As coronavirus cases surge across the state, local assisted living facilities and nursing homes are bracing for what could be a long and isolated winter.
With more than 800 new positive COVID-19 tests reported on Tuesday, just one day after the New Hampshire Department of Health and Human Services announced more than 1,000 new cases on Monday for the first time since the pandemic began, the safety of those in regional facilities is the issue that keeps those in charge awake at night.
Locally, there have no outbreaks like those currently taking place at the New Hampshire Veterans Home in Tilton, where 28 people have died due to COVID-19 as of press time Wednesday, and like others previously reported at Greenbriar in Nashua and Villa Crest Nursing and Retirement Center in Manchester.
There is a light at the end of the tunnel for the residents who call the local facilities home and staff who have spent more than nine months working to provide care in a PPE safe environment, as the state recently announced that long-term care residents and healthcare workers would be part of the first recipients to receive the COVID-19 vaccine.
At Friendship Manor in New Ipswich, administrator Gary Cahoon said that to date there have been no positive tests for COVID-19.
“We have been very vigilant, followed all the guidelines,” Cahoon said, who is also on the board for the NH Association of Residential Care Homes.
Friendship Manor is home to 19 residents and up until recently, Cahoon felt very lucky to be in New Ipswich. The numbers had been relatively low and there was very little community spread, but positive cases surged in New Ipswich this November and continued to increase in December, with nine active cases reported on Tuesday and 79 cumulative cases. Cahoon’s seen how quickly things can change.
“I have a number of colleagues in the Manchester, Dover, Portsmouth area and I know they’re good providers, but they’ve had devastating outbreaks,” Cahoon said.
They test employees every 28 days, which Cahoon realizes is “a very long time,” but so far there have been no cases. And now “the demand for testing has increased dramatically,” he said.
Scott-Farrar CEO/Executive Director Lara Shea said there have been no positive cases among the residents and just last month the first staff member, who provided direct care to residents, tested positive. But subsequent testing proved it to be an isolated case, although residents of the Memory Care Neighborhood were quarantined for 11 days.
“We feel our policies and procedures, everything we put into place is what kept us safe,” Shea said.
Since the summer, Shea said they have conducted monthly testing.
Dr. Richard Feifer, Chief Medical Officer of Pheasant Wood Center in Peterborough, said currently that Pheasant Wood Center does not have any positive COVID-19 patients, residents or staff. He said the center did have two cases earlier in the year and two positive staff members in November, but nothing since.
Feifer added they are testing staff every three to seven days due to the prevalence of the virus in the surrounding community.
Shea said the potential for a vaccine being available before the end of the year is a relief, but realizes there are a lot of unknowns that come along with it.
“It’s our first step out of this pandemic, but it’s not the only step,” Shea said.
She said there are still a lot of questions and a more to do in terms of education. Shea added there is no mandate to get the vaccine as of now, calling “it a real collective decision making process.”
Feifer said they were pleased to learn that the Centers for Disease Control Advisory Committee on Immunization Practices voted to include long-term care residents at the highest level of priority for the first distributions of a COVID-19 vaccine.
“Nursing home residents have been the most vulnerable to this virus and priority access to the vaccine is the absolute right decision,” Feifer said.
What comes next, Feifer said, is focusing on the operational challenges of getting the vaccine to nursing homes.
“For example, it is likely that doses in the initial batches of vaccine will not be enough to vaccinate everyone in Tier 1A, so it will be up to each state to decide how to allocate its limited supply of the vaccine,” Feifer said. “We strongly encourage the Governor to prioritize nursing home residents and employees as the first to receive the vaccine in order to stop the spread and harmful effect of the virus in long-term care settings.”
Cahoon is relieved about the upcoming vaccine option and has heard it will be available before the end of the year.
“They said, yes the vaccines are coming and they will be here within the matter of a couple of weeks,” he said.
But he knows it’s not the end all be all.
