On the Front Lines: Mohave County nursing homes battle COVID-19
About one-third of all U.S. deaths attributed to COVID-19 have been connected to long-term care facilities.
It’s a problem across the globe, and Mohave County is no exception to the rule.
After a COVID-19 outbreak in nursing homes in Kingman reported on April 30, Mohave County is now dealing with a new outbreak at Joshua Springs Senior Living in Bullhead City, which has announced it is dealing with COVID-19 cases.
“This particular facility has over 10 cases in a specific unit,” Mohave County Public Health Director Denise Burley told the Mohave County supervisors on Tuesday, May 26, without naming the facility. As of May 30, there were 18 positive cases from the facility.
Nursing home outbreaks have proved to be a problem worldwide. According to the New York Times’ database, on May 11 one-third of all U.S. coronavirus deaths were nursing home residents or workers.
There are five nursing homes in the county that reported cases of COVID-19, Burley confirmed via email on Friday, May 29.
A month ago, on April 30, Burley reported 45 positive cases in the county associated with long-term care facilities, with Kingman having 39 of those cases. At the time there were 116 total cases in the county, according to a county press release issued on April 29. Out of 12 patients hospitalized for COVID-19 at KRMC, nine came from a single facility, KRMC CEO Brian Turney said at the April 30 meeting.
As of May 29, there were 131 nursing home-related cases in the county and 25 of the county’s 42 deaths were connected to long-term care facilities, MCDPH told the Miner.
When Kingman experienced an outbreak a month ago, the facility with most of the cases was identified by Turney as Desert Highlands Care Center, 1081 Kathleen Ave. But MCDPH refused to disclose names of such facilities throughout the county and insists on respecting the residents’ privacy.
Burley repeatedly stated within the last few weeks that she cannot release the names of facilities because those institutions are physical addresses – the actual home – of those patients. That included the current flare-up in the nursing home in Bullhead City.
“The Health Department is working with the leadership of this particular facility, both corporate and on-site,” Burley said. “The patients are all being tested in the unit. The staff will also be tested in this unit. The facility has made arrangements for that.”
Other help the county can provide includes additional testing in other units, Burley said, as well as additional prevention education, and making sure that PPE [Personal Protection Equipment] is being used properly, and that the staff that is working with COVID patients are not working with other patients.
In the case of Desert Highland, “the resources provided to the facility did help to minimize the impact of COVID-19 on staff and patients, Burley said, “assuring the facility had appropriate and adequate PPE, timely testing and isolation of positive staff and patients, and technical assistance and education reduced the spread of COVID-19 in the facility.”
District 2 Supervisor Hildy Angius confirmed once again that this is up to a facility – and the corporation that runs it – to disclose its connection to COVID-19.
“We had this problem before,” Angius said, referring to the Kingman outbreak and the pressure to release the name of the facility. “But these things have a way of getting out anyway.”
“We are guests in those facilities,” Burley said, emphasizing it’s the facilities that manage the patients’ care and all the county can offer is help and recommendations.
“What is their responsibility in reporting,” Angius asked. “As soon as they have one or when they have five cases? I understand that this is a delicate situation but do we have an ability to tell them what to do?”
Burley said facilities report positive cases to MCDPH, but the county cannot force them to do anything.
“When somebody is looking to put a loved one is some of those facilities,” started District 3 Supervisor Buster Johnson. “Obviously, they didn’t come with COVID19. Somebody from the outside must have had bring it in. Are we looking to see how the virus got into those facilities?”
“Yes,” Burley replied. “That’s part of testing staff.”
“So did we located the culprit at the Kingman facility,” Johnson followed up.
“We’ve tested staff and we have at least two positives for this particular facility,” Burley said. “There may be more.”
Burley said a family can remove patients from long-term care facilities at all times.
“A patient can make this decision or a family member with a Power of Attorney,” she said.
“It’s a little surprising to me,” Johnson inquired. “You said that 10 cases showed up yesterday [Tuesday, May 26]?”
“Yes, we have at least 10 cases,” Burley replied.
“So ten plus people came down with it at one time,” Johnson asked. “Were those people showing symptoms before and they were not checking? Were they all in close proximity?”
Burley explained with when it comes to older people, their symptoms present themselves a bit differently.
“What we’ve noticed is a drop in O2, which is not listed by CDC as a symptom,” Burley said.
Johnson asked if the recent increase in cases statewide can be attributed to the testing being conducted now in long-term care facilities. He learned that no, that is not a possibility, since the results from long-term care facilities did not arrive yet from the Arizona Department of Health Services, Burley said.
The county is using rapid kits to test local nursing home residents, MCDPH announced in late May. Negative results will be repeated since rapid test kits are still considered unreliable and provide about 40% of false negatives, Burley said. The repeat is being done with a regular test and positives are not being repeated.
On May 28 board meeting, Angius questioned again if MCDPH is doing enough in terms of assisting the county’s long term care facilities.
“They are clearly not as prepared as they should be,” she said, adding that her impression is nursing homes expect for the county to step in and start mass-testing. She herself would see her as a good step, she said.
But County Deputy Attorney Ryan Esplin explained that it is the state who is in charge here, namely the ADHS that licenses residential facilities and long-term care facilities.
“But we are the closest government to the people,” Angius said. “If we will wait for the state, forget about it.”
“We are always welcome until we find something wrong,” Johnson said, meaning the county. “And we are asked to leave.”
According to the ADOHS website, there are seven long term-care facilities and seven residential facilities in Mohave County. They all received COVID-19 guidelines from the ADHS.
According to state’s website, Desert Highland in Kingman is the only long-term care facility that currently has a “D” quality rating – the last evaluation was done in June 2018 resulting in this rate.
“We act as resource and support,” explained MCDPH Nursing Services Manager Lynne Valentine at the board meeting on May 28, once again letting the supervisors know the department don’t have an authority to tell nursing homes what to do.
Burley said MCDPH is working with five facilities in each of the major cities in the county, those that experienced a case of COIVI and reached out for help. But both Burley and Valentine said repeatedly their department doesn’t have a capacity to test all the residents of all long-term and residential facilities. It’s not only a matter of testing supplies, the Public Health would need to hire more staff to conduct such operation. The only thing they can do is to assist in arranging testing via ADHS and other test providers.
“That [mass-testing in all long-term care facilities] would be a huge undertaking,” Valentine said. “We don’t have enough resources.”
Valentine said the Bullhead City facility that is currently experiencing the outbreak has well over 100 residents, pointing out to the amount of testing supplies that are needed to test each such facility.
Valentine said the testing started with the unit that experience the outbreak, starting with those with symptoms. Western Arizona Regional Medical Center stepped in to assist with testing in the facility, too, she said.
Mohave County is home to many local and out-of-state seniors. According to the U.S. Census Bureau there were 212,181 people in Mohave County in 2019, and 30.3% were age 65 or older. In 2017, the median age was 50.4, according to the census bureau, with more than 22,000 residents over age 75.
With COVID-19 spreading across the nation’s long-term facilities, some of them advertise themselves as COVID-free, as for example The Lingenfelter Center in Kingman.
In February 2019, the U.S. Department of Health and Human Service released “Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.” They include a specific plan for outbreaks of unfamiliar and contagious diseases — such as the coronavirus. The violations occurred in 6,599 facilities, equal to about 43% of the country’s nursing homes, the HHS’s Office of Inspector General inspectors found and Pro Publica first reported on May 29.
The state will not release details on virus cases at Arizona nursing homes despite an early May lawsuit filed by several news organizations. https://bit.ly/2AbfGMP
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