After two years of keeping COVID-19 infections out of its Salisbury nursing facility, Bill Pond, administrator of the Noble Horizons Senior Community, on Friday, Jan. 7, reported the first positive coronavirus case among its residents since the pandemic started.
“It’s more challenging right now than it has been during any other time of the pandemic,” said Pond, who noted that the infected nursing home patient is asymptomatic and showing no signs of illness. “Honestly, it’s not too much of a surprise considering the community spread.”
He said Noble is following all established policies and procedures for reporting and isolating the COVID-positive resident, and he has been in close communication with the state Department of Public Health (DPH), as this is the facility’s first identified case among the nursing home’s resident population.
Nursing homes ‘asked’ to take in COVID patients
Pond’s announcement followed on the heels of a set of directives by the state last week, one from DPH Commissioner Manisha Juthani asking that nursing homes start accepting COVID-positive admissions from hospitals; and a second from Gov. Ned Lamont mandating that all long-term care facility staff receive booster shots by Feb. 11.
The Jan. 6 guidance from DPH and the Jan. 7 order from Lamont came as the state’s case positivity rate soared to a record high of nearly 25%.
“We understand what the problem is, we know that hospitals are filling up with COVID-positive patients and they really need relief,” said Kevin O’Connell, CEO of the Geer Village Senior Community in North Canaan.
“But after what we’ve been through, we are being very, very cautious on who we want to introduce, or cohort, into the building.”
Goal one: safety for residents, staff
Last fall, an outbreak at Geer’s nursing and rehabilitation center sickened 67 residents and 22 staff members. Eight residents died. It took several months to stop the contagion.
O’Connell said his primary obligation is to keep his current residents and staff safe.
“I know the intent is good. They are trying to relieve a bottleneck in the system. But it’s moving the problem from one facility to another.”
He said any referrals of additional, non-resident COVID-19 patients will be considered on a case-by-case basis.
“We will not be denying patients solely because they have not recovered from COVID in the hospital, or those that are not vaccinated, but we have to have the ability to provide care for these individuals.”
Goal 2: properly care for new patients
The overwhelming challenge with accepting COVID-positive patients is having enough staff to man an isolation unit separate from the general patient population, at a time when resources are at a critical point, according to nursing home administrators.
“To have the capacity to do that we may need to deny patients based on our inability to provide care,” said O’Connell. “You have to have the personnel to cover that isolation unit. Just for two or three people you would need staff 24 hours a day, every single day, and that can be really, really challenging in today’s world.”
At Noble Horizons, Pond described his facility’s current staffing situation as “significantly compromised.” As a result, the 91-bed nursing home had paused new admissions “of any kind” over the past six months, he said.
“We have trained our department heads to be temporary CNAs so they can help. We are just not in a position to add any types of admission” to the existing nursing home census, said the Noble administrator.
Pond stressed that while he wants to be able to support the local hospitals, considering the current situation, “It’s not something we can do in good faith and provide proper care, either. It really is a moral dilemma.”
Early in the pandemic, the state had opened several recovery centers specifically to care for COVID-positive patients, including one at the Sharon Health Care Center, part of the Athena Health Care Systems. An Athena spokesman could not be reached for comment this week about whether Sharon will accept new COVID-positive patients.
Sanctions for refusing admissions ‘very vague’
The two-page guidance letter from DPH outlined expectations for “safe and timely transfer of patients to post-acute care after hospital discharge” and updated prior guidance from Nov. 20 on the topic.
It also mandated that any skilled nursing facility unable to care for individuals admitted with COVID-19 infection should report reasons for their inability to do so to the state.
The state has asked hospitals to report any skilled nursing facility that fails to accept new admissions due to COVID-19 infection status.
As for penalties that a nursing home might face from the DPH for refusing an admission, the guidance is unclear on that point, said O’Connell. “Could they sanction you for some reason? They do have the power to apply money penalties, but in this case, I don’t know; it seems very vague.”
