Bacon's Rebellion

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Nursing Home PPE Shortages and Deaths Still Rising

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by

James A. Bacon
in

Deaths in cases originating at Virginia long-term care facilities.

by Carol J. Bova

After a review of over 15,000 nursing home reports submitted to the Centers for Medicare and Medicaid (CMS), Brian E. McGarry, David C. Grabowski, and Michael L. Barnett published a paper in Health Affairs on August 20th. In “Severe Staffing and Personal Protective Equipment Shortages Faced by Nursing Homes During the COVID-19 Pandemic,” they concluded, “Despite intense policy attention and mounting mortality, the shortages have not meaningfully improved from May to July of 2020.”

While six fewer Virginia nursing homes reported nursing staff shortages as of August 9,  there were more reports of all other staff shortages and supplies of Personal Protective Equipment (PPE) between the weeks ending June 7 and August 9 according to the CMS COVID-19 Nursing Home Dataset. Meanwhile, COVID-19 cases and deaths continue to rise.

Cases originating in Virginia long-term care facilities.

On June 8th, I wrote to COVID19JIC@vdem.virginia.gov, healthandhumanresources@governor.virginia.gov, and Tammie Smith at the Virginia Department of Health. She replied to my question of whether the Virginia Department of Health reviewed the dataset and what action they took, if any, in regard to the PPE shortages reported May 31. Her response was:

Long term care facilities are encouraged to practice PPE conservation per CDC guidance and to reestablish their PPE supply chains; access has improved recently. Those unable to source PPE through their regular supply chains routinely contact the State Unified Command for assistance.

Publicly provided PPE is distributed regularly to these facilities to ensure optimum safety in response to the COVID-19 pandemic. PPE requests are coordinated and sent to the Virginia Emergency Support Team (VEST) through their Regional Healthcare Coalitions.

Guidance information for nursing homes is here https://www.vdh.virginia.gov/content/uploads/sites/182/2020/05/VirginiaLongTermCareFacilityTaskForceCOVIDPlaybook.pdf

Two months later, there are still 57 Virginia nursing homes reporting PPE shortages, 20 without a current supply of N95 masks and 13 of those with no surgical masks either, and one without any hand sanitizer.

The system isn’t working. Whether there are additional failures in infection control procedures is to be seen as normal nursing home inspections resume. But there is no excuse for the Commonwealth’s failure to ensure adequate supplies of PPE. If owners are at fault, fine them or take other actions. The Commonwealth needs to act now.

As McGarry et al said, “Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic.”

As of August 21, 14.6% of all LTCF (long-term care facility) cases (1,321 of 9,020) have ended in death, and represent 54.1% of all COVID-19 deaths in Virginia. By comparison, correctional facilities have seen a total of 16 deaths. Our nursing home residents do not deserve a death penalty for being in a nursing home without adequate supplies or staff.

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20 responses to “Nursing Home PPE Shortages and Deaths Still Rising”

  1. Steve Haner Avatar
    Steve Haner

    https://www.baconsrebellion.com/app/uploads/2020/08/Outbreaks.jpg

    The facility outbreaks continue apace….Click on the graph for a larger view, but you can see no real change in intensity over all those months. Mostly long term care medical facilities by far, and that is where the deaths are. Of course now with the colleges back and testing, all of them will be classified and charted too, I guess. When you add the “congregate” category (retirement homes?), correctional and healthcare settings in, they represent closer to 60% of deaths. So far zero deaths in an educational setting, which I assume would include the many day care operations that have been open all along.

    I can’t seem to tell on the VDH site where the new outbreaks are. Are they following the pattern with cases, which are surging in Eastern and SW Virginia, but very diminished now in NoVA and fairly low in Central VA?

    As to the continued equipment shortages, those don’t make any sense now that supply is flowing. In April, yes, but not in August. Do they just not want to spend the money to protect their employees and residents? Somebody needs to press.

    1. Nancy_Naive Avatar
      Nancy_Naive

      Wow, nice sinusoid you got there. Actually a couple. If I were a betting man, I’d drop a fiver on October being another peak.

  2. Baconator with extra cheese Avatar
    Baconator with extra cheese

    Wow. That’s quite the thought. I believe we’re seeing both buisnesses and local government kick the can all the way to January. I guess the hope is the fed money will run unabated.
    Personally I can’t wait until I can get everything for free!
    By the way I was down near VCU this morning…. my investment advice is a short term investment in plywood and spray paint. The kids are really working hard to “beautify” cities and I see no stopping it in sight.

  3. V N Avatar
    V N

    You guys ridiculed me for asking questions like this and others. It has been happening, they’ve refused FOIA over it, and any other questions having to do with COVID. I kept after them.
    They obviously want to let it go with impunity and go after the businesses.

  4. Nancy_Naive Avatar
    Nancy_Naive

    Well, the health of the aged in a nusing home is, by definition, compromised. That a deadly, highly contagious disease will play havoc with that population should come as no surprise.

    Comparing LTCF to LTI(ncarceration)F beyond the fact that both are shut ins is not germane.

    PPE shortage? If the State supplies the stuff, well, that’s more profit, so let’s just drag our feet. Like funeral homes, there’s no shortage of customers, and the LTCF can bury its incompetency.

    1. Nancy_Naive Avatar
      Nancy_Naive

      https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/

      All the LTCF data CMS sees fit to print. As the COVID States go, we appear better than some, worse than others. Take Texas. No, seriously, Mexico, please take Texas.

