Isolation compounds virus impacts in long-term care

BOSTON -- As the COVID-19 pandemic stretches now into an eighth month and the possibility of a second surge of virus activity becomes more of a reality, advocates for people living in long-term care settings said Tuesday another crisis is brewing.

The coronavirus carved a devastating path through nursing homes and other long-term care settings this spring, preying on the elderly, frail and those with underlying health complications, while outsiders were barred from visiting the facilities out of fear that someone could bring the virus in. In June, many facilities were able to schedule outdoor visits and just recently have been cleared to hold indoor visits. But all visits are kept relatively short, must be scheduled ahead of time and can only take place under a series of restrictions.

"As the pandemic continues and when we see cases rising in many states, people with dementia and other residents of long-term care are struggling very much so with social engagement," Daniel Zotos, director of public policy and advocacy for the Alzheimer's Association's Massachusetts and New Hampshire chapter, said during a hearing of the Joint Committee on Elder Affairs. "Social isolation among people with dementia may contribute to individual decline and stress on family caregivers who cannot assess the health of their loved ones."

Zotos said that there have been more than 30,000 more deaths from Alzheimer's and dementia nationwide than expected from the start of the COVID-19 pandemic through the middle of September.

"This is truly a crisis within a crisis," he said.

Nicole McGurin, director of family services for the Alzheimer's Association's Massachusetts and New Hampshire chapter, said the organization was "inundated" early on in the pandemic with calls from family members and caregivers who were struggling to get information about a loved one in a nursing home. She said videoconference visits and later visits in which the guest remained outside but could see their loved one through a window were not always good options for residents with cognitive impairments.

"For a lot of people living with Alzheimer's disease, those are really difficult ways to visit with someone and can actually make someone really upset and have behavior issues, being unable to understand what's going on with the Zoom call or why someone is visiting through a window and not able to come inside," she said. "And a lot of families we talked to were just not able to have these kinds of interactions with their loved one because they were worried that it was just too tough for their loved one, even though they really wanted to see them."

The organization told the committee that the problem could be alleviated if Massachusetts nursing homes had greater access to rapid point-of-care COVID-19 testing, so guests could be tested right before a visit.

Secretary of Health and Human Services Marylou Sudders said the decision to cease visits at long-term care facilities was one the hardest decisions she's had to make in her public service career, but she said rapid point-of-care COVID-19 testing is not the gamechanger some people might think it is.

"Point-of-care testing is antigen testing, it is not the gold standard diagnostic testing. There are significant challenges with both false positives and false negatives," she said. "Antigen testing in and of itself is not going to protect residents or staff from COVID-19. Strong surveillance testing with PCR turnaround of less than two days ... is the best we have at the moment and antigen testing, point-of-care testing, is not approved for asymptomatic people."

Sudders spoke about the state government response to COVID-19 in long-term care facilities and about the outlook for resident and staff safety as the fall and a possible second surge of COVID-19 cases settles in.

"The pandemic has laid bare the unique vulnerabilities of nursing homes and their residents," Sudders said.

As of Tuesday, 25,214 residents or health care workers at long-term care facilities had been infected with confirmed or probable COVID-19, DPH said. That's about 19 percent of the state's roughly 140,000 confirmed or probable cases, compared to the nationwide average of seven percent.

DPH said 6,209 residents of Massachusetts long-term care facilities have died of test-confirmed or probable cases of COVID-19 -- 64.5 percent of the total 9,630 COVID-19 deaths in Massachusetts. Nationally, 40 percent of COVID-19 deaths have occurred among nursing home residents, Sudders said.

In all, 388 of the more than 700 long-term care facilities in the state have reported at least one case of COVID-19 and officials estimate that roughly one in every seven Massachusetts nursing home residents has died as a result of the COVID-19 pandemic.

Massachusetts averaged more than 360 cases of COVID-19 per 1,000 nursing home residents, fifth-worst in the country behind Louisiana, Mississippi, Alabama and New Jersey, according to data reported by nursing homes to the U.S. Centers for Disease Control's National Healthcare Safety Network.

Massachusetts is worst in the country when it comes to nursing home resident deaths, though, with an average of just more than 125 deaths per 1,000 residents, according to the data.

Sudders gave "caveats" for that data, though. When it comes to the number of cases, Sudders said Massachusetts has a higher number because it began testing earlier than other states. And the state's number of COVID-19 deaths in long-term care settings appears higher because Massachusetts uses the broadest definition, she said.

A nursing home resident who gets COVID-19, is hospitalized and dies in the hospital is counted in Massachusetts as a nursing home death, Sudders said, while states like New York would not count that death as one connected to a nursing home.

As the number of new COVID-19 cases each day ticks back up from the lows of the summer, Sudders said she thinks the long-term care industry and the state are better prepared to keep residents and employees safe this fall.

"I think we are prepared, given what we have learned, as we come into the fall," Sudders said. She later added, "I respect this virus, I'm very humbled by this virus. What we know today about this virus is completely different than what we knew in February and March, and it continues to evolve ... We have the infrastructure and building blocks in place to respond to a very evolving pandemic."

The secretary said she pays close attention to what other states are doing to address the risks of COVID-19 in nursing homes and gets a bit skittish when she sees other states modeling their efforts on Massachusetts because the response here is "very much a work in progress and [we're] always learning."

As of Oct. 6, the most up-to-date data available from DPH, nursing homes and senior living centers had received 955,050 masks from the state, including 409,130 N95 or KN95 masks, 1,239,600 gloves and 192,574 gowns, according to DPH.