WEST CHESTER — While state lawmakers are introducing bills calling for safety protocols in nursing homes and personal care homes, the number of COVID-19-related deaths at these facilities continues to rise at a far greater rate than the general population.
In nursing and personal care homes in Pennsylvania, there are 10,506 resident cases of COVID-19, and 1,489 cases among employees, for a total of 11,995 at 514 distinct facilities in 44 counties, health officials said. Out of the state's total deaths, 2,355 have occurred in residents from nursing or personal care facilities.
And approximately 3,437 of the state's total cases are health care workers.
"This virus is tailor-made to attack and live in older adult settings, and it preys on people who have underlying conditions and weakened immune systems," said Adam Marles, president and CEO of LeadingAge PA, which represents more than 365 nonprofit providers of senior housing, health care and community services across the state. "These are the people who are reliant on the care provided in nursing facilities and personal care homes."
In Chester County, there are now 183 COVID-19-related deaths in long-term care facilities since March 28, according to the Chester County Coroner's Office. Forty percent of the 75 licensed long-term care and personal care homes in Chester County have had an outbreak, defined as at least one positive case. And 24 county facilities have reported one or more COVID-19 deaths to the coroner's office.
Five of those facilities, plus one in Montgomery County have had 10 or more residents die of coronavirus, said Dr. Christina VandePol, Chester County coroner.
“Long-term care facilities take care of elderly persons with advanced lung, heart, neurological, and other diseases,” she said.“I believe the staff at these facilities has been doing the best they can while struggling with lack of resources, including nurses, PPE, COVID-19 tests, and space. The vulnerability of nursing homes wasn’t recognized early on when the focus was on hospital preparedness. We need to support these facilities now, and just as importantly, we need to re-imagine what long-term care needs to look like in the future.”
The Southeast Veterans Center in East Vincent Township has been hard-hit by the pandemic. As of May 6, 34 residents of the center had died of confirmed or presumed COVID-19, either at the facility or at a local hospital.
There have been 30 coronavirus deaths at Green Meadows Rehabilitation Center in East Whiteland, 24 at Brandywine Hall in West Chester, 14 at Barclay Friends in West Chester, 12 at Bellingham Personal Care Home, 20 at Parkhouse Nursing and Rehabilitation in Montgomery County and one at Pocopson Home. Coroners count all deaths that occur within a county, regardless of the residence of the decedent.
In Pennsylvania, there are nearly 53,000 confirmed cases of coronavirus, and nearly 3,500 COVID-19-related deaths. In Chester County, 176 people have died of coronavirus as of May 9.
Dr. Val Arkoosh, chairwoman of the Montgomery County Board of Commissioners, said nursing homes and veterans' facilities should be inspected on a regular basis, even when the pandemic ends.
“In the immediate moment, we need boots on the ground to physically visit facilities that are under stress, people who can help answer questions, observe what is happening, and offer advice,” she said. "We also need to connect places to testing, both for residents and the staff. That has to be accompanied by an understanding of how we get staff in place that can relieve those individuals who have to go home for some time.”
State Sen. Katie Muth, D-44th, of Royersford, who is a member of the Health and Human Services Committee, said family members must be accessible to their families to ensure transparency.
“COVID-19 has created intense challenges for direct care providers in congregate care settings," Muth said. "(Health care workers) are putting themselves at risk while trying to protect our most vulnerable. Transparency and communication with families is imperative when people don’t have access to visit their family member. Nursing and veterans homes’ administrators need to provide families with truthful, timely information, as well as peace of mind and that often requires going above and beyond the minimum care the guidelines recommend."
U.S. Sen. Pat Toomey, R-Pa., is calling for states and nursing homes to consider adopting the practice of cohorting, already underway in a handful of states including Pennsylvania. With cohorting, nursing homes can separate residents with COVID-19 and those presumed to have the virus from those who have not been exposed, utilizing separate wings in an existing facility or leveraging nontraditional settings such as hotels and dormitories.
Legislation introduced last week by Speaker of the House Mike Turzai, R-28th, of Allegheny County, would establish a coordinated public-private-partnership approach of regional health system collaboratives. These health collaboratives would administer and manage personnel, protocols, testing and expenditures to protect the seniors in these facilities.
Turzai says health collaboratives would ensure consistency of programs, response, and study of clinical and public health outcomes. The legislation will provide an appropriation of $500 million from Pennsylvania’s allotment of $3.9 billion in COVID-19 money from the federal government.
State Sen. Kim Ward, R-39th, of Westmoreland County, has also introduced legislation that will require safety protocols for Pennsylvania nursing homes to be implemented during an emergency disaster proclamation issued by the governor in relation to a communicable disease. It would require nursing homes to follow the Center for Disease Control’s guidance upon the issuance of an emergency proclamation by the governor. Nursing homes in Pennsylvania were not required to follow the Center for Disease Control’s guidance relative to COVID-19 in the beginning of the pandemic.
Nursing homes, long-term care facilities and personal care homes, Marles said, will remain at the epicenter of the state's battle against coronavirus unless there is more testing, more personal protective equipment issued to staff at those facilities, and more funding is allocated.
"Nursing facilities are well-trained to provide infection control and keep people safe," Marles said. "If you look at the statistics across Pennsylvania with approximately 2,000 nursing care homes, personal care homes and assisted living facilities, 75 percent of those don't have a single confirmed case. But they are at the epicenter of this crisis because of the vulnerability of their population.
Marles said only 5 percent of those living in Pennsylvania retirement communities have a confirmed case of coronavirus.
"We need to recognize the exemplary work done by workers in older adult settings," he said.
LeadingAgePA has partnered with other associations in the state asking the Wolf Administration for additional funding for nursing home facilities. Because of the crisis, PPE must be purchased, additional staff must be hired, food costs have escalated because communal dining has been eliminated, and meals must be individually packaged and delivered.
Marles estimates that during a four-month time period, costs will increase $290 million.
"We asked the governor for a 3 percent rate increase to offset all these losses, but to this day we have had no response from the governor," Marles said.
The state Senate is working on allocating $200 million for nursing facilities, but right now that's only talk. Marles said if facilities don't get an infusion of cash soon, some facilities could be shuttered. The vast majority of nursing homes in Pennsylvania are either non-profits or privately owned. There are 697 nursing homes statewide, 1,143 personal care homes and 58 assisted living facilities.
"You can anticipate bed closures, facility sales and nursing home closures will follow in wake of no funding," he said.