Of the many industries that COVID-19 gripped, few were more devastated than long-term care. Shortages of personal protective equipment, understaffing, and inadequate testing availability contributed to rapid spread of the coronavirus in many nursing homes and assisted living facilities.
“The toll on long-term care of both residents and long-term care staff over the past year and a half has been tremendous,” said Amanda Vickstrom, executive director of the Minnesota Elder Justice Center.
Some of that toll is reflected in the COVID-19 dashboard tallies. Much of it is less quantifiable — the long days in hot PPE, the anguish residents felt when they lost a neighbor and friend, the panic from families when they were unable to hold their loved ones.
While nursing home leaders and eldercare advocates say there’s a new sense of hope with rising vaccination rates, it’s undeniable that the past year deeply changed nursing homes and assisted living facilities in Rochester.
By the numbers
Across the nation, more than 650,000 nursing home residents have contracted COVID-19. One in five of them died. In Minnesota, there have been more than 22,000 cases in congregate care settings, with the death toll topping 4,400.
Of the 24 local long-term care facilities for which The Post Bulletin reviewed data, 15 had one or more resident deaths. In total, the most recent Minnesota Department of Health data shows that of about 300 resident COVID-19 cases in Rochester, one in six were fatal.
While vaccinations for staff in long-term care have fallen behind the goals set by public health officials, cases connected to these facilities continue to dwindle.
From April 15 to May 13, there were 287 new cases among residents and 60 resident deaths statewide. This toll, although devastating when examined alone, is a far cry from the winter, when monthly case counts would regularly run into the thousands.
Mary Jo George, associate state director of advocacy for AARP Minnesota, said some of the devastating effects of the pandemic could have been mitigated with a better federal response and improved infection control procedures in individual facilities. A Post Bulletin analysis of federal inspections from area nursing homes showed that almost all facilities received one or two stars out of a possible five stars for their health inspections.
“I think the crisis just revealed some of these problems. Sadly, it made me feel that maybe we don't care about older people as much in this country as we really need to,” George said.
Multiple academic studies and news reports have determined there were several factors that influenced whether a nursing home would experience an outbreak: infection rates in the community, testing availability, race of the residents, and prevalence of asymptomatic spread. Health inspection ratings made little difference when considering case and death counts, one analysis found.
Patti Cullen, president of Care Providers of Minnesota, often asks herself if there’s anything long-term care facilities could have done differently to prevent rising cases and death tolls. When she considers these factors, along with the other elements largely out of facilities’ control — such as lacking PPE — she comes to her answer: “I don’t think so.”
The residents who survived the past year are haunted by the deaths of their neighbors and friends.
Marie Maher, a resident at Shorewood Senior Campus, was horrified when she learned on the news that some members of her assisted living community died from COVID-19. Now, even as the community's case count dwindles, she's not breathing a sigh of relief.
“People think it’s gone, but it really isn’t gone. We still have to do what we need to do to be careful,” she said.
While COVID-19 dashboards quantify some of the toll this virus took on eldercare facilities, there is damage these weekly tallies can’t capture. It’s been a year of isolation for residents, forced to substitute interactions through windows or computer screens for normal embraces and dinner visits, or give up whatever independence they had pre-pandemic.
“The way that I couldn’t feel independent was scary. Not being able to get the help I need or having the stress that it could be taken away was more scary than COVID itself,” Maher said. She struggled to arrange for grocery deliveries and to get her trash taken out during the pandemic — chores her daughter typically helped with.
Long-term care facilities began limiting visitors in March 2020, following guidance from the CDC and Minnesota Department of Health. During the months when most visits were prohibited, advocacy groups such as the Minnesota Elder Justice Center worked with residents, families and facilities to facilitate more virtual connections.
"Technology cannot replace a hug."
— Amanda Vickstrom, executive director of the Minnesota Elder Justice Center
“Technology cannot replace a hug,” Vickstrom said. Still, providing iPads and teaching residents how to use Zoom was a necessary lifeline.
While the uncertainty about when they could see family again weighed on residents, quickly changing health guidance also created stress for providers.
“Anything that we said in April of 2020 held up for a few weeks only,” Cullen said.
From spring to summer of last year, the long-term care community was constantly adapting to a changing set of circumstances: PPE shortages, testing lags, vacillating guidance on how the virus could be spread.
“I never thought I would say the words asymptomatic transmission as much as I have said them in the last year and a half,” Cullen said.
Staff at facilities such as Samaritan Bethany nursing home stepped up to provide extra support for residents as they were distanced from their families, said Sue Knutson, the facility’s mission leader.
“We often hear from our staff that this is their other family. And the pandemic just really increased that care and dedication to the residents. Because they knew that their real families weren't able to be there all the time,” she said.
After restrictions over vaccinated residents loosened on March 17, many could once again meet face-to-face and embrace their loved ones after a year without those comforting interactions.
As the dust clears from a punishing year, nursing home leaders and advocates are considering what issues may have slipped through the cracks — whether related to resident health or the facility and staff itself — as all eyes have been focused on fighting COVID-19.
“I wonder what we're going to be seeing now,” Vickstrom said. “We had to buckle down and focus so much on this fire that we couldn't deal with the other small smoke in the corner.”
For George and her advocacy colleagues, the past year has only intensified the urgency for goals they had to improve elder care that predated the pandemic. Issues such as improving wages and paid sick leave for staff, investing more money in preventive measures such as PPE supplies and infection control procedures, and increasing surveys by governing bodies are at the top of their priority list.
Another ember pile that may have caught flame over the last year? Worker burnout.
Cullen said she and her colleagues pushed for greater availability of counseling and mental health-related resources for staff members during the past year. She’s worried exemplary staffers will leave because of the strain of working through the pandemic.
“They don't have time to use (mental health resources) because we have a worker shortage," she said. “A lot of them have post-traumatic stress. They just don't know it."