Florida nursing homes see climb in COVID-19 cases; workers hardest hit

Death rates are still relatively low in local long-term facilities

Coronavirus cases in Florida’s nursing homes and assisted-living facilities have accelerated sharply in recent weeks, more than doubling among both residents and staff and causing large outbreaks even in Central Florida, which once had been largely spared from virus’s devastation.

While death rates are still relatively low in local long-term care facilities, some fear that will soon change, given the rate of infection and the vulnerability of elderly, frail residents. “The one thing we know about this virus is that the deaths are a trailing metric,” said Brian Lee, executive director of the national advocacy group Families For Better Care. “As the cases surge higher, the deaths will follow. And right now we’re seeing the virus spread like wildfire.”

Three weeks ago, there were roughly 1,400 residents of the state’s longterm care facilities who were positive for COVID-19. By Thursday, that number had reached 3,652. And for senior-care workers, the rise was even steeper — from about 2,500 to 6,368 — the total dramatically eclipsing that of

residents.

The facilities have been closed to all visitors since mid-March. And early on, nursing home coronavirus cases were almost exclusively in Broward, Palm Beach and Miami-Dade counties.

But this week, scores of nursing homes and assisted-living centers in Orange, Osceola, Seminole, Lake and Volusia reported new cases, including several facilities with more than 25 people infected and two in Seminole that had over 50 — Eastbrooke Gardens, a Casselberry assisted-living center that specializes in residents with Alzheimer’s disease and dementia; and Life Care Center of Altamonte Springs, a nursing home where 53 residents and 22 workers have tested positive.

Some attribute the rising numbers in part to increased testing for the virus. In mid-June, the state Agency for Health Care Administration ordered all longterm care facilities to test every worker — doctors, nurses, janitors, security guards — every two weeks.

“That’s one of the reasons why you’re seeing the increase in numbers,” said Kristen Knapp, spokeswoman for the Florida Health Care Association, which represents most of the state’s 700 nursing homes. “We’re actually into our second round … and we welcome testing. It gives us the ability to make good decisions and try to keep the virus out of our buildings.”

With the number of cases rising among residents, though, it is clear that there are still gaps.

Although the turnaround for testing results is relatively quick — 24 to 48 hours — long-term care employees remain on the job during that window, as well as when tests are inconclusive. In those hours and days, social distancing with residents is impossible.

“Due to the nature of this virus, every interaction is a risk,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, which represents over 14,000 facilities across the country. “Residents need personal, one-on-one care and assistance with daily activities. That is why nursing homes and assisted living communities have been calling for access to additional testing, personal protective equipment and staffing.”

In Florida, facility administrators complained for two months that they lacked sufficient quantities of masks, gowns and gloves to follow CDC guidelines to stop the spread of the virus. Since then, though, Knapp said most facilities report that supplies are plentiful.

Yet the union that represents more than 8,000 elder-care workers in Florida charges that some workers are still being told to re-use the personal protection equipment that is supposed to be changed between patients.

“We have facilities that are giving one surgical mask for three weeks,” said Margarette Nerette, vice president of long-term care for 1199SEIU United Health Care Workers East. “That is unacceptable. We’re still in crisis — but we’re not supposed to be in crisis for surgical masks.”

In its most recent weekly update, the Florida Department of Health reported that the coronavirus death toll at long-term facilities — now at 2,255 — included 21 workers.

“I knew of several of them,” Nerette said. “One was a nurse in her 40s. They were fighting for PPE [personal protective equipment] on her job. She had four kids.”

There’s little question, though, that most facilities are working hard to prevent infection.

“Every day upon reporting for work, we are tested for temperature and fill out a short questionnaire with respect to symptoms and possible exposures,” writes a worker at an acute long-term care facility who requested anonymity because he is not authorized to speak. “Staff are trained in the proper use of PPE … It is not simple and is an ongoing process. There are various circumstances that require different protocols. We also have quality assurance nurses patrolling the facility to ensure/enforce PPE compliance. All this takes time and costs money, which complicates things for already stretched staff.”

When facilities do have outbreaks, it triggers another set of protocols, including moving infected patients to designated isolation centers.

The state now has 19 such facilities with over 1,200 beds, and some nursing homes are large enough to have their own isolation units.

At Avante at Orlando — where 32 residents and 13 employees were recently infected — staff have set up a designated COVID-19 unit that is closed off from the rest of the building. Workers there wear full protective gear.

Kimberly Biegasiewicz, vice president of clinical services for parent company Avante Group Inc., said most residents recover, despite their age and underlying health problems.

“As an organization, in [facilities] where we had COVID-19 positive residents, 76% of them were asymptomatic and remained asymptomatic throughout their course to recovery,” she said.

And some additional help is expected to come soon from the federal government.