For much of last year, the Los Angeles Jewish Home had relatively few COVID-19 cases, evading the pandemic’s hefty toll on long-term care residents in Southern California.
But an unprecedented, post-Thanksgiving Day surge in Los Angeles sparked a deadly rise of cases in the facility that lasted into January, said Dr. Noah Marco, the Los Angeles Jewish Home’s chief medical officer.
With 99 percent of all Jewish Home residents and most staff now vaccinated, the tide has turned, Marco said. As of early March, the last time a resident tested positive was in mid-January.
“We’ve come out of a very challenging, long dark tunnel,” Marco said recently by phone as a spokeswoman listened in. “There is much more light ahead than there is darkness behind.”
In the past year, more than 400 skilled nursing home residents and staff tested positive for COVID-19 at the Jewish home’s Eisenberg Village and Grancell Village campuses in the San Fernando Valley, with more than 85 residents dying, according to California Department of Public Health data.
The non-profit Jewish home, which houses roughly 1,000 residents, declined to disclose how many COVID cases and deaths it has had in its assisted living and independent living populations. More than 180 of its assisted living residents and staff became infected with COVID, according to the state’s Department of Social Services.
Jason Belden, emergency preparedness director of the California Association of Health Facilities, which represents about 900 nursing homes in the state, shared Marco’s optimism about the future one year after the start of the coronavirus pandemic.
“Closing down the economy and schools and restaurants reduced the surge in Southern California but it also coincided with the initial vaccine deployment,” Belden said, adding the industry is “very strongly positioned” to deal with the pandemic going forward.
With most nursing home residents and staff now vaccinated, he said, “we generally feel pretty confident that we can protect residents that currently live in skilled nursing facilities in Southern California.”
More than 5,300 nursing home residents and staff, and at least 1,850 assisted living residents and staff, have died in Los Angeles, Orange, Riverside and San Bernardino counties after contracting the the novel coronavirus since the start of the pandemic, according to state data.
Long-term care facilities, their residents and their families have long awaited new guidance for visitors in light of vaccination efforts. The California Department of Public Health, along with the Centers for Disease Control and Prevention, issued new guidelines for visitation in recent days to facilitate in-door visits with residents and even physical touch under certain conditions.
“Now, it looks like the risk of contracting this terrible virus and it killing a senior is much lower than it was since (before) the vaccine,” Marco said before the guidance was issued. “Certainly it makes sense to allow adults who are seniors to have the opportunity to hug their loved ones.”
During the week of March 13, advocacy groups, including the Southern California-based Essential Caregivers Coalition, launched a national campaign across 17 states to honor those lost in long term care facilities and demand change to nursing home visitation policies. Events in each state are also calling for the federal designation of an essential caregiver, according to campaign organizers.
While California has safe, responsible visitation guidelines, much of it has been contravened by local public health authorities and facilities, said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform.
“My old complaint is that county public health departments don’t know nursing homes from holes in the ground,” he said. “They are thinking about community spread and positive tests. They are not thinking about social isolation costs.”
There should be better enforcement of the state’s visitation mandates, including the citing of nursing homes, to curb the toll isolation is taking on residents, Chicotel said.
Meanwhile, Southern California nursing homes are still dealing with other pandemic challenges.
Finding enough adequate personal protective equipment, particularly protective N95 masks, for nursing homes “is still an issue,” Belden said. As a result, nursing home staff are reusing these masks for extended periods when they are intended for single use.
“Until we get back to that — that we use it for what it’s intended for — there’s always a risk,” he said.
Legislation now requires acute hospitals to keep a 90-day supply of personal protective equipment on hand while “we’re still trying to buy PPE for our resident population,” Belden said.
There are only two very large medical suppliers of PPE equipment for long-term care facilities in the U.S, he said. Ideally, N95 masks would be manufactured in California and provided directly to nursing homes.
Another challenge will be ensuring there will be enough vaccine supply since the nursing home and assisted living populations are constantly fluid. In the midst of vaccination efforts of long-term care residents, the state has tapped health insurance giant Blue Shield of California to oversee the state’s vaccine distribution.
“There are still a lot of questions regarding how this will be rolled out, especially in disadvantaged and vulnerable populations,” said Dr. Michael Wasserman, who is a member of the state’s Community Vaccine Advisory Committee and immediate past president of the California Association of Long Term Care Medicine.
This is also the case with the end of the Federal Pharmacy Partnership program, which has been used by most California counties to vaccinate residents and staff of long-term care facilities, he said.
“How are nursing homes and assisted living facilities going to continue to make vaccines readily available for residents and staff?” Wasserman said via text. “We must make it easy for staff and not burden them with added responsibility.”
