Dozens of Kansas nursing homes still wait three days to a week for overwhelmed labs to tell them if their residents have COVID-19.
As of mid-November, 30 facilities had less than a week’s worth of N95 masks on hand. Another 100-plus didn’t have enough nurses.
Nine months into a pandemic that has proven most deadly to older people, Kansas nursing homes tell federal regulators they’re still struggling to get the basic tools of defense.
Perhaps most disturbing of all — as the virus rages in cities, suburbs and rural towns — nursing homes simply can’t keep coronavirus out. Two-thirds of them have had confirmed cases among their residents.
Things were bad enough in August and September, when Kansas long-term care facilities were fighting around 40 to 60 active coronavirus outbreaks (meaning two or more cases) at any given time.
October and November brought a vicious surge of the disease. Now, in early December, facilities are dealing with more than 200 ongoing outbreaks.
That escalation brought the virus to the Centennial Homestead in rural Washington County along the border with Nebraska. Centennial had managed to keep the disease out. Until late October.
“Once it’s in your building, you beat yourself up,” said Haely Ordoyne, who co-owns and runs the 30-bed home. “How could this happen? How did it get in? Where did we go wrong?”
And that followed months of isolation and constant fear of a potential outbreak.
“You have PTSD in residents and in their families,” she said. “And I guarantee that my staff has some form of PTSD after this is all said and done.”
Centennial gets five out of five stars on the federal government’s nursing home rating, with two low-level citations on its last annual inspection, compared to a national average of eight.
In July, a federal inspection found Centennial was following best practices to control infections amid the ongoing pandemic.
Sidelined by the virus
During the summer months, about one in five Kansas nursing homes didn’t have enough nurses. Now, a third of them are in that boat.
Even outbreaks that don’t infect residents sideline employees who need to go into quarantine.
Meanwhile, nursing homes experiencing outbreaks need more staff — not less — to maintain strict separation of their “COVID” and “non-COVID” wings.
“Every day is tooth-and-nail” trying to bring in enough workers, Ordoyne said. That means finding temporary workers willing to drive in, usually from other counties.
Like many nursing homes, Centennial turned to temporary staffing agencies for help. But they can charge four times the normal going rate.
“We’re not just bleeding,” Ordoyne said. “We are hemorrhaging.”
Nursing homes received federal stimulus funds to help, but part of the problem is they don’t know when that money will run out.
The holidays risk spurring even wider community spread. That could fuel yet more outbreaks and sideline more workers.
Meanwhile, problems that nursing homes hoped would be resolved months ago haven’t gone away.
High-quality coronavirus testing can run upward of $100 a pop. Gloves and other protective gear continue to sell for several times what they cost before the pandemic.
“The last couple of months, the shortage has been on gloves,” said Debra Harmon Zehr, who heads the nonprofit nursing home association, LeadingAge Kansas. “Three months ago it was hospital gowns.”
“It’s sporadic,” she said. Just when it seems the pipeline is fixed, a different item becomes scarce. “And you think, ‘Well, that wasn't a problem a week ago.’”
Kaiser Health News reports the problem remains especially acute for small health care providers, who struggle to compete with major health systems stockpiling supplies.
To Zehr, it drives home the nation’s poor preparation for a pandemic, for which older people are paying the dearest price.
“When it actually happened, any (government) plans that had been made and any systems that were supposedly put in place failed miserably,” she said.
Coronavirus is now so widespread in Kansas that almost every nursing home in the state has to test its workers twice weekly for the virus. Federal regulations require it.
Workers without any symptoms can unwittingly carry the coronavirus into nursing homes.
The U.S. Department of Health and Human Services sent out small machines for on-site testing. But as of mid-November, two dozen Kansas nursing homes told regulators they still don’t have any such device or enough supplies to use it.
Regardless, those machines — and, more recently, federal shipments of paperstrip COVID tests that don’t require electronic hardware — are only used until a coronavirus case has been confirmed in a building.
At that point, nursing homes turn to outside labs for PCR tests, a far more sensitive tool that long-term care facilities can’t afford on a daily basis.
But from the start of the pandemic, high demand backlogged the labs that conduct PCR tests. That led to long waits for results. Forty-one nursing homes in Kansas say they still wait three to seven days for results when they test residents.
Centennial is one of them. It’s had to wait between three and five days for results.
It sent samples hours away to a major lab in the Kansas City area after its on-site rapid tests uncovered a single asymptomatic case. The PCR tests revealed several more cases among people who had tested negative with rapid tests.
Soon people started showing symptoms. Ultimately, 18 residents and 18 workers tested positive. Four residents have died.
The state recently began helping more nursing homes with PCR testing, but it’s unclear how far that program funded with federal stimulus dollars will stretch.
Statewide, the more than 200 ongoing COVID-19 outbreaks in Kansas long-term care facilities have taken 360 lives so far.
Combined with other outbreaks that have already ended, the virus’ toll in nursing homes and similar facilities makes up more than 750 of the nearly 1,700 pandemic deaths in Kansas.
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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