By Jason Pohl, The Sacramento Bee, April 17, 2020
Long-term care facilities and other senior living facilities are struggling across WA state and the nation to contain outbreaks of coronavirus, COVID-19. BY Jennifer King
One in three California counties has confirmed at least one case of COVID-19 inside an assisted-living facility or nursing home, and the bulk of infected residents remain clustered in three metropolitan areas and a single Central Valley county, a Sacramento Bee survey of public health departments found.
Los Angeles, Riverside and Santa Clara counties have suffered the brunt of COVID-19 outbreaks in these long-term care facilities for the elderly, with hundreds of residents sickened and at least two-dozen dead from the disease.
Rural areas are not exempt either. Redwood Springs Healthcare Center in Tulare County is experiencing one of the most severe known outbreaks, with at least 73 infections and 6 deaths.
At least 19 California counties reported cases inside their long-term care facilities, the Bee’s survey shows.
Despite these details, a lack of widespread testing for the disease, incomplete reporting of cases and an outright refusal to share detailed information with the public continues to paralyze a broader effort to understand the spread of the new coronavirus inside facilities that care for California’s most vulnerable residents.
The Bee contacted each of the state’s 58 county health departments this week with a list of questions about long-term care facility infections. The questions included if the county had any facilities with a confirmed COVID-19 case; whether there were any related deaths at those places; and how many suspected cases from long-term care facilities were awaiting test results.
Eight counties did not reply to questions by Thursday afternoon, but some had confirmed that there were cases in long-term care facilities previously.
The answers nevertheless provide the most complete picture to date of how the coronavirus pandemic has spread through elder-care facilities in California. However, some responses were incomplete and vague, so it remains impossible to know exactly how many residents have been infected or died because of COVID-19.
For anyone to feel safe in long-term care facilities, and for public officials to make informed decisions about them, there needs to be a clear understanding of what’s working and what’s not, said David Grabowski, a professor of health care policy at Harvard Medical School.
That relies on the public having confidence in the decision-making process. And that, he said, is dependent on good data.
“If we are going to make the case that we need more nursing home resources, we need to know the extent of the problem,” Grabowski said Thursday. “How do we learn best practices from a public health perspective if we don’t even know which facilities have cases?”
Gov. Gavin Newsom last week said at least 1,266 nursing home residents and staff spread across 191 facilities had tested positive for the disease. At least 370 people living and working in 94 assisted-living facilities had also tested positive.
It was the first — and only — time the state had provided that kind of information.
California remains one of the few states that does not provide data about nursing homes and similar facilities with confirmed cases of COVID-19. Newsom and other state officials will not release the names or locations of the facilities, or even the counties where they’re located.
They’ve instead deferred to county health departments to release that information, although Newsom also said understanding and controlling outbreaks in nursing homes would be among the criteria used to decide how and when to reopen California’s economy.
Dr. Sonia Angell, director of the state’s health department, said this week that there were 6 million older adults in California isolating at home or in “congregate care” settings like nursing homes. “And every one of them deserves the support they need to be able to stay safe in their own home,” she said.
At the same time that California is withholding details from the public, individual counties vary widely in what they’ll share and how they do so, hindering any broader state-wide understanding of how the pandemic is playing out across county lines, health care experts said.
Mike Connors, a spokesman for California Advocates for Nursing Home Reform, on Thursday said he thinks outbreaks are being under-reported statewide. The lack of information, he said, has been “infuriating.”
“Given what we know about how deadly COVID-19 is in nursing homes, it is unconscionable that California public health officials have chosen to keep the public in the dark about facilities that have outbreaks,” Connors said. “This is especially so because families have not been able to visit their loved ones in nursing homes for weeks and are tremendously concerned about their safety.”
INCONSISTENT DATA ON NURSING HOME CASES
Six weeks have passed since Newsom declared a state of emergency over the coronavirus and California recorded its first death attributed to the disease in Placer County. Since then, counties known to be experiencing the most widespread outbreaks have generally shared the most information about long-term care facilities, albeit inconsistently.