“I’m not sure how quickly it will be a game-changer,” Cahoon said. “It’s the light at the end of the tunnel, but you realize there’s a ways to go in the tunnel.”
Shea said that outdoor visits at Scott-Farrar went well through mid-September and they had allowed monitored indoor visits, but those ended Sunday after administrators decided the rising number of cases and positivity rate warranted taking a step back.
“We decided it was time,” Shea said, adding that they gave enough warning to allow for each person the chance to schedule a visit. “Obviously it doesn’t bring any of us joy to implement the restriction, but it’s in the best interest of everybody.”
Cahoon said residents of Friendship Manor had indoor and outdoor visits once they were allowed to resume them in June per state guidelines, but now that the test positivity rate in Hillsborough County approaches 10 percent, those will no longer be an option.
“It is beginning to make a noticeable difference and you can see it in our residents. They’re really sick of it,” he said.
Cahoon said they used to do a lot of outings, but they haven’t been able to hold those either.
Feifer said that Pheasant Wood has only been offering compassionate care visits over the last two weeks, but as of Monday was reopening to visitation this week assuming there are no new cases.
“Every week, centers receive an update on how their local communities have done containing the virus during the past week. When rates of local community transmission are higher, centers are more restrictive with precautions. When community transmission is lower, centers continue good practices of infection control – social distancing, mask wearing and frequent hand washing – but may be able to flex their precautions (subject to state and local rules and regulations) in areas that are extremely important to our residents and their families, including visitation,” Feifer said.
Cahoon said that Friendship Manor ranges on a weekly basis between 12 to 16 on the payroll, and he’d like that number to be more steady at 19 employees. The problem has been finding people to fill vacant spots, like aides and an activities director.
“One way we’re meeting our shortage is coercing my grandchildren to work as dietary aides but they’re not permanent solutions,” Cahoon said. “It has worried me for years, but certainly over the last few years, its been a crisis or near a crisis.”
While Cahoon said they have had luck retaining the people in house, thanks to what he equates to a $2 per hour bonus, bringing new people in has proven difficult.
“Part of it is that people are worried about COVID and don’t want to work in long-term care,” he said.
He understands that it is difficult work and people don’t get paid enough to deal with the physical and emotional exhaustion that comes with it.
“Much of the world values this work more than we do,” Cahoon said. “It’s valued as a minimum wage position and it should not be.”
Shea said the majority of the staff have been at Scott-Farrar for two years or more, over half the time since it reopened in 2016, and they haven’t felt the crunch of being understaffed.
“We actually have not seen challenges for employees through the duration of the pandemic,” Shea said. “But I think that’s been a real concern for healthcare around the state and the country.”
She credits her employees for helping to navigate through this uncertain time.
“This has been an incredibly hard time in and out of work,” Shea said.
For Pheasant Wood, Feifer said, staffing continues to be ongoing problem.
“Even before the pandemic, staffing shortages have been an issue in New Hampshire,” Feifer said. “With that said, we are affiliated with a large national organization so we have been able to pull in resources from other centers and through our own staffing agency as needed.”
Cahoon said there isn’t a shortage of people who will need long-term care in the coming years. It’s no secret that New Hampshire has an aging population, and “the numbers are going to basically double,” Cahoon said. “The demographics are truly scary.”
He said they have brought in a couple new people since the pandemic began, but it’s difficult to have space for quarantining in an older facility like Friendship Manor. Currently they have two open spots.
“It’s if we can make a room available for someone to quarantine in,” Cahoon said.
Shea said Scott-Farrar’s policy is that they can take on residents as long as there isn’t an active case. Those who do move in must quarantine, which Shea said “is not a welcoming way to move in.” She said for those where there’s a need, they will still continue to do so, while others who have a choice are likely waiting.
It’s hard to tell what the winter will bring, but even with the vaccine becoming available, local facilities will continue to institute the safest practices to avoid the onset of any coronavirus outbreaks.