By Lauren J. Mapp, Jeff McDonald, San Diego Tribune, May 2 2020
Inconsistent reporting makes finding safe quarters difficult for families, advocates say.
At least 310 healthcare workers and residents of senior-living homes in San Diego County tested positive for the virus that causes COVID-19, according to state data released Friday.
That number could be as high as 400, the state reported, because regulators allow facilities with 10 cases or less to report them as “fewer than 11,” instead of the actual number.
Almost nobody believes that the state reported totals reflect the actual caseload of COVID-19 victims in long-term care facilities, where senior citizens have been among the most vulnerable targets of the virus behind the worldwide pandemic.
The statistics are self-reported, meaning no state official has confirmed the data. And there has been no systematic testing of workers and residents.
In San Diego County the numbers for senior living are lumped in with other facility totals. The county this week reported 664 cases of COVID-19 and 57 deaths in “congregate living” facilities, which includes sober-living homes, homeless shelters and jails, among other settings.
The inconsistent reporting at state and local levels has left many consumers in the dark when it comes to finding a safe place for their aging loved ones, who move in and out of licensed senior homes as they receive different levels of care.
“Families are making placements, and if there’s not going to be transparency then they are flying blind,” said Chris Murphy of Consumer Advocates for RCFE Reform, a San Diego nonprofit that monitors state-licensed residential care facilities for the elderly, or RCFEs.
“This is not a scarlet letter,” Murphy said about virus test results. “This is about public safety. In the absence of public information, it’s not clear how the public can respond in an informed way.”
State officials say they are doing the best they can to keep the public informed about COVID-19 infections. But at the same time, they acknowledge making concessions in the way they monitor more than 14,000 adult and senior care facilities.
“Under normal circumstances, the department conducts in-person visits to facilities in response to every complaint,” Department of Social Services spokesman Jason Montiel said by email. “Due to the COVID-19 emergency, in order to reduce potential exposure for facility residents and staff, most complaint investigations are currently initiated through a tele-visit.”
Through late April, regulators received more than 160 complaints related to COVID-19 at state-licensed residential care facilities for the elderly, including 19 in San Diego County, officials said.
No citations have been issued.
Skilled nursing facilities and assisted living homes have recorded some of the highest concentrations of COVID-19 infections —and deaths — across the country, along with hospitals, meatpacking plants, jails and prisons.
In San Diego County, only 14 of 86 skilled nursing homes reported any infections among staff and residents. Five did not provide any information to the California Department of Public Health.
Out of 591 local residential care facilities for the elderly, only four reported COVID-19 infections.
The vast majority of assisted living homes don’t have to disclose cases to the state because they each have fewer than six beds. Facilities with six beds or less account for about 80 percent of state-licensed assisted living homes.
Limited testing also has clouded the actual number of positive COVID-19 infections. Barely 2 percent of the nation has been tested for the virus.
San Diego County public health officials announced this week that hospital patients, healthcare workers with symptoms and “close contacts” of people in higher-risk settings like long-term care homes will be the top priority as testing for the virus increases.
Even so, results are mere snapshots; someone who tests negative for the virus could be exposed a day or a week later. And researchers already concluded that asymptomatic people have infected thousands of people.
Michael Dark, a staff attorney for the California Advocates for Nursing Home Reform, a nonprofit, said the infection rate is certainly higher than the data reported by state and county officials.
“It’s much worse than anyone realizes,” he said. “The problem is the number of patients that are infected and the number of deaths are self-reported by the facilities that are also businesses that have to be worried about publicity that’s going to drive down profits.”
The confusion over COVID-19 case reporting is happening while a group of organizations representing hospitals, skilled nursing facilities and assisted living homes in California is seeking protection from disciplinary actions — and lawsuits.
In a letter to Gov. Gavin Newsom, they requested immunity for facilities and staff from administrative sanctions, criminal or civil liability, or claims for injuries or deaths allegedly connected to providing or arranging services.
They also want state statutes and regulations to be waived even as they make life-or-death decisions.
