Nursing Homes Most at Risk from Virus are Bigger, Urban

Die, virus, die!

Three out of five of the 1,645 Virginians who have died from COVID-19 have been residents of long-term care facilities — one of the highest percentages of any state in the United States. There has been considerable speculation why. Vincent Mor, a research scientist with the Brown School of Public Health, has found that nursing-home staffing levels aren’t the issue. Neither is the source of funding, whether Medicaid or private insurance.

Mor argues that the size and location of long-term care facilities are the most decisive factors. Facilities most likely to have COVID-19 cases tend to be (1) located in larger urban areas with large populations of Hispanics and African-Americans, who are disproportionately likely to have the virus, and (2) the size of the facility, or, more specifically, the greater the number of employees coming and going.

“It’s all about the traffic,” he says in this PowerPoint presentation summarizing his research. “The bigger the building, the more people enter. … So, it’s NOT about the facility but the virus.”

I had never made these connections, and I think they are worth exploring here in Virginia. If the same pattern holds, it may influence how public health authorities prioritize the allocation of resources in the battle against the virus.

Mor advocates more testing, more support for staff, and more personal protective equipment. Speaking of PPE, it’s worth noting that the Virginia Hospital and Healthcare Association nursing home dashboard indicates that access to PPE, once a significant problem for many Virginia nursing homes, is far less of an issue. Only two facilities reported difficulty obtaining N95 masks, and hardly anyone reporting problems getting other types of PPE.

— JAB

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11 responses to “Nursing Homes Most at Risk from Virus are Bigger, Urban

  1. If Mr. Mor’s premise is true – and I have seen other articles making the same premise – then what would be VDH’s big sin that warrants sanctions against it?

    re: ” it may influence how public health authorities prioritize the allocation of resources in the battle against the virus.”

    what resources?

    We’ve heard folks advocate that VDH take more control of how the LTCF do business. What should VDH be doing if Mr. Mor’s premise is correct?

  2. It seems like there might be lessons learned that will benefit future residents, such as more attention to prevent spreading flu to the residents.

    Still nobody is talking much about the “hidden” COVID-management issue of intentionally putting COVID patients in the nursing homes. Not all of these nursing home deaths are people who got the disease in-situ. The InsideNoVA.com article I posted a few days ago gave some numbers on this.

    I just happen to have an very elderly mother who is perhaps losing her ability to live alone, perhaps in part due to indirect impact of COVID, cutting off all of her formerly active social life and other losses of freedoms she formerly had.

  3. If nursing homes are private sector – under what circumstances would they be taking COVID19 patients? Are they ordered to or do they willingly accept them or what?

    • It seems that, in most cases, nursing homes are being told they cannot refuse to take a patient that has had COVID-19, was in the hospital, but now is stable enough to leave the hospital.

      • These are folks that are still infected? Who is it that is forcing the nursing homes? I thought they were private sector and could refuse a patient if they did not have the means to care for them.

        Do we not have a process for what happens to people who have an infectious disease leave the hospital?

        Nursing Homes seem to be between the devil and the deep blue sea.

        On one hand, they are, in theory, a private sector business – regulated, yes, but like other regulated businesses they run their own operations.

        In practice, it sounds like they may not be as wholly independent as is said sometimes.

        But I cannot imagine ANYONE who is suffering from an infectious disease – even if recovering – be sent to a facility with people who are highly vulnerable to such diseases… it makes no sense.

        • Yes. New on the news this AM, old people retain active virus up to 6 weeks after symptoms abate, whereas younger people shed the virus faster.

          This virus is cool. Not saying cool as in good, just way different than anything to date. It has a lot of age specific properties.

          Cuomo was bemoaning this several weeks ago when he discovered patients were leaving the hospitals for the nursing homes. The homes are supposed to certify they understood the risk. Apparently, many didn’t.

          • whoa!

          • re: ” Cuomo was bemoaning this several weeks ago when he discovered patients were leaving the hospitals for the nursing homes. The homes are supposed to certify they understood the risk. Apparently, many didn’t.”

            Well that was Cuomos side of it…

            I wonder how much of a practice this is across the country.

            I wonder if Centers for Medicare and Medicaid Services has issued guidance with respect LTCF receiving COVID-19 patients.

            It seems to be a really dumb thing to do… cannot imagine any of the regulating agencies being mute about it.

          • Nancy_Naive

            I do fear that we will chalk one up on the “lessons learned” column when it comes to marking down “where one dies”.

      • Dick, the nursing home associations’ guidance doesn’t say they have to accept an active case if they’re not prepared for it.

        I think the weak point in transfer guidance is “Hospitals are NOT required to perform COVID-19 testing on patients solely for discharge considerations unless new respiratory infection symptoms develop.” So pre-symptomatic cases can get transferred without hospital or nursing home knowing in advance.

        The rest of the guidance says:
        Those investigated and have negative tests, can be transferred.
        Those with pending tests cannot be transferred until results are in.

        Patients positive for COVID-19 testing: •An LTCF can accept a new admission and readmission with a diagnosis of COVID-19 and who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow CDC infection prevention and control recommendations for the care of COVID-19 patients, including having adequate staffing levels and adequate supplies of PPE.

        •If transmission-based precautions have been discontinued* AND patient’s symptoms have resolved, a patient can be discharged back to the facility they came from. Hospital discharge planners should provide advanced notice to the LTCF for any transfer of a patient with COVID-19.

        https://www.vhca.org/files/2020/04/COVID-Hospital-to-Post-Acute-Transfer-Form_04-22-20final.pdf

  4. So far.

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