Los Angeles County publishes a list of places — including nursing homes, assisted living facilities and even jails — that have reported at least one positive COVID-19 case. It does not say precisely how many people from those places are sick or have died.
Meanwhile, Santa Clara County this week launched an online dashboard that reports the number of cases, hospitalizations and deaths from nursing homes and assisted-living centers. It does not say exactly which facilities they are from.
In the latest chapter of testing woes hobbling any broader understanding about COVID-19’s spread, some public health departments say they’re unaware of how many nursing home residents are even being tested in the first place.
“Due to commercial testing, we don’t know how many have been tested,” said Jason Hoppin, a spokesman in Santa Cruz County where there were no known cases in long-term care facilities.
Other places aren’t nearly so transparent. Sacramento County, which has at least one death tied to an assisted living center — Carlton Senior Living in Elk Grove — refuses to provide information about the number of long-term care sites with confirmed cases, let alone the names of them.
A Kern County spokeswoman cited a 69-page state guidance document from 2016 as a reason to deny answering whether any long-term care facilities in the county had a positive COVID-19 case. She did not cite a specific section of the report.
And in the hard-hit Bay Area, San Mateo County has reported more than 760 cases and 28 deaths. While its online dashboard is revealing, it does not provide information about nursing homes.
When The Bee contacted the county’s health department, spokeswoman Diana Rohini said: “The constraints on the health department mean that we currently don’t have the capacity to answer your questions.” She did not explain what those “constraints” are.
TRACKED, BUT NOT SHARED
In his new briefing last week, Newsom tried to reassure California residents that he’s working on the problem of nursing home infections, even if he did not provide details.
“I just want folks to know that we have short-term strategies, but we also have a longer-term vision that is being prepared and advanced at the same time,” he said of the response to outbreaks in elder-care facilities.
He did not provide specific details about the plan or how positive tests or outbreaks would be communicated to residents, family members or the public.
A spokesman for the Department of Social Services in an email that he would not provide general information about the location of facilities with infections “in order to protect confidentiality.”
A California Department of Public Health spokesperson said they were working to provide information on its data portal, which tracks hospitalization and COVID-19 testing data.
“We are working in real time to provide additional data sets in a manner that is usable for the public, that is appropriately respectful of patient privacy, and that is fully in line with all patient privacy laws,” the department said in an email Thursday.
Neither state department has fulfilled a request for the information under California’s public records law.
Agencies, including health departments, have been using the coronavirus crisis as a pretext to withhold medical data from the public, The Bee reported this week. Experts, however, say laws such as HIPAA don’t apply because there’s no realistic way for the public to glean individual patient information from the release of raw numbers for hundreds, if not thousands, of residents, employees and patients.
‘WE NEED TO KNOW THE EXTENT’
As counties and states slow-walk data about facilities with infections, news organizations are increasingly documenting the crisis independently. Results nationally so far have painted a far more dangerous scenario than government officials have let on.
A USA TODAY review this week found at least 2,300 long-term care facilities in 37 states have reported positive cases. At least 3,000 residents had died. California did not provide information, nor did Florida or Arizona.
And federal authorities this week are facing intense scrutiny to publicly track infections and deaths inside nursing homes. Not doing so, experts say, masks what’s happening and hamstrings response efforts.
Seema Verma, head of the Centers for Medicare & Medicaid Services, which oversees nursing homes, on Wednesday told reporters that CMS was working with the U.S. Centers for Disease Control and Prevention to increase reporting.
“We recognize that there should be more reporting,” Verma said. “We’re going to be enhancing our reporting requirements to get more real time information about where there’s outbreaks across the country.”
She did not provide further details, saying only that additional information would be provided later in the week.Sacramento Bee reporters Alexandra Yoon-Hendricks, Ryan Sabalow and Michael Finch II contributed to this report.