“Effectively minimizing death and serious illness among the population as a whole entails distributing finite resources to those who have the greatest opportunity to benefit, thereby maximizing appropriate care for the greatest number of patients likely to benefit from these resources,” the letter states.
The push for blanket immunity is the latest effort in the history of senior care facilities trying to operate below staffing requirements, said Philip Lindsley, a founding attorney at the San Diego Elder Law Center.
“This has been a problem that has been stewing for years,” he said. “You can talk to any nurse anywhere in a skilled nursing facility and ask, ‘Are there enough nurses and (certified nursing assistants) on ward to adequately take care of everybody?’
“You will look long and hard to find somebody that will say that they are adequately staffed,” he added.
Families that Lindsley works with often visit their loved ones and provide their own basic care to fill in the gaps inadequate staffing has created. With families banned from visiting senior care facilities, his clients have expressed worry to him about how their loved ones are doing.
“I’d call it the ‘dirty little secret,’ but it’s certainly not much of a secret among healthcare providers and advocates,” Lindsley said. “COVID-19 is a perfect storm for them in that it has laid this bare.”
This is especially problematic for elderly patients who have trouble eating, said Dr. Aram Harijan, who provides wound care at 25 facilities in the county through AAA Surgical Care.
Basic aid that family members provide during visits can include help with feeding, he said. This ensures their loved ones have sufficient time to eat and improves the likelihood that they consume a healthy amount of food.
“When the patient’s family is allowed in they do better,” Harijan said. “Stroke patients and patients with dementia in particular do better with their families there feeding them.”
Harijan has seen some patients lose 20 pounds or more in recent weeks while care facilities have been closed to family members. In one such case, the resident died.
He worries that the measures taken to protect residents may be causing more harm.
“I think because they’re trying to mitigate the potential risk of COVID-19 coming into the nursing home, we’re protecting against potential risk for actual harm,” he said.
Nonetheless, trade groups like the California Association of Health Facilities said granting skilled nursing homes broad legal immunity is critical, because they are on the front lines of the COVID-19 fight and a crush of litigation is widely expected.
“The proposed liability protection is not absolute, “ association spokeswoman Deborah Pacyna said in a statement. “Facilities are still exposed to liability resulting from willful conduct during the emergency.”
She said governors in a host of other states — including New York, New Jersey, Illinois, Michigan, and Hawaii — have granted similar protections.
Despite the lack of more specific COVID-19 infection data in long-term care homes across the state, several facilities in San Diego County have reported serious clusters.
State records show 42 residents of the Country Hills Post Acute skilled nursing facility in El Cajon tested positive for the virus. The facility also reported fewer than 11 staff members tested positive.
It is not clear if any of those residents or healthcare workers died as a result of their illnesses because San Diego County does not disclose the identity or other details of COVID-19 victims.
A Sacramento public relations firm retained by Country Hills said the number of positive cases inside the facility was actually 45 and that company leaders are working to contain the outbreak as effectively as possible.
“We take our infection control protocols very seriously, and we are in communication with local and state health authorities about the positive tests we have had,” Daniel Kramer of KPS Strategies said by email. “We want to limit the spread to the greatest extent possible.”
The Victoria Post Acute Care senior home, also in El Cajon, disclosed 26 residents acquired the virus, along with 15 employees, an increase from 22 clients and 13 healthcare workers reported earlier this week.
Officials from the skilled nursing facility did not respond to requests for comment. The most recent COVID-19 update posted on the company’s website is dated March 22.
At the Elmcroft of La Mesa assisted living home, 34 residents and 12 employees tested positive for the virus.
A company official said the staff is in regular contact with all residents and their relatives about efforts to control the virus and works directly with physicians who treat clients.
“Whenever there is an update, Elmcroft of La Mesa communicates in (a) timely manner within 24 hours, and sends an informational email like the one attached on a daily basis, for at least five days a week,” executive director Wes Hebner said in a statement.
“Elmcroft of La Mesa always coordinates all medical care with primary care physicians, and immediately notifies all PCPs when there is a new case,” he wrote.
Several other San Diego-area homes with notable COVID-19 clusters among their staff and residents did not immediately respond to questions about how they are confronting the ongoing threat posed by the virus.