Gov. Brian Kemp extended lockdowns and extra safety precautions in long-term care facilities through June 12. But with the general population already emerging from weeks of sheltering in place, the workforce at long-term care facilities could face more exposure at home and in the community.
Long-term care facilities are grappling with how to manage this risk, knowing that workers with no signs of the virus can carry it and unknowingly expose vulnerable residents. It’s why health officials and industry leaders are crying out for access to tests that will allow them to quickly identify those who are infected to manage the virus and keep it from spreading.
“This literally is what keeps me up at night,” said Dr. S. Elizabeth Ford, DeKalb County’s public health director. “Trying to keep that already vulnerable population safe is really the highest level of anxiety I have.”
Signs of trouble
At Westbury Medical Care and Rehab, a highly rated facility in Jackson, about an hour south of Atlanta, the staff has adopted a motto this past month: Tough times don’t last. Tough teams do.
The group of 200 workers has been challenged like at no other time in the facility’s six decades of ownership and operation by the Westbury family.
“Everyone is working a lot of extra hours right now,” said Jennifer Vasil, the home’s administrator. “We’re all pulling together.”
The first sign of trouble came on April 3 when the home received its first positive test result — a man in his 60s. The home started urging health officials to get every resident tested, but it took nearly a month before all resident test results came in. By that time, the home had a major outbreak that has resulted in 102 resident infections and 20 deaths.
Some two-dozen staff also are known to have been infected, but the number of actual infections is likely higher. The facility has only been able to secure tests for about 50 workers. Of those, 24 tested positive as of Tuesday. One of those infected and hospitalized was the wife of owner Ron Westbury. She is a social worker at the nursing home.
Westbury said he is bewildered why more resources were not devoted to long-term care facilities early in the pandemic.
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“Our staff goes into a burning building every day as it relates to this disease,” Westbury said.
The outbreak has taken a heavy toll even on staff who weren’t infected. Many workers have had to pick up extra shifts as colleagues were out sick, and the home has had to offer incentive pay to help cover childcare costs with schools out of session. It’s been challenging to hire new staff as workers have been reluctant to start at a facility with such a significant outbreak, Vasil said. And many of the residents who’ve died had been part of the community for years.
“The numbers have been shocking,” she said. “We did everything exactly by the book from day one…To see the level of cases we have it is disturbing for us. It is sad. We’re dealing with the grief.”
Seeking more help
Amid the coronavirus crisis, many long-term care operators are aggressively trying to recruit workers to reinforce depleted staffing levels. They’ve been helped by the relaxation of some state and federal rules that govern the hiring workers.
Background checks during the emergency have not required fingerprint tracing. And some training and certification prerequisites have been relaxed to allow homes more easily to hire workers.
These changes have been a big help to ensure facilities have enough staff, said Tony Marshall, CEO of the Georgia Health Care Association, which represents nursing homes and assisted living centers. Residents in long-term care settings often have chronic health issues or challenges with mobility that require intensive attention from caregivers.
“The COVID-19 pandemic has exacerbated our already challenged workforce situation in long-term care,” Marshall said. “The number of staff who’ve tested positive for the virus or self-quarantined has created a significant challenge to ensure an adequate workforce to meet the needs of residents at our centers.”
PruittHealth, which has reported coronavirus cases at more than two dozen Georgia facilities so far, is looking for more than 2,000 new workers for its homes across the Southeast. The company has set up a rapid hire program amid the crisis.
It’s part of the company’s plan to manage the coronavirus threat at its facilities for the next 18 months. The company sees an opportunity with so many unemployed because of the recession to bring some into their workforce. The company is “going all out” to retrain workers to ensure they have enough staff, said Neil Pruitt, the company’s chairman and CEO.
“I’m not scared we’re going to run out, but we’re being super aggressive in trying to recruit the best folks as our caregivers,” Pruitt said.
Even with the rapid hiring, the company had to turn to the state for help at a couple homes overwhelmed by the virus.
An outbreak last month at PruittHealth-Marietta turned dire quickly. Since last month, some 86 residents tested positive for the virus as well as 17 employees — many who were asymptomatic. Four residents have died. The state sent in nurses and other support to help stabilize the workforce while staff recovered from the virus or self-quarantined at home.
