By Ginger Christ and Rachel Dissell
Data analysis and graphics by Cid Standifer
In early March, just as Ohioans were learning about the first cases of novel coronavirus in the state, Anna Bondar’s grandfather fell at his Cleveland home.
Luckily, the 92-year old, who lives with dementia, wasn’t injured badly.
The tight-knit family started to discuss the possibility of a nursing home, though they had serious reservations.
Their tough choice was made even more difficult by mounting fears about the coronavirus. In nearly four months, COVID-19 has infected more than 31,191 people statewide and has proven particularly deadly for residents of long-term care facilities in Ohio.
Seventy percent of the reported deaths in Ohio due to COVID-19 complications have been in long-term care facilities, which is among the highest in the country.
Nationally, the portion of COVID-19-related deaths in long-term care facilities has hovered just over 40%, though the amount of testing done in nursing homes varies significantly by state.
Every day, families like Bondar’s are making what can feel like an impossible choice– whether to send a loved one to a nursing home where they will receive around-the-clock specialized care, but face a greater risk of contracting COVID-19; or to care for that person at home where risk of transmission is lower but providing care can be more challenging.
Even before the pandemic, sorting through the myriad of quality ratings and measures was daunting enough. Then, COVID-19 deaths started to soar.
Now, families and seniors agonize over what could be a life or death choice, using confusing numbers on infection “hotspots,” and without the ability to visit nursing homes to observe how the staff there cares for residents– which is the number one recommendation of most advocates.
State officials, including Dr. Amy Acton, director of the Department of Health, have emphasized that “congregate” settings like nursing homes are at the highest risk for infection. Staff, who often travel between facilities, need to be in close contact with residents to provide care. And residents, who are primarily older and have multiple medical conditions, are more susceptible to COVID-19-related complications.
“All of this makes it high risk. At the same time, it’s really necessary for many patients to be there,” said Dr. Steven Schwartz, a geriatric physician at the Cleveland Clinic who travels to nursing homes as part of the Clinic’s Center for Connected Care.
Ohio National Guardmembers will begin testing all staff members and any residents who likely were exposed to COVID-19 in the state’s nursing homes, Gov. Mike DeWine announced May 27. What are being called Congregate Care Unified Response Teams will focus on facilities where confirmed or assumed positive cases are reported in hopes of reducing the number of COVID-19 cases and deaths in Ohio’s nursing homes, which as of May 27, was 5,324 resident cases and more than 1,442 deaths.
Making an educated decision
Last month, state officials began to release the numbers of reported infections and deaths in long-term care facilities, which include nursing homes, rehabilitation centers, and assisted living centers.
But it’s unclear how much the numbers– which are reported weekly and are also tracked cumulatively– matter for families currently trying to choose a facility.
The state on its coronavirus website says the infection and death numbers shouldn’t replace a thoughtful conversation with a nursing facility about infection control practices and that “residents and family members should understand that the presence of COVID-19 at a facility is [in] no way an indicator of a facility that isn’t following proper procedures.”
Yet many in the health care industry say infection information should be considered along with other factors when deciding which site to choose.
“If you see a nursing home with a large outbreak, that’s something to worry about. If you see a nursing home with a small outbreak, I’m not sure it means anything but bad luck,” said Dr. James Campbell, department chair of geriatric medicine at MetroHealth.
The infection information provided by the state can be useful. For instance, if a family is choosing between two similar facilities, said Nate Cyrill, a long-term care ombudsman for Cuyahoga, Geauga, Lake, Lorain and Medina counties.
Since information on the virus changes rapidly, most families still rely on the quality measures that were available before COVID-19, including existing state and federal online guides Cyril said.
One of the commonly-used ranking systems maintained by the Centers for Medicare and Medicaid Services assigns ratings from 1 to 5 “stars” to facilities based on performance, quality measures, staffing, and inspections.
The number of “stars” Ohio’s nursing homes received, however, does not appear to have a correlation to the number of infections reported to the state, based on a comparison of the publicly available information. The analysis did not include assisted living facilities.
“You want to look for a nursing home that’s 4 of 5 stars preferably, but even that doesn’t tell you the whole story,” Steven Schwartz said.
There are numerous 1-star-rated facilities that have reported few infections, like Whetstone Gardens and Care Center in Columbus, which has reported 9 cases or 8 per 100 residents.
Salem North Healthcare Center in northern Columbiana County had 51 patients test positive for the virus as of May 20, as well as five staff, according to the state. It is rated a 5-star facility, the highest rating from CMS.
It’s one of four 5-star facilities with an infection rate over 50 cases per 100 residents, based on Medicare’s calculation of each facility’s average number of residents. (The rate does not include infections among staff because the number of staff in each facility was not available).
Since April, the focus on high numbers of reported infections (often referred to as clusters) in long-term care facilities has intensified. In some cases those numbers are a reflection of the level of testing, said Fred Stratmann, general counsel and chief compliance officer for CommuniCare Health Services. It doesn’t mean all of the residents with a positive test had symptoms of COVID-19. The state infection numbers also don’t show the residents who have recovered from the virus, he said.