The latest surge of coronavirus cases is fueling a record number of nursing home outbreaks, as the virus is spreading quickly inside long-term care facilities in the Midwest and the Great Plains while also re-emerging in facilities swamped by the first wave of the virus.
More than 1,300 nursing homes across the U.S. reported having three or more confirmed Covid-19 cases during the first week of November — the highest number ever reported in a single week, according to an NBC News analysis of federal data. The figure does not include outbreaks at assisted living facilities, which the federal government does not track.
Many of the new nursing home infections are emerging in the Midwestern states where the virus is besieging the broader community, including Illinois, Ohio, Missouri, Indiana, Wisconsin and Iowa, which reported some of the country's biggest weekly increases in suspected and confirmed cases among residents, the data showed. (Facilities report suspected cases when residents exhibit Covid-19 symptoms but have yet to receive positive test results.)
Nursing home case numbers have also been surging in rural areas, with spikes in the Great Plains. Facilities in South Dakota reported 253 new infections among residents during the week that ended Nov. 8 — three times the number reported a month earlier. And across the country, a large number of facilities are reporting staff shortages, and some are still struggling to acquire personal protective equipment and reliable testing.
"It's an out-of-control fire. You stamp it out in one place, then it pops up somewhere else," said Bill Sweeney, senior vice president of government affairs at AARP, which has urged Congress to pass more funding for testing, personal protective equipment and staffing for the country’s 15,000 nursing homes.
Friendship Haven, which runs a nursing home and assisted living facility in Fort Dodge, Iowa, had a few isolated Covid-19 cases over the summer, but amid the state’s record surge, 12 staff members and 14 residents recently tested positive.
"Masks are still not acceptable here, and that is very frustrating. The community is not really understanding," said Julie Thorson, the president and CEO of Friendship Haven. "You are worried about the inconvenience of a mask, and my staff has been sweating and crying through their masks since March."
New outbreaks are also emerging in facilities that were pummeled by the first wave of the pandemic — which killed tens of thousands of residents in the Northeast and other early hot spots — only for the virus to return.
Jewish Senior Services, a nursing home in Bridgeport, Connecticut, had 22 residents die from Covid-19 during the spring; about 10 percent of the staff became infected, said Andrew Banoff, its president and CEO. Personal protective equipment was so scarce that the facility resorted to purchasing supplies directly from a company in China, he said.
Within a few months, cases finally subsided at the facility and within the broader region. In mid-June, Connecticut began requiring weekly Covid-19 tests for all nursing home staff members and residents and funded all the testing. Other states have implemented similar testing requirements, although not all are paying for the tests.
The nursing home was virus-free throughout the summer and early fall. Then, in mid-October, as case numbers began rising once again in Connecticut, the first staff member tested positive. Nineteen more staff members and eight residents have become infected, as well, Banoff said. Two of the residents died from Covid-19 last week.
"We knew we were on borrowed time," Banoff said. "But it was devastating when we all had to go in and call the families — not just of the residents that tested positive, but those exposed through staff. We had to make 84 phone calls."
Jewish Senior Services and other long-term care facilities have better access to testing and personal protective equipment compared to the spring. The federal government has also distributed billions of dollars in Covid-19 relief funding to nursing homes, along with rapid testing machines, although they are less accurate than lab-based tests.
But nursing homes across the country are still reporting shortages of protective equipment and testing delays. As of the first week of November, 1 in 10 facilities said they did not have a week's supply of N95 masks, according to the federal data. Nearly a third of all nursing homes said they had to wait three to seven days to receive Covid-19 test results.
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Providers worry that access to both protective equipment and testing will become more difficult as case numbers continue to rise. The federal government unveiled new testing guidelines in late August, requiring staff members to be tested monthly, weekly or twice a week, depending on a county's overall positivity rate. But nursing homes are still facing difficulty getting access to tests, freeing up staff members to administer them and covering the cost, according to LeadingAge, an industry group that represents nonprofit long-term care facilities.