One employee who contracted the virus was the facility’s administrator, Antonio Jones. His pregnant wife was going into the hospital for a C-section on April 16, the same day Jones learned he had the disease. Jones had to be hospitalized, and he didn’t get to see his daughter the first two weeks of her life.
Jones returned to work a week ago, but he knows there are still tough days ahead for the nursing home and his staff.
“The next month is going to be a challenge,” he said. “Everything I do is faith driven. I will definitely not be in it alone. It’s basically getting everyone, every family member, every resident, every (staff member) to understand they are not in this fight alone.”
Workers at risk
Advocates for the elderly worry that some facilities may not work hard enough to keep their staffing high in nursing homes and assisted living communities, where many residents need constant assistance. They say facilities, especially those with outbreaks, should have on-site inspectors to check for adequate staffing, PPE and testing.
Homes can face abrupt gaps in staffing when workers test positive and have to take time off or leave their jobs after getting sick. Some workers quit because they don’t feel safe at facilities that are short on supplies. They also face uncertainty about who may have the virus, since about 80 percent of Georgia’s 58,000 long-term care workers still have not been tested.
Mary Almon, a licensed practical nurse, started worrying in February that the coronavirus would threaten the nursing home in Carrollton where she worked. She said Carrollton Manor did not provide masks and other protective equipment early on and didn’t deal with risks of staff members working at more than one facility. By mid-April, the state released reports showing a major outbreak. At least 11 staff have tested positive, while 44 residents have been infected, including seven who died.
Almon decided on her own to get tested, and while she was awaiting results, she said her employer said she could continue to work if she did not have symptoms. She declined then found out April 12 she had the virus. She blames the facility for not providing proper PPE and hasn’t returned to work since.
“COVID-19 is nothing to play with,” she said.
Trace Thompson, Carrollton Manor’s administrator, said getting adequate supplies was initially a problem. “When this first started, we didn’t have enough masks for everyone,” he said. But he said by the time the facility had its first resident test positive at the end of March, it did have masks and other PPE.
The facility has paid staff while they were out after testing positive and paid bonuses to get staff to work extra hours to cover for those who were out. Hiring new workers has been difficult, though, he said.
“Everybody is scared to go to work in a nursing home right now,” he said. “It hasn’t been easy, but we have managed.”
Kemp has repeatedly said the coronavirus poses a mortal danger to many Georgians in long-term care. He's taken steps to try to protect them, including issuing an order in early April restricting visitors and requiring enhanced infection-control protocols and screening of employees before shifts. But his decision to reopen much of Georgia's economy has compounded the challenge of shielding front-line workers from the virus.
Kemp was asked about this risk at his press briefing Thursday. He acknowledged it’s a concern for all medical facilities but said people are now more knowledgeable about the virus and precautions to limit its spread.
“This is going to be a long fight in our long-term care facilities until there’s some sort of medication or a vaccine that can protect these vulnerable individuals,” he said. “They need to continue to be very careful in this environment.”
Affinity Living Group, which operates 140 senior communities across six states including 11 in Georgia, has encouraged its workers to sign a “Hero’s Pledge” acknowledging the need to protect residents by protecting themselves from exposure around the clock, not just when they are at work.
Dr. Kevin O’Neil, Affinity’s chief medical officer, said he’s “very concerned” about the risks in states where restrictions are being relaxed.
While Affinity has no major outbreaks in its Georgia homes, O’Neil said workers may do everything right but still get exposed to the disease by contact with people who are going to establishments that reopened. In Georgia, that could be everything from hair and nail salons to restaurants and gyms.
“I think the opportunity to spread this within the community now is going to be so much greater in those states that are relaxing these restrictions too early,” O’Neil said.
At St. George Village in Roswell, which has nursing care, assisted living and independent living, no cases of the coronavirus have been found. Mark Lowell, the executive director of the community, attributes that to a mixture of good fortune, hard work on the fundamentals of infection control and trust among his staff, many of whom have been at the community for years. Among the community’s precautions, staff every day answer a brief entry questionnaire meant to detect potential risks, such as exposure outside work to anyone who has tested positive.
But Lowell said he needs more testing and more rapid testing in a world where carriers can go days without exhibiting symptoms, if they exhibit them at all.
“The asymptomatic side is the scariest,” he said. “That’s why we cross our fingers. I knock on wood. I’m very superstitious.”