While a dozen Spokane long-term care facilities are battling COVID-19 outbreaks and rising numbers of deaths, state officials announced plans Thursday to give such residences the opportunity to gradually ease their restrictions on visitations.

Officials imposed  tight rules on  those facilities early this year, after the state saw  its first deaths from COVID-19 in a Kirkland nursing home that was the site of a major outbreak of the virus. As of Wednesday, nursing homes and adult family homes will be able to begin working their way through a four-step process of gradually returning to pre-pandemic visiting rules.

Despite ongoing issues in Spokane and elsewhere, Gov. Jay Inslee said the state has “come far enough in restraining the pandemic” to allow families to have greater contact with family members inside long-term care homes.

Inslee, Secretary of Health John Wiesman and Social and Health Services Secretary Cheryl Strange, who announced the  rules together, said the phases do not correspond directly with the phases of the state’s economic reopening plan. Instead, they are tied to the number of COVID-19 cases in the community.

In Phase 1, where all long-term care facilities will start on Wednesday,  indoor visits are allowed  only for “compassionate care” and residents are only allowed two outdoor visits each day.

Phase 2 allows limited indoor visits by a single person who is wearing a face covering and has been screened for symptoms, but only if the visit can’t be done outdoors.

Phase 3 allows more indoor visits, but outdoor visits are still preferred. It also allows residents to leave the facility if they wear a mask, practice social distancing and are screened for symptoms on their return.

Phase 4 allows a facility to return to its normal visiting protocols, though it must continue to follow state testing guidance for staff and residents and screen people for symptoms.

Wiesman said long-term care facilities are connected to 10% of the state’s  COVID-19 cases and 56% of its deaths, when considering residents, employees and people who had visited a facility and later contracted the virus.

But the facilities aren’t islands, and the infections now being reported seem to be brought in by staff who don’t yet know they have the virus, he said. As many as 50% of the cases can occur before a person knows they have symptoms.

“We all have a responsibility to protect the most vulnerable members of our community,” he said.

Facilities are required to report any new cases among residents or staff to the Department of Social and Health Services, Strange said. A facility will have to “jump through a lot of hoops” to move forward to a looser phase, she added.

The state will consider the rate of cases per 100,000 people in the community in deciding whether a facility moves forward in the plan. A facility must also go 28 days without a resident or staff member testing positive for the virus.

In the last two weeks of July, Spokane County had an incidence rate of 215 cases per 100,000 residents, state data show, which could make it challenging for facilities to advance past Phase 1. But  many metrics will be considered in a facility’s application.

When the new rules take effect  Wednesday, all facilities will be in Phase 1, but those in communities with appropriately low COVID-19 case rates that haven’t had a positive test in the previous 28 days will be allowed to apply immediately for permission to move to Phase 2.

Providing absolute protection to vulnerable people in long-term care facilities is extremely difficult, he said.

“We can’t just create bubbles like the NBA has,” he said.

Although Inslee announced Wednesday he was recommending students start the coming school year learning at home, he said he saw no contradiction in announcing a path to open up visits at long-term care facilities.

There’s a difference between keeping 25 children in a room together for six hours and allowing someone to visit their parent or grandparent inside or outside while wearing a mask and keeping 6 feet apart, he said.

“Our Washington public is really smart,” he said. “I’m sure they can understand the difference.”

Local facility outbreaks

COVID-19 has hit some long-term care facilities in Spokane County hard in the last few weeks, leading to an uptick in deaths and the virus spreading to both residents and staff members.

“As you see a higher number of positive cases especially in groups that are at risk for severe symptoms, it is naturally a correlation to higher hospitalizations and higher deaths,” said Kelli Hawkins, public information officer at the Spokane Regional Health District.

The health district is reporting current outbreaks at 12  facilities, totaling 248 confirmed cases, although that number is likely lower than current case counts reported by each long-term care facility.

Franklin Hills Health and Rehabilitation, Royal Park Health and Rehabilitation and Sullivan Park Care Center have all reported outbreaks that began in late July. Now  each facility has more than 70 confirmed COVID-19 cases connected to their outbreaks, data from the Spokane Regional Health District show.

Sullivan Park Care Center, a rehabilitation and assisted living facility in Spokane Valley, had an outbreak of COVID-19 that started on July 19.

