Addressing Struggles Of Long-Term Care Facilities Amid Pandemic

May 22, 2020

Coverage of novel coronavirus is supported by the Mick Hitchcock, Ph.D., Project for Visualizing Science, a science reporting project from the Reynolds School of Journalism.

Arbors Memory Care in Sparks is a long-term care facility for seniors with Alzheimer’s or dementia. It was the site of Washoe County’s recent COVID-19 outbreak. Thirty-eight people have been confirmed and three residents have died. 

In Nevada, nearly a quarter of COVID-19 deaths are associated with long-term care facilities. But in Washoe, more than half of the 48 deaths are from long-term care communities.

KUNR’s Anh Gray talks with Lori Smetanka, who heads up The National Consumer Voice for Quality Long-term Care, an advocacy organization for quality care, to learn more about the common challenges experienced at facilities across the states.

Anh Gray: Long-term care facilities nationwide have disproportionately been affected by the COVID-19 pandemic, and also here in Washoe County. Local news reports including stories produced by KUNR have revealed several issues such as shortages of personal protective equipment and access to testing. What can be done going forward to mitigate these shortages?

Lori Smetanka: Those are issues that we're hearing across the country. The lack of protective equipment is really critical in some areas and in some facilities--the lack of available testing or testing of staff and residents to determine who has the virus and who doesn't. We really call on the federal government to take a much more aggressive role in helping to coordinate a national response to getting the supplies into the states and facilities. Right now, the states and communities are being left to their own devices to find the equipment and the supplies themselves and they are really, really struggling.

Gray: And what about staffing? KUNR has also reported about concerns that staff members have raised, including shortages of PPE and their own fears for their health and the health of their families.

Smetanka: This virus has exacerbated the problems with staffing that we have traditionally seen in long-term care facilities. Normally, almost 75% of facilities do not have enough staff caring for residents and that's become even more critical during this virus, where not only are staff becoming ill themselves and contracting the COVID-19 disease, but many of them are afraid. They don't want to put themselves at risk; they don't want to put their families at risk. And we have heard a number of situations where staff have stopped going to work because of fear when the personal protective equipment is not available for them.

Gray: And as the pandemic is still an ongoing issue, what can be done to ensure limited staffing doesn't continue to be an issue at the long-term care facilities?

Smetanka: With respect to staffing, it definitely has been a longstanding issue in facilities and part of that is due to the difficulty of the job, the low wages that are paid to staff, the lack of benefits, all of which causes high turnover among staff as well as causes many of them to try to find multiple jobs in more than one facility in order to make ends meet and so there really need to be efforts to put more resources into the system to support the staff. We should be raising their wages, we should be providing to them and providing support that they need in order to help them come to work every day. We are seeing some states start to look at that, providing hazard pay, for example, providing some minimal benefits or some other supports such as some help with daycare expenses or even temporary housing so that they can actually come to work.

Gray: Many families have had challenges with reaching their loved ones or getting adequate information. How can this issue be addressed?

Smetanka: It has been a real problem for many family members to get the information they need about not only what's going on with their loved one, but also what's happening in the facilities, and state responses to that have been very uneven across the country. But starting on May 8, which is just not that long ago, the federal government now requires facilities to not only report to the CDC the number of COVID cases and the facility, the staffing levels, the number of people who have died as a result of COVID. Facilities also are required now to report to families. And so, when we talk about federal guidance coming down and who that applies to, they apply to nursing homes. That, and more than 95% of them receive Medicare and or Medicaid. So generally almost all nursing homes have to abide by the federal rules. Where it gets tricky is when it's not a nursing home, like assisted living, for example, or boarding care facilities, or personal care homes, they're called different things. They are licensed and regulated at the state level and so when we look at those types of facilities, you have to look at what the state rules specifically say, and what the state's guidance is. 

Gray: And then for you as someone who advocates for people in long-term care facilities, these communities have been hit hard during the COVID-19 pandemic. What keeps you up at night?

Smetanka: The stories we're hearing directly from residents and families keeps me up at night. The fear among them about how to protect themselves. This is from some of the residents, we're hearing from who are watching the COVID spread through their facilities and [they] are afraid they'll be next and the stories from families who are not able to connect with their loved ones, but are also hearing examples of how their loved ones are feeling isolated, depressed, withdrawing, and declining as a result of the isolation. Those are the things that really concern me and we need to figure out a way to stop the spread of this virus and get families and residents back in together and do a better job of supporting the residents themselves right now.