Lack of Testing Hinders Nursing Home Safety as Central Nebraska COVID Cases Rise

As the COVID-19 cases mount in central Nebraska, so does the anxiety level at nursing homes and assisted living communities attempting to protect their elderly residents and staff.

In the three counties served by the Central District Health Department (CDHD), the coronavirus has claimed eight lives since April 17. All were over 60 years old, and most acquired the virus at the facility where they lived.

Statewide, the coronavirus found its way into 31 nursing and assisted living facilities out of 497 licensed in Nebraska, according to the count tally by the Health Care Association.

"These providers are at war with this COVID-19 virus," said Heath Boddy, the president of the Nebraska Health Care Association.

His assessment came just as director of the CDHD Teresa Anderson told NET News she's "concerned there may not be anything that we can do to slow the spread" of the coronavirus in that area.

"It feels like every day we have a lesser chance of controlling it," Anderson said.

There are concerns the lack of testing and protective gear may result in more illness or deaths in assisted living facilities.

"The big difference for us in the eldercare work, where we have elders living in congregate living environments, is that when this virus gets in, it has catastrophic effects," Boddy said. "We worked like crazy as a profession here in Nebraska and across the country to keep it out."

On those occasions, when the virus slips through, there are always consequences.

On the Saturday before Easter, a staff member working in the Memory Care unit for Heritage Cat Sagewood in Grand Island went in for a coronavirus test after experiencing fever and body aches. While isolated at home, the test came back positive. It was the third staff member testing positive for COVID-19 at Heritage.

Two days later, the center announced "with a heavy heart and extreme sadness" the disease ended the life of a resident in the same memory care unit where the staff member cared for the residents coping with their dementia.

Nebraska has been spared some of the most horrific mass casualties suffered by nursing homes around the country. In some areas, single facilities coped with dozens of elderly residents died within days when staff lost control of the virus.

The 31 Nebraska facilities reporting positive cases in mid-April represent less than 10% of the number of nursing homes and assisted living facilities registered in the state. That compares favorably to a "flash survey" done by McKnight's Long-Term Care News, an industry trade journal, found a third of the facilities responding had a staff member or resident who had tested positive for the virus.

(On April 19, a federal regulatory agency released new guidance requiring all nursing homes to report COVID-19 cases directly to the Centers for Disease Control. Family members of residents must also be kept informed.)

Data provided by the Nebraska Health Care Association indicates the rate of confirmed cases in Nebraska remains comparatively low — under ten percent — based on testing.

But testing is acknowledged to help reduce the guesswork within elder care facilities.

"It's good prevention not to let the fox into the henhouse if you have a 'for-sure' COVID positive," said Sheri Terry, Chief Operating Officer for Vetter Health Services. The company operates 32 senior care facilities, including 26 in Nebraska.

A Vetter facility reported the first reported COVID case at a Nebraska nursing home. Recently a staff member tested positive at their Grand Island location. In both cases, steps were taken quickly to avoid further spread, according to the company.

Testing remains a weak link in the company's prevention efforts, and it is a factor outside its control. Because coronavirus test kits and supplies are scarce nationally, only those already showing symptoms are authorized to get tested in Nebraska.

"Requesting testing has not been fruitful for us," Terry explained in a telephone interview.

In West Virginia, Governor Jim Justice issued an executive order requiring re-testing of all nursing home residents and staff within the state. Nebraska has yet to discuss such action.

With nursing homes unable to schedule testing for the staff or residents not showing symptoms, facilities must remain on guard all day, every day.

"We always treat them as if they're COVID positive with all of the personal protective equipment that we need to," Terry said.

Asked if more testing could result in saving people's lives, Terry said she believes it "would save a lot of lives" because "you would know for sure what you're dealing with and when you're dealing with it."

Many in the nursing home industry believe a lack of testing aggravates the well-documented shortage of protective gear used by nursing home caregivers.

"The shortage of PPE continues to be a massive pressure point," said Boddy of the Nebraska Health Care Association.

Fewer tests equal additional anxiety and heighten caution plus higher demand for protective gear.

With visitors already banned at most facilities and residents mostly confined to their rooms, the most crucial defense against the virus becomes the personal protective equipment (PPE), now a cautious necessity.

To be proactive, there can "be areas (of a nursing home) that would be considered 'hot areas' where they would wear a lot more PPE," according to Boddy.

Many homes and assisted living facilities must rely on community donations of new or home-made supplies while extending the life of any piece of gear that can be safely reused.

Testing remains the most critical shortage. The National Guard did additional testing in Hall County over the weekend — just 50 a day for those with symptoms in a health district with nearly 80,000 residents.

Nursing homes have been told by state officials getting everyone tested may be a disadvantage.

After Grand Island's Heritage Center at Sagewood discovered the third employee had been infected, the facility posted the following on its website: "With our previous confirmed cases, the guidance we received from appropriate agencies was not to test everyone. Performing tests on all individuals right away, especially those without symptoms, may have resulted in a high number of false-negative tests."

Medical journal articles have raised those concerns, but the director of the Central Public Health District remains concerned that too little testing means they can't tell who needs to be quarantined.

For the Vetter facilities, Sheri Terry believes the information becomes essential.

"When you have a COVID virus, you can't see it. You don't know exactly where it is. You don't know if you would get it," she said in explaining the need for additional testing.

Terry says she considers the more human aspect of the need for testing.

"We are taking care of the frail elderly who taught us Sunday School, who taught us in second grade. They are our parents friends. There are our grandparents. We really hate to see anything tragic happen to them, so we will do our darndest in the state of Nebraska to provide the services that these families these residents need."