Nursing homes in Chautauqua County and those owned by the University of Pittsburgh Medical Center have had no positive COVID-19 cases yet.

Other nursing homes and long-term care facilities, particularly in New York state, haven’t been so lucky.

Why is that?

Dr. Donald Nace, UPMC Senior Communities chief medical officer, credits the hospital system’s success in protecting its patients to the same factors local nursing homes credited– fast action in keeping the virus outside of facilities. Anyone entering or living in UPMC nursing homes has been masked since mid-March while UPMC adopted very quickly enhanced health screenings that include taking a visitor’s temperature, a symptom review and direct questioning about potential exposures. Residents are screened several times a day for temperature changes, oxygen levels, vital signs and a screenings for a host of symptoms.

“And we’ve used a lower, more sensitive threshold for temperature screenings,” Nace said. “Our cutoff here is actually 99 degrees, not 99.5 or 100 or higher, which has been used at other locations. Because we know that older adults have a lower temperature threshold, they often don’t have the same fever response as a younger adult.”

Special attention is also paid to high-risk individuals, like dialysis patients, who have to leave UPMC’s senior facilities. New residents are carefully screened both before and after they arrive at a UPMC facility. There is additional testing of seniors at UPMC facilities on-site and regular testing of respiratory and less common COVID-19 symptoms as they become apparent.

“Tragically many long term care residents have not had UPMC’s success at preventing COVID-19 infections,” Nace said. “These residents have been transferred to our hospitals for care. We have seen firsthand how devastating this illness can actually be. We must learn from these deaths — and we are. We know that protecting the elderly is a critically important component of safely reopening society.”

WHAT’S HAPPENING IN NEW YORK

Nationally, more than 16,000 nursing home residents and staff have died, according to a May 1 report by USA Today, or roughly a quarter of the nation’s overall COVID-19 deaths. Through Tuesday, it was estimated that at least 4,813 people have died from COVID-19 in New York’s nursing homes since March 1, including 1,700 previously undisclosed deaths of people believed to have been killed by the coronavirus before their diagnoses could be confirmed.

Exactly how many nursing home residents have died remains uncertain despite the disclosure. The list released by Gov. Andrew Cuomo’s administration did not include nursing home residents who were transferred to hospitals before dying.

With the inclusion of the additional deaths, the state now lists 22 nursing homes as having at least 40 deaths. Most of the facilities are in New York City and on Long Island. Sixty-two nursing homes reported between 20 and 39 deaths.

Back on March 2, when only a handful of coronavirus cases had been reported in New York, Cuomo promised to make a “special effort” for nursing homes and congregate homes housing senior citizens. Several days later, on March 6, the state directed nursing homes to screen visitors and consider modifying visiting hours. A week after that, officials suspended visits to nursing homes statewide and required temperature checks of staff.

In late March, New York prevented nursing homes from refusing to admit or re-admit confirmed or suspected COVID-19 patients. But officials clarified on April 7 that nursing homes cannot accept symptomatic patients if they do not have needed staff. New Jersey and Michigan issued similar orders, and federal guidance says nursing homes that follow infection protocol can accept COVID-19 residents.

Regulations unveiled April 23 require nursing home staff to have appropriate personal protective equipment and temperature checks before entering a facility, isolation of COVID-19 residents in quarantine, separate staff for COVID-19 patients who would not deal with non-COVID-19 patients, notification within 24 hours of residents and family members if a resident tests positive for COVID-19 or suffers a COVID-19-related death and readmission of COVID-19-positive patients only if a nursing home has the ability to provide an adequate level of care under state Health Department and CDC guidelines.

In late April, Cuomo directed the state Health Department and Letitia James, state attorney general, to investigate nursing homes for compliance with state and federal directives on COVID-19 separation policies, staffing and personal protective equipment. Facilities could be fined $10,000 per violation or risk losing their operating license. A coalition of nursing homes has sent a letter to state health officials asking for guidance regarding testing protocols, resident transfers and staffing issues.

UPMC’S APPROACH

Compare those questions with UPMC’s approach, which Nace spelled out on recently. UPMC is doing some similar things when compared to the state’s requirements, but UPMC has a very stringent policy allowed by Pennsylvania officials when it comes to admitting COVID-19 patients to a UPMC-owned senior care facility.

“We are capable of accepting patients with COVID-19 but each referral for a person with COVID-19 is carefully reviewed and evaluated,” Nace said. “We want to ensure that the appropriate precautions and safety have been put into place. We are looking to make sure if a person has had COVID-19, do we have an appropriate bed availability for that person? Do we have appropriate protective equipment available to care for that person? Do we have the adequate staffing capability necessary to take care of that individual? We’re also looking to see if that individual has tested negative for COVID-19 on two separate days. So that individual who has had COVID, they’re recovering, their symptoms have to be resolved, their fever has to be resolved, but we also want to make sure when we test them we’re not actually finding active virus. In those circumstances that gives us a good indication that we could accept that person safely within our environment.”

It wasn’t until Sunday that Cuomo said New York hospitals cannot discharge a patient to a nursing home unless the patient tests negative for COVID-19 while making clear there are alternative facilities available for nursing home patients — but using them could come at a price. Nursing homes have to call the state Health Department before turning away a COVID-19 patient and the Health Department will investigate and find alternate placement. There is a chance nursing homes found not following the state’s procedures could lose their license to operate in New York State.

“If a nursing home operator does not follow these procedures, they will lose their license,” Cuomo reiterated Sunday. “Well, that’s harsh. No. Harsh is having a nursing home resident who doesn’t get the appropriate care. That’s what’s harsh — having someone’s parent or mother or brother in a situation where they’re in a facility, they can’t even get a visitor, they’re isolated, they feel alone, and they’re not getting the appropriate care. That’s what is harsh. If that’s what happens, then that facility operator should lose their license. I have no problem with that. I was the attorney general. I did investigations of nursing homes. I have tremendous respect for what they do, but this is the essence of their responsibility and obligation. Again, we have the facilities. We have the beds. It’s not like a situation where there are no options. We have options and we want to use them. So if there’s any reason why you can’t provide appropriate care let us know and we will put them in a facility that has it.”