Virginia Health Commissioner Dr. Norm Oliver, flanked by Gov. Ralph Northam, left, and Secretary of Health Dr, Daniel Carey, right, at a news conference on Capitol Square in last year. (Ned Oliver/Virginia Mercury)
LeadingAge Virginia — an association of nonprofit senior living centers — asked the Virginia Department of Health last week for a daily list of nursing homes and assisted living facilities with COVID-19 outbreaks.
“We just wanted the names of the communities,” said Dana Parsons, the association’s vice president and legislative counsel, in an interview Tuesday. “We’re not asking them to tell us who’s infected, but it’s helpful to know which facilities are seeing outbreaks.”
The state agency refused, Parsons said in a later email.
The agency responded that its “long-standing policy is not to release the name of facilities unless there is a public health reason to do so or the facility has given permission.”
VDH spokeswoman Maria Reppas confirmed the agency’s response at a news conference on Wednesday. Both she and Health Commissioner Norman Oliver cited a section of Virginia code dealing with patient anonymity and health investigations.
However, knowing where outbreaks are happening is a way to reduce the risk of transmission, Parsons added. Staff at LeadingAge Virginia’s member facilities sometimes work at more than one site— a common occurrence among nursing homes and long-term care centers. And anxiety over preventing the spread of the disease is mounting as the death toll at a Henrico long-term care facility keeps rising.
Dr. Terry Jones, an associate professor at the VCU School of Nursing, said that certified nursing assistants at senior living centers are among the lowest-paid workers in the health care industry, forcing many to take another job.
“If there’s more than one long-term care facility within a certain geographic region, it wouldn’t be uncommon for these folks to work at both,” she added. “They don’t bring in a lot of income, so they might have to juggle more than one job to make a decent living.”
The law cited by VDH requires patient confidentiality and allows Virginia’s health commissioner to release the identity of patients and practitioners only “if pertinent to an investigation, research or study.” The department has interpreted the code to prevent it from disclosing a comprehensive list of facilities with outbreaks — even to other long-term care centers concerned over possible transmission.
The Mercury asked why the current pandemic wouldn’t classify as a “public health reason” to release the names of facilities with COVID-19 cases. Oliver said that widely releasing that information wouldn’t assist state health officials with tracking or containing the spread of the virus.
“The way the code reads is that when we are conducting a public health investigation, we can release information if it furthers the investigation,” Oliver said. “But doing a blanket release to all nursing homes in the commonwealth wouldn’t, per se, advance the investigation.
“If I know that you work at nursing home A and you also work at nursing home B, then I’m going to let nursing home B know about that,” he continued. “It becomes part of the investigation. But I wouldn’t tell nursing home F if they had no connection.”
The lack of broader information has become a source of frustration to many facilities amid increasing pressure to prevent, or contain, COVID-19 outbreaks among one of the most vulnerable segments of the population. Parsons emphasized that LeadingAge Virginia was only requesting the names of facilities — “not any patient-identifying info.”
“We need to know when a positive case is reported in a long-term care setting,” she wrote, “so we can notify any members in that area who may share staff for the best interest of their residents.”
Oliver said Wednesday that local health departments were notifying specific facilities if they discovered that one or more of their staff members held jobs at other sites with known COVID-19 infections.
But some nursing home and assisted living administrators want more information. Many say they’re not being notified of outbreaks at other facilities, even if they share the same regional health district. After the briefing, LeadingAge Virginia CEO Melissa Andrews said she emailed her full board — a group of 13 executives at senior living centers across the state — to learn if they had been notified of outbreaks at other facilities in their community.
“Six responded and said they have had no notification from their local departments of health,” Andrews said. “They’re finding out through the grapevine or by watching the news.”
Even without a comprehensive list of affected facilities, it’s clear that nursing homes and long-term care centers are bearing the brunt of Virginia’s COVID-19 cases. There have been at least 35 resident deaths — more than 40 percent of the state’s total COVID-19 fatalities — at Canterbury Rehabilitation & Healthcare Center in Henrico County since its first confirmed case of the virus.
Earlier this week, VDH unveiled a weekly dashboard with more information on coronavirus cases across the state. Twenty of 43 confirmed outbreaks have occurred in long-term care facilities.
In other areas of the country, outbreaks at nursing homes and assisted living facilities have been traced directly to shared staff members. In March, a report from the U.S. Centers of Disease Control and Prevention found that employees at the Life Care Center in Kirkland, Washington — a nursing home with at least 35 coronavirus deaths — spread the virus to other facilities where they worked.
Nursing homes in Virginia are under “extreme pressure” to prevent similar outbreaks at their own facilities, wrote Amy Hewett, vice president of communications for the Virginia Health Care Association/Virginia Center for Assisted Living, in an email on Wednesday. Many are limited by shortages of staff, testing and personal protective equipment, which makes it even harder to ward off new COVID-19 transmissions.
Staffing shortages, especially, present a huge quandary for senior living facilities, Jones said. The state’s latest guidance for long-term care centers allows exposed employees to “work while wearing a facemask as long as they remain asymptomatic,” according to Oliver’s most recent letter to clinicians.
The guidelines might sound risky, but provider fatigue and personnel shortages can also become a patient safety issue, especially when residents are sick and require a higher level of care, Jones added.
“What’s the bigger risk — people not getting basic care because we don’t have enough employees to do that?” she said. “Or having employees present even if we’re not 100 percent sure they’re not a carrier? You’re sort of damned if you do and damned if you don’t.”
The situation is compounded by a lack of testing and state guidelines that explicitly discourage testing “exposed, asymptomatic [health care providers],” according to Oliver’s letter. Amid the uncertainty, some facilities have been forced to improvise.
David Abraham, CEO of Beth Sholom Village in Virginia Beach, said administrators at the nursing facility have reached out to board members and the community to assemble a list of volunteers if staffing runs short. So far, the facility has no known cases of COVID-19, he added. But his team is preparing in case they do need to isolate patients and providers in a separate wing on campus.
“We did what we needed to do from a regulatory standpoint, as far as running criminal background checks and other screening,” he said. “These are people who can help pass out ice or fold linens — anything we need as we work to contain this thing.”
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