomatic, we are getting that person tested, which is why you’ll see our numbers going up,” Johnson said.
The local health department also has issued three orders that Johnson said should be adopted statewide:
❚ First responders and EMS should wear personal protective equipment (PPE) when responding to a medical call of any sort at a facility.
❚ Staff at all long-term care facilities should be wearing PPE and all residents should be quarantined in their rooms.
❚ All staffing agencies and hospice agencies that provide services to facilities should be limited to providing services to one facility to limit the potential of spreading the virus.
The state Department of Health Services does have guidelines for long-term care facilities with some similar language, and in Milwaukee County, emergency medical services personnel have started wearing personal protective equipment when they enter longterm care facilities.
“That is a new directive,” Ben Weston, medical services director for the Milwaukee County Office of Emergency Management, said Friday.
“On the one hand we want to conserve personal protective equipment, on the other hand these are extremely high-risk populations that we want to avoid any sort of spread of COVID to,” he said.
Darren Rausch, director and health officer with the Greenfield Health Department, said each municipality in the county has met with long-term facilities and developed different rules. Greenfield has adopted many of the same provisions in the Washington-Ozaukee order, he said.
Nursing homes at risk for outbreaks
Seniors and people with underlying health conditions appear to be the most vulnerable to coronavirus. An outbreak at a nursing home or other senior living facility can be particularly dangerous.
Already, 147 nursing homes in 27 states have at least one resident who has tested positive for COVID-19, according to information released this week by the federal Centers for Medicare and Medicaid Services, which regulates nursing homes.
“Although 147 is a small fraction of the over 15,000 nursing homes across the country, given the disproportionate effect on our nation’s older population, this is a cause for concern,” the release stated.
CMS has now temporarily postponed routine inspections to focus solely on infection control and “immediate jeopardy” violations.
Seventy-five percent of U.S. nursing homes have been cited for failing to properly monitor and control infections in the last three years — a higher proportion than previously known, according to a USA TODAY analysis of federal inspection data.
Those citations have been as mild as a paperwork problem and as serious as a nursing home not telling state officials about an outbreak as unmonitored workers spread disease to patients.
In Wisconsin, 71.8 percent of the 362 nursing homes were cited in at least one infection-control inspection in the last three years, according to the analysis.
Of the 260 cited nursing homes, 80 had infection-control inspections at least as bad as Life Care Center in Kirkland, Washington, a nursing facility that has been linked to 35 coronavirus deaths.
Learning from the Washington state outbreak
Federal authorities are continuing to study what happened at Life Care Center so they can prevent similar outbreaks.
A federal and Washington state review found the Kirkland facility:
❚ Failed to rapidly identify and manage ill residents.
❚ Failed to notify the Washington State Department of Health about the increasing rate of respiratory infection among residents.
❚ Did not have a sufficient backup plan after the absence of the facility’s primary clinician, who fell ill.
A study released Friday by the CDC found that of the residents at the facility who tested positive, at least half did not present symptoms on the day of their test.
So, screening based only on symptoms could fail to identify a large portion of those who have the virus, which can contribute to the rapid spreading of the respiratory disease inside a facility.
Once a facility has a confirmed case, the CDC recommends staff restrict resident-to-resident interactions and that all health care personnel use face masks and CDC-recommended personal protective equipment for the care of all residents.
Think before moving a loved one out of a facility
Johnson believes Washington and Ozaukee counties are ahead of the curve because of the orders that are in place and the collaboration that already exists.
“I think we have a really good relationship with all of our nursing homes and our law enforcement and all of our community partners, so they are calling us,” she said.
Families have not been moving their older relatives out of facilities en masse, but some may be considering it. Those who are should think carefully about the logistics and health care required for them, Johnson said.
“They need to be honest with themselves about whether their family member is going to be safe with them and if they are medically stable enough to actually do that,” she said. “Can they provide the services within their family that their loved one actually needs?“
Just because someone is in a nursing home or senior care facility does not mean they will contract the virus, she said.
She encouraged family members to tell relatives in such facilities to stay in their rooms and to wear personal protective equipment if they do leave.