Last spring, the novel coronavirus had Michelle Bourque worried. Not just because she feared catching it, although that was a big concern, but more because her 81-year-old mother was in Chateau de Notre Dame, a New Orleans-nursing home with one of the earliest confirmed clusters of the virus.
Locked out after the federal government recommended that nursing homes ban visitors, Bourque worried about her mom’s health and wondered why authorities weren’t doing more to test residents and staff and ensure stringent infection control procedures.
After all, the virus was taking a deadly toll on senior populations, thought to be among the most vulnerable, and health officials warned it would only get worse.
Bourque implored officials to give specifics on how they would fight the pandemic in long term care facilities. “What’s the plan?” she asked in April. “That’s critical to protect residents and staff at these facilities.”
Bourque wasn’t alone. Across the U.S., families with loved ones in nursing homes were confronting the same problem as news reports detailed the dozens of deaths in homes in Ohio, Washington state, New Jersey and New York. Closer to home, outbreaks at nursing homes in New Orleans, Reserve, Arnaudville and Covington had also claimed dozens of victims.
Seven months later, coronavirus cases are again on the rise again around the country and in Louisiana. And Bourque’s mother, who contracted the virus and was hospitalized in April, is back in her room in Chateau de Notre Dame.
But this time, Bourque is far more sanguine.
“Things are so much better now,” she said. “I’m not that worried.”
Louisiana, like the rest of the country, is on the upslope of a feared fall/winter spike of coronavirus cases — a third wave — that experts warn could be worse than the two waves that preceded it. Gov. John Bel Edwards has pronounced himself “troubled” by the trend, and last week, the White House Coronavirus Task Force urged Louisiana to further tighten restrictions to slow the virus.
As it did in the previous waves, the rise in cases portends bad things for nursing homes.
Since the beginning of November, there have been more than 550 reported cases among residents at more than 270 Louisiana nursing homes, as well as nearly 50 deaths, according to an analysis of the latest state data.
Of the state’s more than 6,200 deaths, approximately 43% have been nursing home residents, according to Dr. Joseph Kanter, interim Assistant Secretary for the Louisiana Office of Public Health.
The reasons are clear. Most nursing home residents are elderly and many possess the underlying health conditions — high blood pressure, heart and kidney disease, diabetes — that can more easily turn the virus into a killer.
But home administrators, state health leaders and families appear to be more optimistic this time around.
Much more is known about how to prevent the spread. Staffing levels are better, as are supplies of personal protective equipment, more commonly known as PPE. Perhaps most importantly, rapid testing has been widely deployed in nursing homes, making it easier to identify and isolate positive cases.
“There’s just been a lot more experience,” Kanter said. “Every day that goes on, nursing homes get better at it.”
In is role, Kanter is at the forefront of the state’s efforts to help support nursing homes in their fight against coronavirus.
The state is pushing out PPE to nursing homes, offering training and counseling in infection control and supporting testing in the homes, Kanter said. The effort is far more robust than in the spring, when PPE and testing were largely unavailable and state officials were often left scrambling to react to the spread rather than proactively prevent it.
But Kanter cautioned, nursing homes remain vulnerable.
Studies have shown that in significant spikes seen in communities will find their way into long-term care facilities.
“When you have a spike in the community, you invariably see it in the nursing homes,” he said. “No testing strategy is 100% effective.”
Lisa Gardner, of CommCare, a company that operates 13 long-term care facilities throughout Louisiana, said administrators are far better equipped than in the spring.
“Just having a better knowledge from a public health perspective makes it a lot more manageable,” she said. “The knowledge is better, the equipment and supplies are better.”
Gardner pointed specifically to the testing piece of the puzzle. In the summer, many nursing homes received rapid testing kits from the federal government, which has since required them to conduct regular testing of all residents and staff. Since then, tens of thousands of tests have been conducted.
The state also provides financial support to some homes to assist in testing, Kanter said.
But challenges remain.
The Louisiana office of the AARP produced a report earlier this month that said some homes were still short on PPE and staffing as recently as last month.
That report found that as of the month before Oct. 18, about one-fifth of the state’s roughly 270 nursing homes didn’t have a week’s supply of protective gear — like masks, gowns and gloves. Over that same period, more than a third of the homes had staffing shortages, the report found.
Denise Bottcher, the head of the Louisiana AARP, urged any lagging homes to request help.
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“If you have staff that don’t have access to or use PPE, you are behind,” she said. “If you know you have a shortage of PPE and staffing, reporting that the Louisiana Department of Health and responding needs to be the next step.”
Katherine Robins has seen that concern first hand.
Her husband Doug, who lives at Carrington Place in Baton Rouge, tested positive for the virus in the spring, but she worries about him contracting the virus again and worries that her husband and other residents are being kept safe.
The rise in cases has some family members fearing that they could be cut off from their loved ones again.
But visitations don’t appear to be on the chopping block yet.
Per federal guidelines, homes that haven’t had a case in 14 days and are in parishes with 10% or lower positivity rates can allow indoor visitation. Even homes that don’t fit those criteria can host outdoor visits with social distancing.
The resumption of family visits has been a lifeline for many who spent months isolated from their elderly or sick relatives — and for the residents themselves, a population already susceptible to loneliness.
“During the spike, she didn’t leave her room at all,” Carol Nunez, of Mandeville, said of her 92-year-old mother, Leatrice Lobell.
Lobell is a resident at Forest Manor in Covington, where 38 residents have died from the virus. The absence from their mother was difficult on the family, Nunez said.
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When Nunez visits her mother now, Lobell is behind a barrier. Hugs and kisses are not allowed, Nunez said. But it’s better than nothing.
Recently, visitation at the home was shut down for two weeks after a positive test. But Nunez said it has since reopened, thankfully in time for the Thanksgiving holidays.
“I’m there just about every day,” Nunez said.
CommCare’s Gardner said that getting visitors back into the homes has been key.
“That was an important piece,” she said. “We all recognize that it was very much needed.”
Emily Deibel moved her 70-year-old mother into Trinity Trace in Covington in October. She’s comfortable, even knowing what happened earlier this year.
“I feel like she’s well protected there,” she said. “I feel like she’s in the best place.”