Misplaced Priorities at VDH

by Carol J. Bova

The Virginia Department of Health (VDH) announced January 19 that it has launched a COVID-19 Outbreaks in Virginia Higher Education dashboard. The department included a disclaimer that the dashboard reports only “outbreak-associated cases and not the total number of cases at the college or university.” For more information on COVID-19 numbers, the dashboard points to a separate website hosted by eleven schools which contains information about their cases at www.covid19.va.education.

The VDH rationale for a new dashboard with incomplete information? “This dashboard helps to provide awareness of the spread of SARS-CoV-2, the virus that causes COVID-19, in colleges and universities statewide.”

This new VDH dashboard does not show the true extent of COVID-19 in colleges and universities. It is a waste of time and resources. Having this information at the beginning of the fall semester might have been useful. Citizens are already acutely aware of the spread in their communities, and efforts need to be redirected to the state’s older population.

For example, since November 1:

Colleges and universities have had 13 outbreaks involving 556 cases and no deaths.
Long term care facilities have had 490 outbreaks with 12,024 cases and 1,012 deaths.
Totals for higher ed: 55 outbreaks, 3,026 cases, zero deaths.
Totals for LTCF:  806 outbreaks, 24,935 cases, 2,795 deaths.

On November 17, 2020, the Centers for Medicare and Medicaid Services (CMS) recognized 1,092 nursing homes with half or more of their staff who completed CMS training to help control COVID-19 in their facilities. There were only 32 nursing homes in Virginia on that list.

Over 125,000 of approximately one million staff from 7,313 nursing homes completed the training. That means 254 Virginia nursing homes were among the 8,000 others in the country whose staffs did not complete the training.

Long term care facilities, including the state’s 286 nursing homes, are responsible for 94.5% of Virginia’s COVID-19 outbreak deaths, and 48% of all Virginia COVID-19 deaths.

In November, I asked Brenden Rivenbark, senior policy analyst, office of the commissioner at VDH and a member of the Governor’s Long Term Care Task Force, if the task force had taken any action encouraging nursing homes to take part in these CMS training modules.

In his reply, he said:

“The Task Force and our partners continue to encourage facilities to participate in the Targeted COVID-19 Training for Nursing Homes for clinical staff and management. In addition, our local health departments provide infection control guidance to long-term care facilities. Lastly, [Virginia Commonwealth University] and George Mason University are implementing the Project ECHO (Extension for Community Health Outcomes) model for Virginia’s nursing homes to connect facilities with subject matter experts across Virginia for knowledge exchange.”

Since November, almost 500 LTCF outbreaks, 12,000 cases, and more than 1,000 deaths show that encouragement, guidance, and experts for knowledge exchange have not reduced the overall nursing home cases and deaths.

CMS classes can help only if nursing home staff take them. Instead of creating dashboards that have limited information and do nothing to save lives, VDH should refocus on getting nursing homes to get more staff members to take the free CMS online training to control COVID-19 in their facilities. 

If that’s not to VDH’s liking, then put the dashboard people to work helping to schedule distribution of the vaccine instead of partly duplicating already available information. Either way, the priority needs to be on saving lives.


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28 responses to “Misplaced Priorities at VDH”

  1. Carol, you might have buried the big story. You wrote:

    “Nationally, CMS recognized 1,092 nursing homes for having half or more of their staff who completed the training. Only 32 of 286 Virginia’s nursing homes were on that list.”

    How many nursing homes are there in the country? Of that number, what percentage is 1,092?

    For purposes of comparison 11.2% of Virginia nursing homes can say that half or more of their staff completed the training. Is that more or less than the national average?

  2. Baconator with extra cheese Avatar
    Baconator with extra cheese

    Google says there are about 15,600 nursing homes in the US. 1,092 is about 7 percent. So VA is above average.

    1. With 89% who didn’t take the training, and no VDH inspections, and slow vaccine delivery, we can expect the deaths to continue unless something changes.

      1. Baconator with extra cheese Avatar
        Baconator with extra cheese

        89% didn’t cross the 50% threshold. So realistically maybe 10-15% of nursing home employees took the training.
        I agree they are probably understaffed and struggling….
        But we have a “wartime” Dr Governor so I’m at ease… we’re in good hands! (Nah… we’re F’ed)

  3. Carol, you might have buried the big story. You wrote:

    “Nationally, CMS recognized 1,092 nursing homes for having half or more of their staff who completed the training. Only 32 of 286 Virginia’s nursing homes were on that list.”

    How many nursing homes are there in the country? Of that number, what percentage is 1,092?

    For purposes of comparison 11.2% of Virginia nursing homes can say that half or more of their staff completed the training. Is that more or less than the national average?

  4. Baconator with extra cheese Avatar
    Baconator with extra cheese

    Google says there are about 15,600 nursing homes in the US. 1,092 is about 7 percent. So VA is above average.

    1. With 89% who didn’t take the training, and no VDH inspections, and slow vaccine delivery, we can expect the deaths to continue unless something changes.

      1. Baconator with extra cheese Avatar
        Baconator with extra cheese

        89% didn’t cross the 50% threshold. So realistically maybe 10-15% of nursing home employees took the training.
        I agree they are probably understaffed and struggling….
        But we have a “wartime” Dr Governor so I’m at ease… we’re in good hands! (Nah… we’re F’ed)

  5. ksmith8953 Avatar
    ksmith8953

    VDH needs to spend their Covid money on a website to register, track, and communicate the distribution of the vaccine with the public. They don’t have the infrastructure to scale up distribution. It’s been four days and counting for a return phone call from Crater district. Ridiculous.

