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Some long-term care facilities can welcome visitors, but rules remain strict

The Royal Park Health and Rehabilitation Center is seen on July 28, 2020. The assisted living facility is in the midst of a COVID-19 outbreak and is located at 7411 N. Nevada St. in Spokane.  (By Libby Kamrowski / The Spokesman-Review)

Some long-term care facilities in Spokane can welcome outdoor visitors under new state rules , but indoor visitation will have to wait until the county’s virus incidence rate falls further.

Visitor restrictions were put in place with good reason: COVID-19 outbreaks in long-term care facilities have been consistent and deadly throughout the pandemic.

So far, 1,036 of 1,953 deaths due to COVID-19 in Washington are associated with long-term care facilities. Residents over the age of 60 make up 89% of deaths due to COVID-19 in Washington .

As of Aug. 24, at least 82 of Spokane County’s 136 deaths are associated with outbreaks in long-term care facilities. More than 546 cases are connected to long-term care facility outbreaks in the county .

August was the deadliest month on record for Spokane County, with a near doubling of deaths due to the virus. Through July, 65 people died in Spokane County of COVID 19. In August alone, that number was 55. Spokane County Health Officer Dr. Bob Lutz confirmed that this is largely due to the outbreaks in facilities .

Cases in Spokane County began to climb with predominantly 20 and 30-year-olds testing positive earlier this summer, but as health officials predicted, that virus spread to other age groups and eventually made its way into long-term care facilities via workers. With no visitors allowed in just about all facilities until August, staff members were bringing it in to residents.

“As we had predicted that we would see more hospitalizations and community spread, we saw, unfortunately, residents in long-term care facilities being diagnosed with COVID-19 and succumbing to it,” Lutz said. “The vast majority of deaths we’ve seen are residents from long-term care facilities and outbreaks.”

As of Friday, there are still ongoing COVID-19 outbreaks in 15 long-term care facilities and a handful of adult family homes. There are 431 cases associated with these current outbreaks.

Franklin Hills Health and Rehabilitation, Sullivan Park Care Center and Royal Park Health and Rehabilitation have outbreaks of more than 80 cases among staff and residents, according to data from the Spokane Regional Health District.

Avalon Care Center at Northpointe, Lakeland Village, Rockwood Retirement South Hill and Cornerstone Memory Care have outbreaks of more than 20 cases among staff and residents.

System challenges limit options

Why do these outbreaks keep happening more than half a year into the pandemic?

Lutz pointed out that outbreaks must be occurring due to staff members unknowingly bringing the virus into work with them.

“There’s a perception that a mask is in and of itself sufficient, but we know that not to be the case, so you can be masked and still transmit the infection,” Lutz said.

“We’ve heard of staff coming in asymptomatic and become symptomatic after the fact,” Lutz said, noting that in some cases staff members did come to work while exhibiting symptoms. “These are the individuals that have to work multiple jobs, so it’s a challenge, the lessons learned are you have to be on top of infection prevention from the get go.”

Patricia Hunter, the state’s long-term care ombuds, agrees.

“I don’t think we’ve cracked the nut yet,” she said. “I think we know what needs to happen, but we are so dependent on the limited number of caregivers that we’re not willing to go there.”

She points to facilities elsewhere in the country that have successfully kept out COVID-19 – they either created bubbles allowing workers to live and quarantine safely, or pay their workers well enough so they don’t need to work multiple jobs.

Those options are not available to most long-term care workers. Hunter acknowledged the hard work of caregivers and the potential for burnout as the pandemic continues .

“People have no idea how hard the caregivers and nurses work in long-term care, it’s a very, very tough job,” Hunter said. “And they’re subjected to really tough situations every single day on the job, some are pulling double shifts, there was a shortage before COVID of caregiving (workers), and it wasn’t abnormal to see CNAs (certified nursing assistants) and nurses pulling double shifts.”

Hunter is nervously watching case counts in the coming weeks, following Labor Day weekend, noting the reality that so many counties in the state and country have experienced: that an outbreak in the community will eventually find its way into a long-term care facility or congregate living setting.

“We’re not siloed as a community,” she said.

Her office is seeking new volunteers, as she said, nearly 100 of her usual volunteers are considered high-risk for contracting severe disease or illness if they should get COVID-19, due to their age or underlying health conditions. Hunter said that her office is preparing volunteers to expect that residents are likely to have experienced some level of trauma in the last few months.

A slow, phased reopening

Hunter and her office were involved with the governor’s new guidance for reopening, albeit methodically, long-term care facilities in the state.

On Aug. 12, new guidance for reopening long-term care facilities statewide took effect, but for counties with more than 75 cases per 100,000 residents, visitation is still fairly limited. Long-term care facilities in counties with this high of an incidence rate are allowed to have residents do window, remote or outdoor visits as well as compassionate care visits in Phase 1 of the new reopening guidance.

Limited indoor visits are not allowed until Phase 2, however, and a facility cannot enter Phase 2 until the county has an incidence rate between 75 and 25 cases per 100,000; the facility goes 28 days without a COVID cases in a staff member or resident; has a two-week supply of personal protective equipment on hand; and is not moving past where the county is in the state’s phases.

For instance, a long-term care facility could not move to Phase 2 if its home county is in Phase 1 of the governor’s Safe Start phases. The phases for reopening long-term care facilities are not synonymous with county Safe Start phases, however.

Hunter expects to see more facilities enter Phase 2 of the long-term care guidance by Sept. 12, given that they’ve had no outbreaks in the past month.

She said allowing more compassionate care visits for residents not just in end-of-life care but also for those on hospice care, and individuals with psychosocial needs, will really benefit residents.

“An adult with developmental disabilities who may have a limited understanding of what’s going on, they benefit from having a family member there to advocate for them, especially when it comes to health care or financial decisions,” Hunter said.

Gov. Jay Inslee’s guidance also allows for an “essential support person” to visit a loved one in a facility in Phase 2. These visitors will be allowed to see loved ones inside the facility, after being screened and wearing a face covering, particularly those residents who have difficulty doing virtual visits with loved ones, such as those with dementia or neurological limitations.

“The reason we wanted to push for that was because six months in isolation is an extraordinary challenge for the most healthy and the best of us,” Hunter said. “And we’re very concerned about people’s emotional and mental and physical health, visitors are more than just a social connection they provide care and coordination – and they keep caregivers and providers honest.”

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.