Every morning, the Minnesota Department of Health releases the numbers of new fatalities officially determined to be directly related to COVID-19.
And every morning, the dead are more likely than not to have at least one thing in common: the majority reside in long-term care facilities such as nursing homes and assisted-living centers.
State figures show nearly 80 percent of known COVID deaths take place in long-term care, raising a host of questions with state lawmakers and the general public.
What’s being done to protect the state’s most vulnerable residents? And why is the state mostly focusing testing on residents of care facilities who show symptoms or have known exposures, instead of doing widespread testing of all staff and residents in centers statewide, regardless of their lack of symptoms?
On Tuesday, state Sen. Karin Housley, R-St. Marys Point, raised both questions in a public statement calling on the administration of Gov. Tim Walz to conduct universal virus testing in long-term care facilities.
“We are facing an unprecedented crisis at long-term care facilities in Minnesota,” said Housley, the assistant Senate majority leader and chair of the Senate Family Care and Aging Committee.
“It is critical that the Department of Health work with these facilities to deploy resources and issue guidance to prioritize the testing of all facility residents and staff,” she said.
As of Tuesday, 233 of the 301 known deaths from COVID-19 were in congregate care facilities, or 77 percent. The state has published a list of more than 100 facilities where there’s been a known exposure (though not necessarily ongoing transmission), and some sites have announced evacuations or permanent closure.
Among the hotspots, more than a dozen COVID-related deaths have occurred at the Catholic Eldercare facility in Minneapolis and 32 fatalities at St. Therese of New Hope, the Star Tribune reported.
Meridian Manor, a Wayzata assisted-living facility, relocated all of its residents after an outbreak and has announced it will not reopen.
In Colorado, Pennsylvania, California and elsewhere, governors have deployed National Guard troops to assist with testing and staffing shortages at long-term care sites. Housley, in her statement, encouraged Walz to do the same.
HEALTH DEPARTMENT RESPONDS
Part of the challenge with meeting those demands is the limited amount of available testing. The state, which is home to 368 nursing homes and 1,700 senior housing buildings, is currently conducting around 2,500 tests per day, mostly focused on meatpacking plants, very ill patients and residents of care facilities with symptoms or known exposures.
“It will not be something we’d be able to do immediately with the available capacity,” said state Department of Health Commissioner Jan Malcolm on Tuesday.
In a conference call with reporters, Malcolm and other state public health officials said they’ve indeed paid special attention to nursing homes and congregate care facilities, albeit mostly on a piecemeal basis as outbreaks emerge.
The Minnesota National Guard has helped with staffing once or twice, but they could play a larger role once the state rolls out more of a statewide approach toward keeping the vulnerable safe, beyond the general guidance they’ve offered to date.
“We’re working on it right now,” Malcolm said. “We have a team from the CDC that is visiting Minnesota. We’re looking forward to some recommendations from them to inform that plan.”
Since April 16, the Centers for Disease Control and Prevention’s Community Protection Team has been visiting long-term care sites with state health officials to help form a strategy around safety assessments and treatment responses.
The percentage of known COVID cases that take place at long-term care facilities may appear high, Malcolm said, because that’s where the state is focusing much of its testing.
But it could be weeks before Minnesota has the capacity to do a full-court press on testing all nursing homes and senior buildings. There’s also some question as to how useful that information would be.
“Yes and no,” said Patti Cullen, CEO of the Care Providers of Minnesota, which represents about half the nursing homes in the state. “It’s not the perfect answer. You could test negative one day, and have a grand party and not be as careful as you should be, and be positive the next day.”
MORE STAFFING, VIRUS TESTING, PPE NEEDED
Cullen, however, agrees that long-term care facilities need more of everything — virus testing, personal protective equipment and staffing, especially in instances where a nursing facility has sent half its staff home because of an exposure.
“There’s a whole hierarchy of steps we take to try and get staffing, because staff are afraid,” she said.
Testing, Cullen said, would help screen asymptomatic staff and residents — those individuals who do not show symptoms — and allow the care sites to segregate residents and quarantine staff accordingly.
“Unfortunately, we found a couple staff who had to stay home for 14 days in Worthington and in Willmar,” said Cullen, pointing to meatpacking communities where testing has ramped up.
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But “it’s not going to be the answer to make sure it doesn’t get in,” Cullen said. “In one instance, a resident tested negative twice but had symptoms, and it wasn’t until the third test they tested positive. It’s just one more tool in our tool kit.”
Over the objection of the Minnesota Nurses Association, the state last week relaxed rules allowing out-of-state workers not licensed in Minnesota to float into nursing homes, and nursing assistants who had yet to pass clinical exams to work in long-term care facilities on an emergency basis.
“It was surprising how many barriers were in the way,” Cullen said. “The finger-printing stations were closed. The colleges (testing sites) were closed.”
MNA officials said it was irresponsible to look out of state for labor at a time when hundreds of workers are being furloughed in Minnesota, though Cullen noted that the eased regulations will be of special help to rural border communities.
The state Emergency Operations Center is collecting names of laid-off nurses, nursing assistants, EMS workers and others who would be willing to be deployed to long-term care facilities on short notice. Some county public health agencies organize a medical reserve corps.
Cullen was aware of only one instance where a licensed practical nurse from the National Guard had been called in to complete a shift at a long-term care facility, and perhaps two more instances where a facility had called the Guard to check nurse availability.State epidemiologist Dr. Ruth Lynfield is taking the long view. The types of interventions needed in long-term care facilities go beyond a one-day test, she said. They’ll have to be in place for months, if not permanently.
“We can’t put a bubble around them. I wish we could,” she said. “But health care workers come in and out, and there are some patients that need to go out for dialysis.”
“This is not a simple thing that you just do testing one day … and then you don’t have to worry about it,” she added. “We’re talking about a really, really long time.”
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As deaths in MN long-term care centers rise, a call for more coronavirus testing - TwinCities.com-Pioneer Press
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