Some of Florida’s long-term care residents are eager to get out to visit family members over the holidays, but their return runs the risk of pushing up coronavirus cases.
A state executive order issued in October mandates that facilities allow residents to visit their families’ homes. Experts and advocates worry that the state has not simultaneously put in place more safety protocols.
Florida nursing homes and assisted-living facilities have not reported coronavirus surges so far this fall, according to researchers.
On Nov. 17, the Florida Department of Health reported that 1,358 long-term care residents and 1,769 long-term care staff had tested positive for the coronavirus. Those numbers were less than half the average daily infection rates reported in homes in July.
But community numbers are rising again. The Florida Department of Health reported more than 10,000 infections statewide on Nov. 15 — the highest single-day total since July 25.
Case rates in Florida’s long-term care facilities have been on a different trajectory than facilities in other states, which experienced a coronavirus surge this fall, according to a report by researcher Tamara Konetzka with the University of Chicago. Instead, Florida facilities reported a surge in the summer.
“It seems to be picking up again, in terms of community spread,” Konetzka said. “We don’t really see that in the nursing home data yet. But I’m sure we will.”
Current levels of testing may not be stringent enough to keep COVID-19 out of these facilities through the holidays, experts say.
Until mid-September, the state required bi-weekly tests of staff members at nursing homes and assisted-living facilities. However, the state has not required regular testing of residents.
The state Agency for Health Care Administration wrote in an email to the Tampa Bay Times on Wednesday that the state encourages facilities to use free testing resources, but did not respond to a question about why testing will not be mandated for returning residents.
Last week, the Florida Health Care Association, a trade group representing nursing homes, reminded its member facilities that families should take coronavirus precautions if they bring their loved ones home, said spokeswoman Kristen Knapp. While not required, some facilities may test residents upon their return or isolate them, Knapp said, and all homes will screen residents for coronavirus symptoms and potential exposure.
If testing is optional, then an asymptomatic resident could pass a facility’s screening and bring the coronavirus in, said Brian Lee, director of Families for Better Care, an advocacy nonprofit for long-term care facilities. The safest way to keep the coronavirus out of these facilities is testing at the door, he said.
When cases swell in a given county, some testing protections kick in, said Lindsay Peterson, research assistant professor of aging studies at the University of South Florida. The state follows federal orders from the Centers for Medicare and Medicaid Services, she said, which apply only to nursing homes.
Nursing homes in counties with a positivity rate of less than 5 percent in the previous week must conduct monthly coronavirus testing for staff, according to the Centers for Medicare and Medicaid Services. Those in areas with positivity rates between 5 and 10 percent must test once a week, and those in areas where it’s higher than 10 percent must test staff twice a week.
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“Routine testing of asymptomatic residents is not recommended unless prompted by a change in circumstances, such as the identification of a confirmed COVID-19 case in the facility,” the guidelines recommend.
Konetzka’s team analyzed federally reported data for 679 of Florida’s nearly 700 nursing homes for the week ending Oct. 25. The study found that 11 percent of facilities had less than a week’s supply of personal protective equipment. And 10 percent of facilities reported nursing shortages.
Nearly all homes reported that residents had been tested for COVID-19 in the previous week. Seventy-four percent of nursing homes said they had tested staff the previous week.
“Twenty-six percent of nursing homes not having tested staff (in the previous week) is a little alarming, given that staff present the main vehicle bringing the virus in,” Konetzka said. “This to me is the most alarming of all of these figures.”
Because staff members are often younger and often asymptomatic, they should be tested twice per week when there is a community surge to make sure they’re not bringing the coronavirus inside, she said.
“Even then, we’re not going to keep out the virus completely, but at least we have a chance of finding it and containing it,” she said.
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