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CityWatch: How New York’s nursing homes prep for potential second wave of COVID-19

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As cooler weather descends on New York City and bring fears of a possible second wave of coronavirus, nursing homes and adult care facilities are hopeful that more access to testing, quicker test results, stockpiles of personal protective gear (PPE), and a better understanding of the virus will result in residents being safer.

But after a disastrous spring, fears remain about how these facilities will be better able to protect their residents if infection rates spike.

Advocates of nursing homes and assisted care facilities in New York City say that currently, tests and PPE are more widely available, and they have learned more about how to deal with the virus. 

“It’s just really a totally different world from April,” said James Clyne Jr., president of LeadingAge New York, which represents not-for-profit and government nursing homes in the state.

Health-care facilities, including nursing homes, are now required to have stockpiles of PPE, and make a pandemic emergency plan available to the public. Visitation restrictions for nursing home residents were even slightly relaxed recently if they are complying with other requirements and have had no new infections for 14 days. 

To prepare for a possible second wave, Scott LaRue, the president and CEO of ArchCare, a continuing-care organization that’s part of the Catholic archdiocese of New York and runs several nursing homes in the city, has hired extra staff: an infectious disease medical director, a nurse whose specialty is infection control, and eight nurse infection specialists at the program and facility level. Staff at various facilities has been trained how to respond if there’s an outbreak.

“That doesn’t mean we didn’t have infection control nurses before, but we didn’t have the depth or the level of expertise,” LaRue said.

He’s spent more than $2 million on PPE, and millions more on testing and temporary staffing. As mandated by law, the nursing home staff is tested every week, and LaRue has rented a warehouse to stockpile months worth of PPE; there are additional 60-day stockpiles at each nursing home.

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Nursing home facilities have had the summer to come up with comprehensive plans to protect their residents. When the coronavirus swept through New York City in March and April, killing thousands, it soon became clear that the elderly and infirm were particularly vulnerable.

To date, almost 6,500 nursing home residents and nearly 180 adult care facility residents in New York state have been confirmed or presumed dead from coronavirus. There is reason to believe that officially, these numbers are dramatic undercounts. There are 613 nursing homes and 540 adult care facilities in New York state, according to the DOH. 

Today, many nursing homes have changed their protocols around testing and moving residents, according to Michael Balboni, executive director of the Greater New York Health Care Facilities Association, a trade association for long-term care providers.

Nursing homes that he is in contact with are now using more telehealth technology for patients to see doctors, and have instituted protocols around testing — if a patient has a pending coronavirus test result, they are treated as if they have tested positive. There’s also a better understanding of how to use PPE effectively, and how to transport patients who need to leave the facility for medical care, according to Balboni. 

“Now we’re very, very aware of that. And we’re really looking for decontamination records for the transport vehicle, making sure that everybody who handles the patient has the appropriate PPE,” Balboni said. “There are now rules about when you go into a ward that has COVID, you must re-gown upon entering and re-gown upon leaving. So these were all things that just didn’t happen before.”

Meanwhile, the New York State Department of Health (DOH) has done more than 1,900 inspections at nursing homes and adult care facilities since March 1 to check that they are adhering to infection control measures and agency guidance, said Jeffrey Hammond, a public information officer with the DOH.

“By adhering to DOH guidance, facilities are taking the proper steps to protect their residents from COVID-19,” he said.

Struggles, however, remain as nursing homes and assisted care facilities prepare for the winter.

LaRue is most concerned about a “twindemic,” during which coronavirus and the annual flu will be active in the population at the same time.

Test turnaround times, though recently improved for some nursing homes, are not instantaneous. Until as late as August, the average coronavirus test waiting time for ArchCare staff and residents was six days. The average wait time more recently has been slightly under two days. 

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The costs of PPE, testing and other preparation have been huge for long-term care providers, and accessing PPE is still a concern, according to Clyne Jr. 

“N-95 masks are still the biggest issue that I’m hearing from some members, getting access to them,” he added. “Sometimes you can’t get gloves…other times, for some reason, it’s gowns.”

In early August, Lieberman testified at a state legislative hearing that among other things, the state should ensure coronavirus safety compliance among adult care homes with unannounced in-person inspections, relocate residents to hotels and motels to reduce density if necessary, deploy additional staff when needed, and arrange funding for tablets and laptops for adult home residents.

If a second wave of coronavirus hits, he hopes for more transparency about residents who died, and for that information to be provided to family members.

“It’s critically important that we have a clear idea of what’s happening in facilities to identify hot spots, inform staffing and cohorting measures to reduce the spread of the infection,” he added.