INDIANAPOLIS — More than one in every seven COVID-19 deaths in Indiana originated from one of the state’s 735 nursing homes, according to information released Wednesday by the Indiana State Department of Health.
The department didn’t provide geographic information on those 31 deaths, 15% of the state’s total 203 COVID-19 deaths, but at least 15 occurred in Madison County. Many nursing home residents have underlying health conditions and are among the most vulnerable to the virus.
“Of those tested (in long-term care facilities), 191 came back positive with nearly 170 of these being among our long-term care residents,” Kristina Box, the state health commissioner, said Wednesday. “More than a dozen positive cases have occurred in group homes, with the rest being in correction facilities.”
Box identified the spread of the virus in long-term facilities as one of her greatest concerns after the devastating deaths reported in nursing homes in Washington state. An estimated 65,000 Hoosiers live in long-term care facilities, such as nursing homes, residential facilities and correctional facilities.
Though Hoosiers 70 and older represent just 19% of confirmed COVID-19 cases, 70% of the state’s deaths have occurred in that age range.
The state’s 11 “strike teams” targeting coronavirus hot spots had reached over 600 residents at 200 facilities by Wednesday, but that’s just a fraction of the state’s total facilities. All long-term care facilities fall under ISDH’s order to report proven or suspected cases and deaths to the department within 24 hours.
“This includes your employees, and that’s very important,” Box said. “We provided a checklist very early on to all of our facilities emphasizing the importance of not only reporting this to your local and to your state public health officials, but making sure that your residents and their families were notified about the positive cases or deaths that occur.”
Some families said they weren’t informed about coronavirus cases in the troubled Bethany Pointe assisted living facility. At least 11 residents died from symptoms related to COVID-19 at the Anderson facility, representing one-third of the state’s nursing home fatalities.
CHALLENGES
Dan Rusyniak, chief medical officer for Indiana Family and Social Services Administration, has been appointed to oversee and coordinate care at long-term care facilities, including nursing homes.
Rusyniak said the state endorsed a Centers for Medicare & Medicaid Services recommendation to bar nursing home visitors and communal activities on March 13, later releasing guidelines on protecting workers.
“This disease creates the potential for a perfect storm in a long-term care facility: large groups of vulnerable people living together and a highly transmissible virus that may not cause symptoms in those who care for them,” Rusyniak said.
The state has waived hiring requirements for residential facilities, many of which are understaffed, and is allowing those with out-of-state licenses to practice in Indiana, according to Rusyniak.
“Staffing in our long-term care facilities is challenging during this pandemic, similar to staffing in a hospital, because they’re front line workers,” he said. “A lot of the long-term care facilities are large corporations and have been able to move staffing around.”
When a long-term care facility identifies a positive case, a state strike team is sent to test all residents and staff and distribute personal protective equipment. The strike team consists of a coordinator, a nurse surveyor, an infection control expert and an epidemiologist, who review the facility’s readiness and infection control practices.
“As the state approaches the coming surge, it may also be necessary to expand the capacity of our nursing homes and skilled facilities to care for patients coming out of the hospital with COVID-19,” Rusyniak said.
COVID-19 PRIORITIES
Box said Wednesday that she’s worried about the coordination of the on-the-ground effort to treat vulnerable populations.
“I’ve also had significant concerns about local decisions that are being made to try to prohibit the transfer of patients, regardless of their COVID-19 infection,” Box said.
In Daviess County, nursing home operator Chosen Healthcare attempted to designate its Washington facility as a treatment center for residents with COVID-19, transferring Washington Nursing Center residents out to accommodate infected residents.
Chosen Healthcare has 14 other facilities scattered across the state, including sites in Greenfield, Indianapolis, New Albany, Lebanon and Vincennes.
But the nursing home received an injunction preventing any residents from being moved, unless the resident’s family requested it.
Ernie Evans, whose son, Cody, lives at the center, filed a temporary restraining order as protesters rallied against the move, saying that families hadn’t been notified.
“I had to do something,” Evans told the Washington Times-Herald. “What they were doing was not right. They were moving people who had been there for years, and they wanted to take those people out and bring COVID patients in here.
“They should not have uprooted these people from the community, and by bringing in COVID patients it was just going to set our small town up for a heck of a mess.”
The CEO of Daviess Community Hospital, a partner of the Washington Nursing Center, told the Times-Herald there are no longer plans to send any residents away.
“In terms of trying to move the patients out quickly, we didn’t support that,” the CEO, Tracy Conroy, said. “We want to do what is best for those residents and the community.
“Bringing a COVID-19 facility to any small community is a problem because small communities lack the resources of an Indianapolis or an Avon or a New Albany that has multiple hospitals and resources.”
Rusyniak didn’t talk specifically about the state’s role in mitigating a faceoff such as the one in Daviess County, instead saying that creating COVID-19 facilities required “communication and partnership.”
“I think for this to work best, you need to have the long-term care facility that’s partnered with the local hospital and with the health department,” Rusyniak said. “That way, the hospital knows if there’s going to be a facility that has dedicated COVID-19 (cases) or whether they have the capacity to manage folks who are ill.”
Lindsay Owens of CNHI News Indiana contributed to this story.