It's tough to get an accurate picture of what’s happening inside some local nursing homes during the COVID-19 pandemic.
Long-term care centers nationwide are being slammed by this new and highly contagious coronavirus that has killed more than 63,000 Americans as of May 1.
With their elderly populations, many with underlying health conditions, and all living under one roof, so to speak, the facilities are hot spots for the virus.
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A single case of COVID-19 can turn into two dozen or more in just a week or so, as some local facilities have experienced. Testing has ramped up at facilities in the Fargo-Moorhead area to try to identify the virus and isolate people who contract it.
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During the pandemic, the Centers for Medicare and Medicaid Services is reinforcing an existing requirement that nursing homes report potential outbreaks to state and local health departments. It also said facilities must report the data to the U.S. Centers for Disease Control and Prevention.
And in the interest of transparency, CMS said nursing homes must alert residents and their families within 12 hours of a single COVID-19 case, and when three or more residents or staff have new-onset of respiratory symptoms occurring within 72 hours.
Long-term care facilities don't have to disclose that kind of information to the media, but some have.
A few CEOs have been responsive to inquiries from The Forum and candid about the challenges they're facing. Eventide Senior Living and Bethany Retirement Living post updates on their websites about COVID-19 numbers, after they've communicated the information internally with residents and staff.
In contrast, other nursing homes have been reluctant to respond or acknowledge cases to the media and, according to some local nursing home residents and families, even to them. Some with a known local administrative presence have referred media to public relations people in other states hired specifically to run interference during the pandemic.
That may cause some people to incorrectly assume that any nursing home not acknowledging COVID-19 cases is doing a better job than those with publicly known cases.
Invariably, the tight-lipped facilities have invoked the federal privacy law known as HIPAA for not answering questions or releasing case numbers.
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The Health Insurance Portability and Accountability Act is designed, in part, to protect a patient’s personal health information.
Maloye Lesmeister, 74, lives at Riverview Place, a few doors down from a man who became North Dakota’s first fatality from coronavirus.
She told The Forum she only recently learned the retirement community had eight COVID-19 cases because a family member saw the information on the North Dakota Department of Health’s website.
“If three on my floor have had it, I have the right to know,” she said.
This week, Catholic Health Initiatives, which operates Riverview Place, announced a policy change "to provide increased transparency" to residents, families and staff. It mirrors the new rules for notifying residents about COVID-19 cases, set forth by Medicare and Medicaid.
North Dakota only recently began reporting such cases in long-term care facilities to the public.
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On April 20, the state health department started listing on its website those facilities and the number of cases they have. Before that, North Dakota left the decision to disclose cases up to individual facilities.
Minnesota started listing affected facilities April 4, but the state health department does not reveal how many cases each facility has.
To date, 29 long-term care centers in North Dakota are reporting a presence of the novel coronavirus. Minnesota's list includes 125 such centers.
Jon Riewer, president and CEO of Eventide Senior Living, acknowledged early on the challenge of keeping COVID-19 from spreading.
In early April, he said what’s important is how well facilities respond because “it’s a matter of when, not if” the virus shows up.
Riewer and his counterparts at other facilities have had to make staffing adjustments on the fly.
Shawn Stuhaug, president and CEO of Bethany Retirement Living, said they were among the first to ask staff who work at multiple senior care facilities to choose one job and let the others go to limit spread of the virus.
As a result of that request, Bethany made the difficult decision to furlough more than 50 staff members until the pandemic is over, he said.
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During staff-resident contacts at Bethany, employees wear masks and face shields while residents wear masks, keeping risk of transmission low.
Staff members have a greater chance of getting COVID-19 outside of the facility than in it, he said.
Both Stuhaug and Riewer are concerned about even more staff exposures happening on the outside, as North Dakota businesses that were closed began opening on Friday, May 1.
When widespread testing was done at Eventide Fargo recently, 30% of those who tested positive were asymptomatic, Riewer said.
People with no symptoms of the illness can be more likely to spread it because they may not be as careful with prevention measures.
And at some point, Stuhaug said, nursing homes will have to ease their visitor restrictions, which have been in place at most facilities since mid-March.
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“The biggest challenge for us is yet to come,” he said.
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