Should we be looking more closely into conditions in nursing homes and senior care facilities?

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Followers know that Gadfly has been “Maddow’d” on the subject of coronavirus and nursing homes (see coronavirus under Topics on the sidebar). Rachel Maddow has made the crucial situation at nursing homes — nearly 50% of all deaths are associated with nursing homes — a subject of consistent concern. Gadfly has provided links in past posts to several of her shows on the subject.

Maddow led with another powerful segment on this subject last night (first 20 minutes), in which she talked about “deaths waiting to happen.”

And then we have this story in the paper this morning.

There is no allegation of poor care, but one can sense “deaths waiting to happen.”

Gadfly, as followers may have sensed, has felt that the subject of nursing homes has been underplayed in City reporting, and wishes that Council members might use their positions to look more deeply into conditions at our potential “hot spots,” if only out of an abundance of caution.

Anthony Salamone and Peter Hall, “ManorCare discloses nearly 100 coronavirus cases, deaths at Lehigh Valley nursing homes.” Morning Call, April 23, 2020.

Amid federal pressure for more transparency about the growing crisis at nursing homes, ManorCare on Wednesday said it is grappling with nearly 100 coronavirus cases and an “unspecified” number of deaths at three facilities it operates in the Lehigh Valley.

Julie Beckert, a spokeswoman for owner HCR ManorCare Inc., said Wednesday that 21 residents have tested positive at ManorCare Health Services-Bethlehem, 2021 Westgate Drive, off Catasauqua Road; 57 at Palmer Township and 21 in Bethlehem Township.

The company owns three other facilities in the Lehigh Valley, two in the Allentown area and one at 2029 Westgate Drive, across from the 2021 Westgate site. Those facilities have had no positive cases, she said.

Beckert said ManorCare has had an unspecified number of patients die during the last six weeks, “but we cannot confirm that it was due to COVID.” She said many patients have significant underlying health issues or are in hospice. “So COVID could be related but not the cause,” she said.

Experts say nursing homes have been ground zero for the virus, and residents of long-term care facilities account for more than half of Pennsylvania’s deaths from the virus. Wednesday’s figures from the state Health Department showed the number of cases in nursing and personal care facilities continue to rise, though the Lehigh Valley’s totals appeared to have steadied.

The state reported among 30 facilities with cases in the Lehigh Valley, there have been 686 infections among residents and staff, with the majority of them residents.

At ManorCare, Beckert said, the company places its senior centers in one of three tiers to “most effectively” treat patients while keeping the environment as safe as possible, Beckert said.

Earlier this week, she said the 2021 Westgate Drive, Palmer and Bethlehem Township facilities are on a “Tier 3” level of care, meaning staff identified coronavirus cases and took steps to isolate the sick. Such measures include installing a dedicated airborne isolation unit. She said those patients are screened, with priority placement given for the highest risk residents.

The home also set up temporary walls with doors and an antechamber for employees to don and remove personal protective equipment, Beckert said. The isolation area allows ManorCare to put “consistent staff” on the unit to care for patients, she said.

Facilities at 2029 Westgate Drive and in Salisbury Township are not on Tier 3, though Beckert declined to say the tier ranking for those two.

Tiers 1 and 2 do not indicate any positive cases, but some Tier 2 centers have COVID-19 tests out and have added airborne isolation to their infection controls, Beckert said.

“We will start to move patients off of isolation since they are recovering and will no longer need to be on airborne isolation,” Beckert said. “The tiered process we have in place for airborne isolation is working at ManorCare.”

Beckert said the company has sufficient staff to care for residents. She said any employee who tests positive would be self-quarantined and able to return to work once cleared of COVID-19 by a health care professional.

“Our caregivers have truly banded together and are working hard to provide compassionate quality care to the patients they serve,” she said. “They are heroes and deserve to be treated as such.”

Beckert said ManorCare is working to make sure people are aware of cases in its facilities, and to prevent people from feeling cut off.

“Our priority is to review our numbers so we can report the most accurate to families,” she said. “We will then post these numbers once families are contacted. We also have systems in place to help families connect with their loved ones during this trying time. We continue to work with the state and the local health department and report daily with any updates in our center.”

New federal regulations could shed additional light on which Pennsylvania facilities have seen cases of COVID-19. The Centers for Medicare & Medicaid Services has announced new reporting requirements that direct nursing homes to inform residents, their families and the federal government about coronavirus infections at their facilities. A CMS spokeswoman said the agency plans to releases data weekly, including names of nursing homes that report information.

Critics have said the move is long overdue. They have called for more aggressive action to track infections in homes and contain outbreaks by helping home operators get greater access to testing and masks, particularly given the vulnerability of elderly patients.

“We don’t know where we should be checking out certain facilities, or the risk part of it is sending staff to a place not knowing if there is a lot of [COVID-19],” said J.R. Reed, executive director of the Lehigh County Office on Aging and Adult Services.

Reed said the state should list the data by facility; currently the Health Department provides a breakdown of the number of cases in each county, without listing specific facilities.

But Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy in Willimantic, Connecticut, said CMS hasn’t issued final regulations yet and questions if those regulations will lead to more transparency in the reporting by care facilities.

“I just think it’s not clear, and they won’t tell you unless it’s in their interest,” Edelman said of nursing homes, whose reporting she characterized thus far as “very spotty.”

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