Since then, 55 patients and 26 staff members have tested positive for the virus, for a total number of 81 cases connected to the facility. To date, 10 residents have died.

“We continue to work closely with the Spokane Regional Health District and the Washington State Department of Health to respond to this situation with urgency and continually reinforce our rigorous preventive measures, including caring for affected patients in isolation in a designated COVID-19 unit within our center and implementing home quarantine measures for staff members,” a statement from the facility shared with The Spokesman-Review said. “We also continue to track all resident and staff interactions and screen for additional signs of COVID-19.”

The facility continues to restrict visitors from coming into the facility and plans to test staff members monthly going forward. Staff members at Sullivan Park Care Center are asking residents to stay in their rooms as much as possible and have kept dining areas closed.

Administrative or corporate staff at Franklin Hills Health and Royal Park Health did not return voicemails left for this story.

Smaller outbreaks at both long-term care facilities and adult family homes are still occurring in Spokane County, too. The Spokane Regional Health District has an infection-prevention specialist who goes to assist facilities when they report an outbreak, which is just one confirmed case in these types of high-risk congregate settings.

At Rockwood Retirement Communities’ South Hill location, preventive measures helped keep the virus out of the 500-resident facility until recently, said general manager Andy Gorton.

SRHD now reports 15  cases of the virus within Rockwood South Hill, while the facility’s website gives a current total of 12 cases – seven residents and five staff members. Gorton said the other three cases were staff members who tested positive at an earlier date and remain under quarantine despite being “nearly recovered.”

Two residents at Rockwood, both with significant underlying health conditions, have died while positive for the virus within the last week, according to Gorton.

The facility became aware of the virus’ presence after test results came back Aug. 1. However, precautions were in place as if the virus were already there, Gorton said. Visitors have been barred from the campus since March, and dining rooms and group activities were closed preemptively. Gorton said administrators had been in constant contact with residents and their families to keep them updated, especially in units with positive test results.

Gorton said Rockwood’s health care units, comprising memory care, assisted living and skilled nursing units, were considered highly vulnerable and have been under quarantine since the beginning of the pandemic.

Cases among residents at the facility are currently limited to the skilled nursing unit, which houses 36 residents with specialized medical needs, Gorton said. One infected staff member worked in the assisted living unit, but no residents in that unit have yet tested positive. Staff assigned to that unit only work within that unit, Gorton said, and an isolation area has been set up within skilled nursing to care for those infected.

All residents and staff with the virus are asymptomatic, Gorton said. Staff will be required to isolate at home until they recover or retest negative, Gorton said, or will have the option to return to work only with already-positive residents.

No cases have been reported among residents in the facility’s independent living units, which include an apartment building and 165 individual homes. Plans are in the works for testing  all residents in the health care units and staff members campuswide next week, Gorton said.

Gorton said health district officials have been “extremely supportive and helpful” in assisting Rockwood through the pandemic. 

SRHD reported 11 cases at Avalon Care Center at Northpointe, a facility in north Spokane, as of July 30. The facility reported 19 cases on its  COVID-19 webpage as of Wednesday.

Allison Griffiths, vice president of legal for Avalon’s Utah-based parent company, said Thursday that six residents and one staff member tested positive within the past 24 hours, and SRHD may not have had time to update the numbers.

Of those cases, 11 were staff and eight were residents, Griffiths said. One resident with COVID-19 has died and one is currently hospitalized.

A specialized COVID-19 unit has been set up for positive residents, physically separate from the rest of the facility and with dedicated staff, according to the website. Only “essential” visitors and vendors are allowed into the facility on a case-by-case basis.

Touchmark on South Hill reported three cases of the virus to SRHD, but Interim Executive Director Michaela Thompson said Thursday the facility was free of the virus as of a couple of weeks ago. All three patients have recovered after spending several weeks in quarantine, Thompson said.

The first case was in a resident of the 300-resident facility’s independent living unit, Thompson said. That first patient experienced moderate symptoms, but no hospitalization was required. A second resident – the spouse of the first infected person – also tested positive, as did a staff member in a different unit, but showed no symptoms, according to Thompson.

Thompson said residents have largely been “staying home and staying safe.” While the campus has been closed to visitors for months now and residents are encouraged not to leave the facility, Thompson said the virus’s entry point is unclear as some residents do choose to leave occasionally.