    1. djrippert Avatar

      Call your delegate, state senator and county board of supervisors representative. The registering, tracking and setting of appointments can be fixed very quickly with the right technology. Tell them to stop being typical “Virginia Way” dipsticks, admit they can’t build the technology and “rent” the technology (on a per shot basis – which is how these platforms are billed) from a reputable vendor. This is easy.

      https://www.baconsrebellion.com/covid-vaccine-distribution-what-can-virginia-learn-from-florida/

      1. idiocracy Avatar

        You do understand, don’t you, that one important part of the “Virginia Way” is to let it all go to hell rather than to admit you are wrong?

  6. LarrytheG Avatar

    If I had to choose between more training versus vaccinations of the folks in the nursing homes, it’s a no brainer.

    In our area, I’m presuming that they have prioritized the nursing homes and front-line health care workers and would not have opened it up to others until they had that well underway/under control.

    VDH is far from perfect, in fact, have their problems, but I see and hear of similar problems in other states. The simple truth is we’ve never seen something the scope and scale of this for a long time, perhaps never.

    FWIW – we do have a sign-up website in Fredericksburg, but truth be known, I was not contacted, I heard about it from a friend who have heard about it from another friend and now they’re saying they’ve maxed out the shot and sign-ups are waiting for more vaccine.

    It’s a mess.

  7. Steve Haner Avatar
    Steve Haner

    But, but, but….the nursing home bosses would have to PAY people to take the training, taking them away from revenue producing activity! They I’m sure want the government to reimburse them….always, always follow the money, the funding, the reimbursement. Incentives.

    And in fairness, if a facility is dealing with an outbreak, staff time is at a premium. We hear about the staffing issues in the hospitals now, but it may be far worse in these places.

    1. Govt did send CARES money, didn’t they? Wouldn’t it be less costly in dollars as well as human life to squeeze in some training to help prevent more cases? Classes were available from August on.

      https://data.cdc.gov/Administrative/Provider-Relief-Fund-COVID-19-Nursing-Home-Quality/bfqg-cb6d

      First round September payments from the Nursing Home Quality Incentive Program – 197 got 7.4 million
      second round October payments for Nursing Home Quality Incentive Program 164 got $8.2 million
      (incentive payments from CMS for weeks in Sept and Oct with 0-1 cases)

      plus, Va had 290 facilities who got 96.7 million of the $4.9 billion distribution to skilled nursing facilities

      286 got $50 million of the $2.5 billion distribution to skilled nursing facilities/nursing homes

  8. Steve Haner Avatar
    Steve Haner

    But, but, but….the nursing home bosses would have to PAY people to take the training, taking them away from revenue producing activity! They I’m sure want the government to reimburse them….always, always follow the money, the funding, the reimbursement. Incentives.

    And in fairness, if a facility is dealing with an outbreak, staff time is at a premium. We hear about the staffing issues in the hospitals now, but it may be far worse in these places.

    1. Govt did send CARES money, didn’t they? Wouldn’t it be less costly in dollars as well as human life to squeeze in some training to help prevent more cases? Classes were available from August on.

      https://data.cdc.gov/Administrative/Provider-Relief-Fund-COVID-19-Nursing-Home-Quality/bfqg-cb6d

      First round September payments from the Nursing Home Quality Incentive Program – 197 got 7.4 million
      second round October payments for Nursing Home Quality Incentive Program 164 got $8.2 million
      (incentive payments from CMS for weeks in Sept and Oct with 0-1 cases)

      plus, Va had 290 facilities who got 96.7 million of the $4.9 billion distribution to skilled nursing facilities

      286 got $50 million of the $2.5 billion distribution to skilled nursing facilities/nursing homes

  9. ksmith8953 Avatar
    ksmith8953

    VDH needs to spend their Covid money on a website to register, track, and communicate the distribution of the vaccine with the public. They don’t have the infrastructure to scale up distribution. It’s been four days and counting for a return phone call from Crater district. Ridiculous.

    1. djrippert Avatar

      Call your delegate, state senator and county board of supervisors representative. The registering, tracking and setting of appointments can be fixed very quickly with the right technology. Tell them to stop being typical “Virginia Way” dipsticks, admit they can’t build the technology and “rent” the technology (on a per shot basis – which is how these platforms are billed) from a reputable vendor. This is easy.

      https://www.baconsrebellion.com/covid-vaccine-distribution-what-can-virginia-learn-from-florida/

      1. idiocracy Avatar

        You do understand, don’t you, that one important part of the “Virginia Way” is to let it all go to hell rather than to admit you are wrong?

  10. LarrytheG Avatar

    Waiting 15, well organised!

  11. I just found out I’m scheduled to receive the vaccine next Friday.

  12. LarrytheG Avatar

    If I had to choose between more training versus vaccinations of the folks in the nursing homes, it’s a no brainer.

    In our area, I’m presuming that they have prioritized the nursing homes and front-line health care workers and would not have opened it up to others until they had that well underway/under control.

    VDH is far from perfect, in fact, have their problems, but I see and hear of similar problems in other states. The simple truth is we’ve never seen something the scope and scale of this for a long time, perhaps never.

    FWIW – we do have a sign-up website in Fredericksburg, but truth be known, I was not contacted, I heard about it from a friend who have heard about it from another friend and now they’re saying they’ve maxed out the shot and sign-ups are waiting for more vaccine.

    It’s a mess.

  13. LarrytheG Avatar

    Waiting 15, well organised!

  14. I just found out I’m scheduled to receive the vaccine next Friday.

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