Nursing homes across the nation have been severely impacted by COVID-19, with outbreaks causing high rates of infection, morbidity and mortality. Collinsville Healthcare and Rehab has had five confirmed cases of COVID-19, none of them residents, according to facility administrator, James Coker.

Four of the five, all employees, have completed the 14-day quarantine and been cleared to return to work while the fifth is still finishing the isolation period. All five were asymptomatic and are doing well, said Coker, noting that younger people appear less affected by the coronavirus.

The facility at 685 North Valley Avenue in Collinsville has 200 certified beds and averages 178 residents per day, according to Nursing Home Compare on medicare.gov. They employ about 250 people in three shifts. Coker said employees are screened at the start and end of each shift with temperature and vitals checked and a questionnaire completed to ask where they have been and who they’ve been around while not at work. Residents are screened for symptoms a minimum of three times daily, and the nursing home requires a three-day period before a new resident can arrive from a hospital or other care facility.

Collinsville Healthcare and Rehab was actually about two weeks ahead of the curve. Their Facebook page shows a March 12 post stating that “ensuring residents are cared for in a safe and healthy environment is our first priority… We need your help in battling COVID-19. At this time, we request that family and friends do not visit.”

Coker said he completed due diligence and reported the coronavirus cases, as required, to the Alabama Department of Public Health (ADPH) and Centers for Disease Control and Prevention (CDC).

“Every resident and their number one sponsor was notified,” he said. “Everyone has done a super job complying.”

Elsewhere in DeKalb county, Crowne Health Care of Fort Payne at 403 13th Street NW in Fort Payne has 123 certified beds and averages 109 residents per day, according to the Nursing Home Compare website.

Crowne Administrator Jim Turnipseed said he remains “cautiously optimistic” that there will continue to be no cases of the coronavirus. He said, “At this point, we have had no cases among employees or residents. All employees are screened, including temperature, at the beginning and end of each shift. [I am] very impressed with the response and cooperation of our staff and families.”

Crowne enacted a policy of “absolutely no visitation allowed except for immediate family in end-of-life situations” prior to the CDC issuing similar guidance to curtail nursing home visitation.

There are also reportedly no cases at Crossville Health and Rehabilitation at 8922 Highway 227 in Crossville. The facility has 143 certified beds and averages 137 residents per day, according to Nursing Home Compare. Administrator Heather Blackburn deferred comment to a spokesperson for NHS Management, LLC, who did not respond before deadline Friday morning.

The Crossville facility is one of 35 nursing homes in Alabama owned by NHS Management, whose president and CEO is Norman Estes, past president of the Alabama Nursing Home Association (ANHA).

ANHA is aware of 144 nursing homes across 60 Alabama counties that have reported a COVID-19 positive resident or patient at some point during the pandemic, according to ANHA Communications Director John Matson.

The vulnerable nature of the nursing home population combined with the inherent risks of congregate living in a healthcare setting, requires aggressive efforts to limit exposure and prevent the spread of COVID-19 within nursing homes, according to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma.

Under the CARES Act, states are required to perform on-site surveys of nursing homes with previous COVID-19 outbreaks and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases.

Since April 19, CMS has required nursing homes to inform, residents, their families, and representatives of COVID-19 cases in their facilities. For the first time, nursing homes are required to report coronavirus cases and deaths directly to the CDC on an ongoing basis as the result of an unprecedented CMS regulatory requirement issued on May 1.

The information does not include COVID-19 data from assisted living facilities, which are not regulated at the federal level.

CMS is planning to post the underlying CDC-collected data starting this week on the Nursing Home Compare website, https://www.medicare.gov/nursinghomecompare/search.html, so the public can view general information of how COVID-19 has impacted nursing homes, with data broken down by state, number of residents and number of staff. The data will be searchable by facility name.

Current ANHA President & CEO Brandon Farmer addressed the releasing of statistics on Alabama nursing homes, saying “The public should know that Alabama nursing homes have reported cases to their county health department and the Alabama Department of Public Health since the pandemic began. Facilities began reporting to the [CDC] in early May. In addition, nursing homes inform residents and their family representatives and employees of cases in their buildings. No other health care provider or business reports COVID-19 cases to more government entities and people than nursing homes.”

Governments have loosened restrictions on public activity since late May, and it’s inevitable that nursing homes will re-open sometime. The federal government issued guidance on May 18 for state and local officials considering the reopening of nursing homes, setting criteria for relaxing certain restrictions and mitigating the risk of resurgence.

These include a decline in the number of new cases, hospitalizations, or deaths in a community, an absence of any new nursing home onset of COVID-19 cases among residents or the staff for 28 days and no staffing shortages. Testing capacity is a must, along with access to adequate Personal Protective Equipment (PPE) for staff and the ability of the local hospital to accept transfers from nursing homes.

The guidance states that “residents and visitors wear a cloth face covering or facemask. If a visitor is unable or unwilling to maintain these precautions (such as young children), consider restricting their ability to enter the facility. All visitors should maintain social distancing and perform hand washing or sanitizing upon entry to the facility.”

Family visitation is generally prohibited, except for compassionate care situations. In those limited situations, visitors are screened and additional precautions are taken, including social distancing and use of an alcohol-based hand rub upon entry. All visitors must wear a cloth face covering or face mask for the duration of their visit.

On June 1, CMS announced increased enforcement in the form of civil money penalties for facilities with “persistent infection control violations, and imposing enforcement actions on lower level infection control deficiencies to ensure they are addressed with increased gravity.”

Verma said, “While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”

Farmer, on June 1, issued a statement saying “fines and penalties will not solve the problems posed by COVID-19” and what nursing homes really need is guidance on how to improve their infection control programs and help implement the changes. “Like other health care providers, nursing homes need a sufficient supply of personal protective equipment (PPE). Infection control measures will only be as effective as our ability to secure PPE,” Farmer said in the statement.

He expects the number of cases to rise as more tests are administered and the data is added to the CDC system.

“[ANHA] hopes this data will be used to prioritize resources for skilled nursing facilities. [We] will continue to work with local, state and federal leaders to address the needs of nursing home residents and employees,” added Farmer.

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