State health officials are developing a plan that could allow visitors back into nursing homes. But facility managers and industry advocates point to complications with testing and a shortage of protective equipment as signals that Oklahoma isn’t ready to reopen the homes.
Federal guidelines released this week for reopening nursing homes provide a framework for states to develop their own guidelines. The three-phase plan from the Centers for Medicare and Medicaid Services includes weekly testing of all staff members, a COVID-19 infection control inspection before each phase and access to expensive, protective equipment that remains in high demand. Visitation would begin in the third phase, after a facility has had no new coronavirus infections for at least 28 days.
Carter Kimble, deputy secretary of health, said Oklahoma is “closing in” on a plan that would incorporate many of the federal recommendations.
State health officials, members of the National Guard and university employees involved in testing are developing the plan with input from long-term care providers, Kimble said. But Steven Buck, president of Care Providers Oklahoma, which represents the for-profit nursing home industry, said more providers need to be at the table.
Once it’s complete, the plan will need approval from Gov. Kevin Stitt’s COVID-19 task force and Stitt himself before facilities can begin opening up to visitors. Kimble said a plan could be ready for facilities to begin the reopening process as early as June 1. As of now, all nursing homes are banned from accepting visitors under Stitt’s executive order, which expires at the end of May but can be renewed.
Kimble said many details are still being discussed, but one thing is certain: Facilities with one or more current coronavirus infections won’t be allowed to receive visitors.
Some families and residents are calling for facilities to allow visitation. Separation from family and friends is causing depression, anxiety and confusion for some residents. And families say video chats and phone calls aren’t a substitute for seeing their loved ones.
Nursing home managers and industry representatives say they’re skeptical about the state’s ability to provide the resources needed to safely reopen to visitors.
Testing, PPE Trials
As of Thursday, the coronavirus has been detected in 82 long-term care facilities, which include more than 650 nursing homes and assisted living, veteran and adult day care centers. At least 1,245 residents and staff had tested positive for COVID-19. And153 residents and staff have died.
Buck said regular testing protocols need to be in place before any long-term care facilities consider reopening.
Stitt announced late last month that all nursing home residents and staff – about 42,000 statewide – would be tested by the end of May. Kimble said Thursday the state would not meet that goal due to congestion at the lab that tests saliva samples. Those tests are performed on nursing home residents because they are less invasive than nasal swabs. The lab was overwhelmed, causing some samples to be invalid and some residents and staff to need retesting.
“We had our fair share of complications,” Kimble said. “But we have made improvements and our testing capacity is only growing.”
So far, facility-wide testing has been completed at 180 of the state’s 308 nursing homes.
Donelle Harder, a spokeswoman for the State Department of Health, said about 20,000 tests were performed at nursing homes in May. That’s equal to the total number of tests conducted on Oklahomans in general in April, she said.
If all nursing home staff members were tested weekly, as recommended in federal guidelines, the state would need to perform more than 20,000 tests per week.
“Right now, as we sit today, we don’t have that capacity,” Kimble said. “What we do have, and have had for a couple of weeks now, is the goal to get to that capacity, and we’re well on our way.”
Buck said the state needs to improve its testing capabilities before a reopening plan is rolled out.
Access to personal protective equipment, such as gloves, gowns and masks, remains a concern for many facilities and could make it difficult for nursing homes to reopen if the state requires certain quantities to be on hand.
But Kimble is not worried about providing nursing homes with adequate PPE.
“We are not concerned with the amount of PPE in this state,” Kimble said. “We, the state, have enough to be able to push out and supply long-term care facilities well through the summer and likely through the fall.”
The state provided a five- to seven-day supply of PPE to every nursing home three weeks ago in response to complaints from managers and staff that the health department wasn’t doing enough. But supplies dwindled quickly and some facilities are still barely getting by.
Buck said many providers still can’t afford to pay inflated prices for equipment that’s in high demand, and the state’s allocations last for days at most. Many can get through the day and maybe tomorrow but they’ll be out of equipment by the end of the week if a new shipment doesn’t arrive, he said.
Kimble said long-term care facilities can request PPE from the state, with deliveries typically made within 48 hours.
‘Facilities Know What’s Best’
A skilled nursing facility with 146 beds in Lawton has remained a safe haven for its residents and staff, despite the city’s community spread.
Lawton ranks sixth among cities statewide for the total number of COVID-19 cases, which totaled 210 on Thursday; more than 100 of them were from the jail. McMahon Tomlinson Nursing and Rehabilitation Center remains virus-free, yet administrator Ricky Coleman is not planning to open the doors to visitors any time soon.
Coleman’s staff is already stretched thin keeping up with new protocols and guidelines, he said. Scheduling visitation and ensuring that visitors and residents are wearing masks and using social distancing would put more strain on his workers, he said.
“Facilities know what’s best for their communities and their resident population,” Coleman said. “Residents have the right to have visitors, and I understand that, but we took an oath to make sure the safety and welfare of our residents is taken care of. And that’s what we’re going to do.”
Mary Brinkley, executive director of Leading Age Oklahoma, which represents nonprofit nursing homes, said it is possible for facilities without COVID-19 cases to safely begin allowing visitation.
Brinkley said outdoor visitation with social distancing, or limiting inside visitation to appointments, would allow facilities to ease back in. Facilities with positive cases will need to proceed with more caution and could face a long road to reopening, she said.