The numbers don’t look good for North Texas’ long-term care facilities, where the coronavirus pandemic has wreaked havoc on elderly residents and staff.
Monday, 19 members of a Plano memory care facility were hospitalized after exhibiting symptoms of COVID-19, according to The Dallas Morning News. Since mid-April, Monticello West, a facility in Dallas, has had 21 coronavirus-related deaths; Mesquite’s Edgewood Rehabilitation and Care Center has seen 14.
As the coronavirus pandemic continues, nursing homes and assisted living facilities statewide are fighting to keep staff and residents safe. Yet from the outset, a lack of resources has made the task seem Sisyphean to some long-term care advocates.
“Funding for long-term care in Texas has been a significant issue for many years,” said Kevin Warren, president and CEO of Texas Health Care Association. “And what you're seeing as a result of the impact of COVID is, it’s only exacerbated those concerns.”
Last week, the Texas Health and Human Services Commission created a multidisciplinary team to help long-term care facilities adjust their preparedness and emergency plans. The new team, called Special Infection Control Assessment, will guide them as needed to adapt policies to reflect best coronavirus practices.
One challenge North Texas facilities may face is how to adopt emergency tornado and active shooter plans to fit social distancing mandates, said Carmen Tilton, vice president of public policy for Texas Assisted Living Association.
People often erroneously assume assisted living facilities and nursing homes are the same, Tilton said. While both accommodate older people who can no longer live alone, nursing homes are for those who require around-the-clock care. By contrast, assisted living facilities house residents who occasionally need help with minor day-to-day tasks.
Nearly half of Texas' 2,000 coronavirus-related deaths have been tied to long-term care facilities, according to the Texas Department of Health and Human Services. Of those, around 86.6% lived in nursing homes.
Those residents likely have a considerable chance of infection because of their greater needs, Warren said.
“These are men and women that require 24-hour assistance in some form or fashion,” he said.
Some nursing homes may have sky-high rates of infection, but assisted living communities have not received as much in aid, Tilton said. The former is federally funded and regulated, but the latter is regulated by their respective states, she added.
That means after the pandemic hit, the federal Coronavirus Aid, Relief and Economic Security Act distributed funds to nursing homes but left out assisted living facilities, Tilton said.
Similarly, Gov. Greg Abbott mandated all nursing home residents be tested for the virus, but the May order didn't include assisted living communities. Tilton also said she had to lobby to get the proper PPE distributed to those facilities.
“It’s still an ongoing challenge,” she said, “but it has significantly improved from even a couple of weeks ago.”
‘It’s emotionally draining’
Nursing home residents are no longer able to mingle as they once did, Warren said. Community dinners and other group activities are largely restricted to limit interaction.
Long-term care facilities already have stringent infection prevention protocols. Even bad flu seasons can be disastrous. However, Warren said that because the coronavirus is more contagious, staff must take greater precautions since many residents are at high risk of infection.
“From the very beginning it’s been stated that this virus is devastating to the elderly,” Warren said. “These individuals are frail and have multiple comorbidities.”
Zoom calls can also be problematic for the elderly, Tilton said. Spotty internet connection will sometimes interrupt a video conference, and many seniors have difficulty communicating because of vision or hearing impairments. Plus, it can be confusing and disturbing for residents with memory issues such as dementia.
In March, Abbott banned nonessential visitation to long-term care providers. That ban placed even more strain on residents and staff, Tilton said. On top of their regular duties, caretakers are now expected to substitute for residents’ families.
“It’s emotionally draining because you’re going from being a care provider to now, in addition, somebody’s best friend and their pseudo-daughter,” Tilton said. “You’re filling in for their family.”
Because some long-term care facilities are seeing substantial infection rates, Tilton said staff retention has greatly suffered. Not only that, but the negative stigma shrouding these facilities demonizes caretakers.
If a staff member gets infected, it’s tough for facilities to fill those positions, Tilton said.
“Nobody’s volunteering to step in to work at an assisted living community or a nursing home right now,” she said. “So it takes a staffing challenge that has always been there and … enhances it.”
Some long-term care workers now live in hotels for fear of spreading the virus to their families at home, Warren added.
Like Tilton, he thinks the ongoing narrative about long-term care facilities unfairly characterizes the people working there. Just as doctors and nurses are being praised, these employees should be lauded for their commitment to the health and safety of others, he said.
“The folks who are working in these facilities day in and day out, and caring for this frail and elderly population, they, too, are heroes within these communities,” Warren said. “They’re putting their own health and safety at risk every day to care for others’ loved ones.”
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