By Matt Hamilton, Alex Wigglesworth, John Myers, Melanie Mason, Los Angeles Times, APRIL 24, 2020
For weeks, public health officials have struggled to slow the deadly spread of coronavirus through nursing homes.
At one facility in Tulare County, 15 have now died. The death toll has reached 18 at a Yucaipa nursing home, 14 at a Pasadena facility and 17 at a convalescent hospital in Bell. And nursing homes account for an increasing share of deaths in Los Angeles County: more than 40% of the 851 who have died countywide.
On Friday, state and local officials announced new measures aimed at tackling the surging fatality rate through more aggressive regulations and help from the California National Guard, which will go into nursing homes to boost staffing levels.
Dr. Barbara Ferrer, the county’s public health director, touted an order that expands testing to both symptomatic and asymptomatic staff and residents, bans visitors, suspends communal dining, and requires staff and residents alike to wear protective equipment. The moves are designed to get a better sense of how many people inside the homes have contracted the novel coronavirus and to limit access to outsiders who could either bring in the virus or acquire it themselves.
The deployment of California National Guard teams is aimed at bolstering staff, as more and more healthcare workers become infected, are scared to come to work, or are sidelined by self-isolation.
So far, the National Guard had only been dispatched to five nursing homes in L.A. County with plans to deploy to four more, but it was a potent symbol of how unprecedented the pandemic has become for long-term care institutions, and the depth of the challenges they face.
“As we’ve identified staff that are sick or staff that are positive with COVID-19, they need to stay out of the workplace for an extended period of time, and in places where there are outbreaks, that can mean there are dozens of employees that are appropriately not coming to work,” said Ferrer, whose office requested the help.
The actions underscore how much nursing facilities have become the epicenter of the coronavirus crisis in California and across the nation.
“In terms of the vulnerable populations, the first priority has to be the skilled nursing facilities,” said Dr. Christina Ghaly, health services director for L.A. County. “That’s where the majority of the outbreaks have occurred.”
Molly Davies, who runs L.A. County’s ombudsman program, which investigates concerns in long-term care, said she had received complaints about lack of staffing but also heard directly from facilities about their needs.
“We have general staffing shortages. Some who are sick and need to quarantine. Some who are scared to come in,” Davies said. “It’s nice to have this other option.”
The announcement of the National Guard conjured images of a convoy of armed soldiers descending on homes for the elderly and infirm. Advocates said there was no indication that the National Guard was imposing its presence in facilities; the military force’s aid was accepted on a voluntary basis.
Lt. Col. Jonathan Shiroma, public affairs director for the state National Guard, said typically teams of eight people, including five medics, a nurse and an administrative sergeant, arrive to help with basic nursing needs.
“They’ll augment the current staff at the respective skilled nursing facility,” said Shiroma, adding that the teams will remain onsite as long as they are needed.
The teams started assisting nursing homes earlier this week. The sites include Pasadena Meadows Nursing Center in Pasadena, where 18 residents have tested positive for the coronavirus and one person died, as well as the Motion Picture and Television Country House in Woodland Hills, where five residents have died and nine staff and 17 residents tested positive, according to county data.
The criteria for deployment remained unclear. For example, Eastland Subacute and Rehabilitation Center, a 139-bed facility in El Monte, received National Guard help. However, Liz Tyler, a spokeswoman for the facility, said no residents or staff had tested positive for COVID-19. Tyler contended there was no shortage of staff, the minimum staffing requirements were met, and she said Eastland’s actual staff was not being diverted to other facilities with pressing needs.
“The National Guard is helpful and extra hands are always appreciated,” said Tyler. “But this wasn’t a crisis spot.”
Neither the state nor county health departments responded to questions about why Eastland received National Guard assistance.
Maj. Chris Scott, medical operations director for the California National Guard’s skilled nursing teams, said his teams were still assessing each facility and working with the leadership and directors at each site to develop accurate information and data.
“There could be tests that are coming back today and tomorrow, and those things are in flux right now,” Scott said.
Gov. Gavin Newsom said Friday that the National Guard was deployed “to help support the efforts to isolate, conduct tests and to make sure that we’re sharing best practices and protocols within the system, particularly for those sites that we identify as more acute, in need.”
Newsom said sites were identified through the state’s admittedly “old-fashioned” method of data collection: “daily check-in calls” to California’s 1,224 skilled nursing facilities.
The governor focused on the statewide effort to reinforce homes, including hiring 600 nurses and contracting temporary staffing agencies to handle case surges.
In Los Angeles County, the number of coronavirus cases in nursing homes and other institutional settings soared to 3,847 residents and 1,492 staff at 293 facilities, said Ferrer, the health director. The rise coincides with an increase in testing in those facilities, leading to infections identified among asymptomatic people.
Ferrer said that the number of asymptomatic cases among staff and residents was a wake-up call. In an order issued Friday, nursing homes and assisted living centers will have expanded testing of residents and staff, but the frequency would be determined for each facility by working with the county health department.
“It’s become really clear that asymptomatic people are in fact, both infected with the virus and capable of shedding the virus, and that means they’re capable of infecting others,” Ferrer said. “So in places where we have a lot of vulnerable people who reside — and that’s our nursing homes, all of our long-term care facilities — it’s really important to acknowledge … this new reality.”
The new health order also required congregate living facilities, including nursing homes, to limit entry to employees only. Staff will be required to wear surgical masks and personal protective equipment, and residents will also be required to wear surgical masks or a cloth face covering.
A few hours after Ferrer’s order, Los Angeles Mayor Eric Garcetti announced “a companion emergency order” that will require the mandatory offering of monthly COVID-19 tests for residents, employees and contractors at the city’s 80 skilled nursing facilities.
Garcetti said he could mandate facilities to offer tests, but had no authority to actually force residents or workers to be tested.
Times staff writers Andrew Campa and Richard Winton contributed to this report.