A Blue Shield spokeswoman said they’ve been “proactively reaching out to important stakeholders,” including to the Community Vaccine Advisory Committee, to help ensure transparency.
“We continue to make significant progress in supporting the state’s goal of providing vaccines to all Californians equitably and as quickly as possible, especially for communities disproportionately affected by the pandemic,” Blue Shield spokeswoman Erika Connor said by email.
During the transition period, providers already administering the vaccine will continue to receive doses to ensure vaccines are available to as many Californians as possible, she said.
There is also some lingering concern about the turnaround times for diagnostic tests.
“Even today, you don’t have guaranteed 24 hour or less turnaround time in PCR testing throughout the state,” Wasserman said. “To me, that’s inexcusable.”
California has seen “significant improvements” in average turnaround times for COVID test results with the current statewide average being about one day, CDPH said via email. Most recently, the average testing turnaround time for PCR tests in the state was 1.1 days, while average turnaround time for commercial labs was 1.3 days.
The use of antigen tests, which have a rapid turnaround time of less than 30 minutes, has also gradually increased in the state particularly in long-term care facilities, CDPH said. Antigen tests are also being used to diagnose acute infection but are less accurate than PCR tests.
Belden said while turnaround times have waxed and waned, his association has not heard of many problems in recent weeks.
Many long-term care facilities are also dealing with the pandemic’s harsh financial impact.
Ensuring adequate amounts of PPE amid shortages, conducting more frequent diagnostic testing of staff and residents and having to restrict admissions due to COVID infections in certain areas have all taken a financial toll on the Los Angeles Jewish Home, said Dale Surowitz, who joined the facility as CEO and president last fall.
“With the revenue loss and operating costs, (the overall loss) has been quite a few million dollars,” he said.
The 108-year-old Jewish Home, which usually has an annual operating budget of about $150 million, has had “tremendous support” from the community as well as grant and government support, Surowitz said. As a result, “we’ve been able to work through it but it’s been a challenge.”
The Jewish Home was recently cleared to admit new residents in certain areas, he said.
As nursing homes became ground zero for the pandemic, government agencies and the industry struggled to curb the devastation.
State and federal guidance that required all nursing home staff members to wear masks in April helped reduce the spread once an outbreak occurred at a facility, Belden said. Secondly, California required nursing homes to develop a COVID-19 plan, including for separating infected or possibly infected residents, that became effective in June.
Moreover, baseline testing of California nursing home residents and staff, which became effective at the end of June, further helped nursing homes identify and isolate infected residents and staff, Belden said.
“Could it have been done sooner? Sure. Could we have more universally passed out the information, not just us as CAHF but (the California Department of Public Health) and health departments? … We could have said things maybe earlier but those three things specifically really worked to reduce the loss of life,” he said.
The development and deployment of COVID-19 vaccines, however, have been the most instrumental in the fight against the virus in these facilities.
“That’s going to save more lives than all the other methods combined,” Belden said.
According to self-reported data, about three-quarters of L.A. County nursing home staff and residents have been vaccinated of the roughly 340 nursing homes the county oversees in its jurisdiction, said L.A. County Department of Public Health’s Dr. Prabhu Gounder, who helps oversee COVID outbreak response in nursing facilities. Of those, nearly 90 percent of staff and more than 80 percent of residents have received a second dose.
Some staff members and residents felt they needed more information about the vaccines and in many cases, providing this information helped, Gounder said. Representatives of residents, when residents don’t have the capacity to make decisions for themselves, also need to be informed about the vaccines and this can take additional time.
But experts warn that the COVID-19 vaccines don’t mean that long term care residents will be home free.
If people let their guard down when it comes to protecting themselves and others or decline the vaccine in significant numbers, that could increase the likelihood that more variants of the virus will arise in the community, which is particularly risky for the elderly and frail, the Jewish Home’s Marco said.
“Will the vaccines protect people enough from those variants?” Marco asked. “That’s my concern not so much for our community but the community around us, that they will not take the responsibility seriously enough and be selfish by not either taking the vaccine or by not continuing to practice good… guidance.”
"term" - Google News
March 16, 2021 at 01:00AM
https://ift.tt/3ljHl1g
After year of coronavirus, long-term care homes finally see the light – though risks remain - LA Daily News
"term" - Google News
https://ift.tt/35lXs52
https://ift.tt/2L1ho5r
Bagikan Berita Ini
0 Response to "After year of coronavirus, long-term care homes finally see the light – though risks remain - LA Daily News"
Post a Comment