BISMARCK — A Bismarck nursing home is staving off a spike of coronavirus cases this week as the recent transmission surge has strained the staffs of long-term care facilities across the state.

The Missouri Slope Lutheran Care Center reported 19 residents and 32 staff members had tested positive for COVID-19 as of late last week. Those numbers dipped in the last few days, with 12 residents and 28 staffers showing positive test results as of Wednesday, Sept. 2, but the east Bismarck facility still has the most active COVID-19 cases of any long-term care center in the state.

And while Missouri Slope is the largest nursing home in North Dakota, with 500 total employees, Reier Thompson, the facility's president, said the recent outbreak of coronavirus cases has put them in a staffing bind.

"We have all hands on deck. We have plans in place, given what we know, to combat this," Thompson said. "We're doing everything we can to control it."

Missouri Slope reported a significant increase in positive cases at the end of last week, according to the North Dakota Department of Health's COVID-19 dashboard, ballooning from 15 residents and 13 staffers to the 19 residents and 32 staffers reported on Friday, a sudden jump that Thompson attributed to a recent testing event at the facility.

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The effects of the statewide surge in coronavirus cases have stretched beyond Bismarck, overwhelming nursing homes in many parts of the state.

"We are definitely stressed for staff right now," said Loretta Gerving, director of nursing at Marian Manor, a smaller facility in the western North Dakota town of Glen Ullin that's currently reporting eight residents and three staffers with the virus. "Long-term care is always in need of staffing, but it's almost doubled during the pandemic."

The recent spike of COVID-19 cases has also coincided with a jump in the number of deaths within North Dakota's nursing homes. Since the start of the pandemic, 82 people have died of the coronavirus in North Dakota's long-term care facilities, up 15 since Aug. 2, according to health department spokesperson Nicole Peske.

Missouri Slope said it was not aware of any deaths in the facility resulting from the coronavirus, and Marian Manor said it couldn't comment on whether it has had any deaths due to the pandemic.

Missouri Slope has had some staffers work overtime to fill open shifts, and the facility also relied on reinforcements from the health department's emergency medical reserve corps, a team of nurses and health professionals the department has deployed all over the state to address staffing shortages. Gerving said Marian Manor has put out a request for extra hands from the emergency medical response corps and is waiting to hear back.

Rachel Stinson, who oversees the emergency medical response corps, said her staff of 169 is spread thin across the state, filling shifts as North Dakota continues to see record numbers of new coronavirus cases.

Stinson noted that her team is hiring for "almost all positions" as it scrambles to address the state's growing need, adding that her team is dealing with a "severe shortage" of certified nursing assistants.

While Missouri Slope and Marian Manor are both running short staffed, Thompson and Gerving said the majority of positive coronavirus cases in their facilities have been asymptomatic, meaning most residents who have contracted the virus are not experiencing health complications as a result.

Like other long-term care facilities in North Dakota, Missouri Slope has taken extreme precautions to prevent an outbreak within their facility. Since the start of the pandemic, the facility has provided staffers with personal protective equipment (PPE) and restricted visitation hours and group activities.

And while many long-term care facilities relaxed some of their visitation and group gathering policies earlier this summer, Missouri Slope tightened its rules again on Aug. 8 in response to surging coronavirus cases in the Bismarck area. Since then, residents have had to take meals alone in their rooms, with no visitations or group activities allowed.

"It's difficult. It's difficult because we worry about the residents themselves and how they're affected by this," Thompson said.

Thompson added that he believes most of the cases in Missouri Slope are the result of the rise in cases in the broader community. Residents who have tested positive were likely infected by interaction with staffers, or could be hangover cases from prior to the tightening of restrictions in August.

Seth Fisher, a state regional coordinator for North Dakota's Vulnerable Population Protection Plan, said the outbreak at Missouri Slope mirrors a pattern in other nursing homes around the state, where positive cases are cropping up again.

"We can all agree that the increase that we have seen in cases in long-term care facilities is a direct correlation with what we're seeing in the community," Fisher said, noting that these elder care facilities have tended to show a lag of 10-14 days before matching transmission trends in the broader community.

"All of us that are dealing with this are in the same boat," Gerving said. "And if you haven't felt it yet, then you better thank your lucky stars."

But for those who work at Missouri Slope, even a single case in the facility is one too many.

"Any time there is a positive, we feel a little heartbroken because of the amount of work that we're doing to try to prevent this," Thompson said.

Readers can reach Forum reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.