“Our pleas are being ignored. The support we have received has been insufficient and is running out quickly,” Katie Sloan Smith, president and CEO of LeadingAge, said Monday on a press call. “The virus is raging, infection rates are skyrocketing, and the pool of financial support is running low.”
The national stockpile — intended to be a backstop for health care facilities that have exhausted their supplies — is also facing shortfalls. In July, the federal government said it wanted to have a 90-day supply of critical personal protective equipment on hand. As of last week, however, the Strategic National Stockpile had only about half of the 300 million N95 masks needed and less than 1 percent of the gloves needed to meet the target, according to figures from the Department of Health and Human Services.
Even more concerning are widespread staffing shortages. One in 5 nursing homes across the U.S. report shortages of aides, and 17 percent have shortages of nurses, according to the latest federal data. While adequate staffing at long-term care facilities has long been a problem, because of low wages and challenging working conditions, the pandemic has worsened the staffing shortages, which new research has linked to higher Covid-19 infection rates.
"We're going to see more and more staffing shortfalls around the country as staff become sick and really unwilling to work in conditions where they don't feel protected. And they don't feel supported in terms of their pay or their benefits," said David Grabowski, a professor of health care policy at Harvard Medical School.
Victoria Richardson, who earns $14 an hour as a certified nursing assistant at a Chicago-area nursing home, said her facility has been bleeding staff members since the beginning of the pandemic. When the first wave of the virus hit Forest View Rehabilitation and Nursing Center in the spring, management began providing hazard pay of $200 every two weeks, but it stopped the extra payments in August, she said.
Now staff members at the facility are becoming infected again, according to federal records, but the hazard pay has not come back at Forest View or other Chicago-area nursing homes run by Infinity Healthcare Management, according to the Service Employees International Union Healthcare, which represents Richardson and other staff members. (Infinity Healthcare Management did not respond to multiple requests for comment.)
Richardson, 51, has been struggling to pay her bills since her husband died of cancer in September, and she now fears losing her home. She also still worries about contracting the virus, which has killed 18 residents at Forest View since the beginning of the pandemic. Even now, she said, staff members struggle to get proper protective equipment. On Monday, Richardson and nearly 700 other Infinity nursing home workers went on strike to demand higher pay and proper protective equipment.
"I have to reuse the same mask for a week, and I don't get an N95 unless I insist on having it," Richardson said.
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The Centers for Medicare and Medicaid Services pointed to efforts to provide long-term care facilities with testing, supplies, training and technical assistance, but said that some nursing home staff members were not following basic Covid-19 protocols, like washing their hands and wearing personal protective equipment properly.
“Based on our inspections and as the field reports from our strike teams, we have found that nursing home staff continue to fail to consistently implement proper infection control practices,” the agency said in a statement.
High death tolls at nursing homes and reports of extreme neglect over the spring led some state officials to open criminal investigations. Attorneys general in four states — New Jersey, California, Pennsylvania and Massachusetts — confirm that they are conducting investigations into long-term care facilities.
Nursing home advocates, staff members and experts say they are especially worried about the coming holidays, bracing for an even bigger wave of infections due to increased travel and large family gatherings.
In November, as the virus surged in Montana, five staff members and 13 nursing home residents at Rimview Square tested positive, said David Trost, president and CEO of St. John's United, a retirement community in Billings. Trost is quarantining at home after his 15-year-old daughter, who was attending school in person, also became infected. And Trost worries that case numbers will rise even more quickly as families and co-workers come together over the holidays.
"The surge for us really is because of community spread," Trost said. "We feel like we're in a spot where we can't win."
CORRECTION (Nov. 24, 2020, 2:39 p.m. ET): A previous version of this article misstated the share of Jewish Senior Services staff who were infected with Covid-19 in the spring. It was about 10 percent, not nearly three-quarters.