    2. cjbova Avatar
      cjbova

      Actually NN, comparing the correctional facilities is germane when there were about 8,000 “geriatric” prisoners of about 30,000 total.
      [“As Virginia’s prison population more than doubled from 1990 to 2018, the number of geriatric inmates increased nearly tenfold, to more than 8,000.” richmond.com 3/29/20]

      “As of August 21, the following numbers of offenders have been released.
      Virginia DOC facilities: 471; Institutional Hospitals 1; State responsible in local jails 230.=702”
      https://vadoc.virginia.gov/news-press-releases/2020/covid-19-updates/

      So let’s say 1,000 were released, leaves around 7,000 over age 50. Many not in good health. Correctional facilities have had 3544 cases and 16 deaths. Means one half of one percent died. Doubt that they were the younger healthier prisoners.

      1. Nancy_Naive Avatar
        Nancy_Naive

        That just tells me that if faced with being placed in a nursing home, I should rob the Food Lion instead. Clearly, they receive better medical care.

      2. Nancy_Naive Avatar
        Nancy_Naive

        That just tells me that if faced with the prospect of a nursing home, that I should rob the Food Lion instead.

        You’re assuming that the geriatric prisoner is the equivalent of a geriatric in a nursing home. At best, you can compare the prisoners to the general population only.

        7,000 over age 50 prisoners. Okay.
        2,500,000 over age 50 Virginians (2012, close enough https://acl.gov/sites/default/files/programs/2016-11/Virginia%20Epi%20Profile%20Final.pdf )

        So, how many of the 2.5 Million are in LTCF? What’s the number of over age 50 residents in LTCF? Call it X.

        One might then take that proportion (X/2,500,000) and apply it to the prison geriatric population (7000*X/2,500,000) to get a number of prisoners to LTCF residents — might, because when prisoners reach that level of care need, they’re usually “released for humanitarian reasons”, unless Kovid Kerry objects.

        For illustration, let’s say there are 100,000 LTC residents over 50. That means 7000/25 or there are 280 prisoners who, but for prison would be in an LTCF. Now, how does 16 out of 280 compare to 1,321 out of 100,000?

  5. LarrytheG Avatar
    LarrytheG

    From the beginning , nursing homes and the govt role has been between the devil and the deep blue sea when nursing homes are supposed to be private sector but if they fail – the govt is supposed to step in and rescue them and if they do it too late, then it’s a govt failure.

    That looks like the worst of all worlds!

    We don’t have a normal government supply chain for PPE for nursing homes, but now that we have a pandemic, the government is supposed to not only have one but have it fully up and functional as soon as nursing homes no longer can get PPE from the private sector market.

    The premise has been all along that the government is terrible at stuff the private sector should be doing – until of course, the private sector “fails” then it’s a government “fail”.

    1. Steve Haner Avatar
      Steve Haner

      Well, this is a “private” industry that is so bound up with Medicare, Medicaid, SSI and perhaps some Veteran’s programs, plus is so heavily regulated by state and fed, that the line is hard to find if it exists at all.

      1. LarrytheG Avatar
        LarrytheG

        tis true, but it’s also true that a lot of doctors and hospitals also are reliant on Medicare and Medicaid and yet they do not seem to have the same level of problem.

        Or perhaps they had a similar problem with elective surgery and that’s why they stopped going them…

        It still looks like it’s the private sector responsibility until the markets “fail” then it’s the govt fault.

  6. VDOTyranny Avatar
    VDOTyranny

    Virginia Health Commissioner says he’ll mandate a COVID-19 vaccine:
    https://www.wric.com/health-2/virginia-commissioner-of-health-plans-to-mandate-coronavirus-vaccinations-once-available-to-public

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Excellent and telling reporting, Carol.

  7. Peter Galuszka Avatar
    Peter Galuszka

    Badly needs a good editor

    1. Nancy_Naive Avatar
      Nancy_Naive

      Who’s Badly? Did you mean Bader? Then, I agree.

  8. Nancy_Naive Avatar
    Nancy_Naive

    “As of August 21, 14.6% of all LTCF (long-term care facility) cases (1,321 of 9,020) have ended in death, and represent 54.1% of all COVID-19 deaths in Virginia. By comparison, correctional facilities have seen a total of 16 deaths. Our nursing home residents do not deserve a death penalty for being in a nursing home without adequate supplies or staff.”

    Apples and oranges. See my post above.

    1. cjbova Avatar
      cjbova

      NN, it’s not a statistics seminar… it’s an illustration using two captive populations under state supervision, not the general population. There’s not much available to give these insane numbers some human scale. If you have better ideas on how to present it, then do the work and write it up yourself.

      1. Nancy_Naive Avatar
        Nancy_Naive

        It wasn’t. But a bad illustration is not helpful.

        Write it up myself? Yikes, no. It would be much easier for me to help you with your statistics and illustrations than it would be for me to do both. I’ve been told that I use strange sentence structures that does not make for a pleasurable read. I keep telling myself, “Hemmingway, not Buckley!”, but alas, that only makes me thirsty for a rum dumb.

        Seriously, the populations can be compared, if you normalize the two with respect to race, age, preexisting conditions, etc. For example, even just comparing by age, according to my link above (2012) versus your estimates of the prison population (7,000 out of 29,000) has nearly 1 in 3 Virginians is over 50 while only 1 in 4 priosoners are. This alone would suggest that, based on age only, prisoners are less susceptible to COV2 than the average, uh, er, freeman?

  9. cjbova Avatar
    cjbova

    Interesting note of the day: For the first time in almost a month, VHHA shows no shortages on their “COVID-19 in Virginia Licensed Nursing Homes Dashboard.” On August 9, where CMS had 20 facilities reporting no N95 masks and 13 without surgical masks, VHHA listed 3 facilities reporting difficulties obtaining N95 masks.and none for surgical.

    https://www.vhha.com/communications/virginia-licensed-nursing-facility-covid-19-dashboard/

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