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As coronavirus spreads across the country, Vermont care homes are worried about low staffing, low funds and the potential for dangerous outbreaks.
Nursing homes, assisted living facilities and elder care homes across Vermont are buckling down, limiting visitors and stepping up hygiene practices as the coronavirus epidemic sweeps the country.
They have good reason to be worried. Exact figures vary, but experts agree that COVID-19, the disease caused by the coronavirus, is far more dangerous for older people, often leading to hospitalizations and complications. In the Seattle area, elder care facilities are contending with an outbreak that has hit 11 nursing homes and caused dozens of deaths.
At a press conference Friday, Monica Hutt, commissioner of the Disabilities, Aging and Independent Living agency, said Vermont was particularly concerned about older Vermonters.
“What we know is that the population served by [DAIL], both older Vermonters and Vermonters with disabilities that have underlying health conditions … are at higher risk from the COVID-19 infection,” she said.
The crisis reveals a long-growing problem in Vermont. Financial and medical problems have plagued facilities that care for an increasing number of older Vermonters and those recovering from health problems.
Several nursing homes in Vermont have come under government scrutiny for poor quality of care. And even those who are trying hard to protect their residents are concerned about their capacity to care for everyone in the event of an epidemic.
“I see in the staff that they’re very professional,” said Jim Holway, president of Living Well. “But I can see in their eyes, people are tired and wearing down because they’re doing the extra work.”
Stepping up prevention, but fearing bankruptcy
Holway is chair of the Living Well Group, a group of three residential care facilities that provide services like hospice care, memory care and more. His facilities have started to take strict precautions for preventing the spread of the illness.
On Friday, Gov. Phil Scott banned visitors to long-term care facilities with some exemptions for certain family measures. Hutt said it was an important step in preventing infections.
“We realize that this response will be very distressing to family members, and acknowledge that it may create some hardship,” Hutt said. “Please know that by doing this, we are prioritizing health and safety of the people that you love.”
The Vermont Department of Health has released guidance for long-term care facilities with new protocols as well. They have asked facilities to monitor residents closely for signs of sickness and step up their work to ensure staff members wash their hands regularly and use personal protective equipment.
Other facilities VTDigger contacted described similar measures. Dane Rank, administrator of the Thompson House in Brattleboro, said they’ve also been careful to stock up on protective equipment, although they had to resort to buying from eBay as other vendors ran low.
Holway said he’d seen a massive spike in the cost of masks — he claimed one vendor increased prices by about 3000%.
“I said well, don’t we have some secret code words, knock on the backdoor of suppliers and say, ‘you know, we have vulnerable people here?’” he said. “No, there’s no such thing, we’re just like everybody else.”
He said they’re also in a bind with their staff. They want nurses and other employees who feel under the weather to stay home to prevent the spread of the disease — but they need enough staff members just to meet legal requirements, let alone care for residents in the event of an outbreak.
“Our [program] is a nonprofit. We run a very thin margin,” he said. “We keep people here even when they run out of money, that’s part of our philosophy. So while we haven’t hit it yet, we do anticipate that we’re going to have a challenge if even a few people stay home.”
The ban on new admissions is also increasing vacancy rates, costing them potential revenue, Holway said.
Laura Pelosi, a spokesperson for the Vermont Health Care Association that connects elder care facilities, said nursing facilities are dealing with the COVID-19 epidemic in the face of an already acute workforce shortage and insufficient reimbursement rates. But she said the focus for facilities at the moment was ensuring the safety of residents and staff.
“The Vermont Healthcare Association is currently working with legislators on emergency measures that may provide some relief with respect to financial and workforce pressures as the situation evolves,” Pelosi said in an email statement.
Other facilities have started to wear down: Holway said he’d heard from smaller groups that have to close their doors and are looking for someone to take the five or so people they care for.
“This industry is a really concerning one,” he said. “It’s already an industry that the state and the federal government are really not prepared for, with the silver tsunami coming.”
A history of violations
There’s no way of truly knowing how Vermont elder care facilities will handle a brand new and complex epidemic. But federal data shows that in some cases, nursing homes have had issues with infection control procedures in the past.
Of Vermont’s 40 regulated nursing homes, 16 have been cited 19 times since December 2016 for infection control procedures, according to federal Nursing Home Compare data. Five facilities have been cited in the past year for a failure to “provide and implement an infection prevention and control program.”
There’s no evidence any residents were harmed by those violations, and none of the nursing homes were fined. Most of the violations were due to improper hygiene practices, such as nurses failing to wash their hands when they were supposed to by law, or leaving oxygen masks out when they should be stored in plastic.
In some cases, those violations are part of a broader pattern of low quality of care. Three of the facilities are current or former “special focus facilities,” meaning that the federal government is giving them extra scrutiny due to their violations or quality. Another two are or were candidates to become special focus facilities, according to a Propublica database of violations.
Pelosi said prior citations are not an indicator of what we can expect. “Nursing facilities are in a heightened state when it comes to infection prevention,” she said.
Nursing homes are only part of the story when it comes to elder care in Vermont.
Nursing homes are intended for patients who require higher levels of care, but there are more places that qualify as assisted living facilities, care homes or other designations.
An investigation by Seven Days found problems with abuse and neglect in the 133 state-regulated elder care facilities that do not qualify as nursing homes. Tracking infection control violations for those facilities is far more difficult than in nursing homes, because they do not publish their reports in a consistent format.
Suzanne Leavitt, survey and certification director for DAIL, said she did not know how many, if any, facilities have been cited for infection control issues. She believes the problem is not widespread.
“We have not had any significant trends with infection control with any of those facilities,” she said. “If I felt it was, you know, a top door issue at this point, I would have looked into it.”
Leavitt said the agency plans to keep a close eye on infection control procedures when inspecting facilities.
“I’ve spoken to a number of long-term care providers, and they’re adopting what VHS has put out there, what the CDC has put out there, what CMS has put out there,” she said. “They might have a question here and there based on a situation with a little bit of a twist, but we’re all talking through it.”
Another battle: Fighting loneliness
As nursing homes, care facilities, and senior living organizations step up their isolation and social distancing, they’re concerned about a different disease that tends to strike hardest on the elderly population.
Social isolation — the condition where someone spends an extended time without social interaction or a community to be a part of — affects 8% of Vermonters and 13% of those over the age of 65, according to the Vermont Behavioral Risk Factor Surveillance System survey.
Loneliness is tied to poor physical and mental health, causing stress, depression and cardiovascular issues. Social interaction can be essential for those with memory-related conditions, Holway said.
“We know that if they get out, these common areas and the different activities are meant to keep them busy and engaged, and that helps them with their memory care stuff,” he said.
Living Well and other facilities said they were in the process of setting up FaceTime calls between residents and family members.
Cathedral Square, an independent living provider with 25 affordable housing communities for seniors, has canceled wider events but is still allowing people to congregate in common areas with careful cleaning, said Deb Bouton, director of communications and outreach.
“That’s one of the benefits of a congregate housing thing, you see people and you’re out and about,” she said.
The Thompson House is even planning to stream musicians coming to the facility while residents stay inside, Rank said.
“All the admin team are going to have to do an hour, somewhere in the day, reading the newspaper or playing an instrument or showing their hobby,” Rank said. “We’re gonna try to make it feel like summer camp, and just work with what we have and make it fun for everybody.”
If you live or work in an elder care facility and have concerns about your preparations for an outbreak, send an email to erin@vtdigger.org.
