Older Adults
Article

COVID-19 and long-term care facilities, be kind

Community Solutions Team
Transforming data into progress
Additional Contributors
No items found.
April 24, 2020
Read time:
Download Fact Sheets
Register now
Share this resource
Subscribe to our Newsletter
By subscribing you agree to with our Privacy Policy.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Download this as a PDF

As Governor Mike DeWine and Ohio Director of Public Health Dr. Amy Acton regularly remind us at their daily 2 p.m. briefings, the data about COVID-19 cases both in the community and in long-term care facilities is emerging and far from complete. As Dr. Acton is fond of saying, it’s really just the tip of the iceberg. Even so, Ohio began reporting COVID-19 cases originating in long-term care facilities on April 16 in an effort to help residents and their family members gain access to information about the number of infections within their facilities. Data was then removed due to inaccuracies and was reposted on April 22. Families and residents have been seeking this information for weeks, as long-term care facilities with high rates of infection have received the attention of both media and public health departments across the country. In fact, one of the first COVID-19 outbreak clusters in the U.S. occurred in a long-term care facility in the State of Washington.

 One of the first COVID-19 outbreak clusters in the U.S. occurred in a long-term care facility in the State of Washington.

Data recently released by the Ohio Department of Health (ODH) includes the number of COVID-19 cases identified in both staff and residents as of April 21, the date of the report. Not included in the count are residents and staff who have either recovered or passed away prior to this date. Data is categorized by county, facility name and the type of facility. The dashboard reports 781 active cases, with 558 residents and 228 staff currently infected with COVID-19. Because this dataset does not include all cases originating in long-term care facilities, the total number of Ohio cases of COVID-19 originating in residents and staff of long-term care facilities is still unknown. The COVID-19 Dashboard will continue to report the number of cases originating in long-term care facilities, including nursing homes, assisted living and intermediate care facilities. The dashboard will not provide data for cases that originate in independent senior housing, or subsidized senior buildings. (Definitions of the various types of living situations in Ohio for older adults can be found here). ODH has indicated individuals with symptoms “in long-term care/congregate facilities” are considered the second priority in the state’s tiered testing approach, behind individuals with symptoms who are hospitalized or those who are health care workers. There are a number of other types of congregate living within the state besides long-term care facilities that will likely see clusters of cases, as has been described here.

 Even with incomplete data, we can start to consider what the numbers may tell us.

Looking at the data available for cases originating in long-term care facilities, it is clear that distinct clusters of infection have emerged in some Ohio counties. What is less clear is whether the clusters truly represent the full penetration of the virus in a community or are a result of where testing has become available.

 One thing we do know is that clusters exist because of how quickly the virus spreads when people spend time together in close proximity.

While there are many questions that remain unanswered about this virus, one thing we do know is that clusters exist because of how quickly the virus spreads when people spend time together in close proximity. The newly-released data shows some clear indications of clustered infections, with eight facilities having more than 25 identified cases among staff and residents. Of the 91 facilities with identified cases, 68 percent have more than one case. Long-term care facilities are by design places where people are in close proximity as they receive medical care and therapies during their residency. Until guidelines were released mandating they stop, many facilities offered congregate dining and social activities to bring residents together as way to reduce isolation, which may have unknowingly spread the virus. As Dr. Acton mentioned in the April 16 briefing, clusters of COVID-19 do not mean that long-term care facilities are doing something wrong. These are high-risk places, with many people often exposed before the first case is known to exist. She explained that we should not be surprised, it is in fact, the nature of the virus to spread this way.  

As it became increasingly clear, older adults and those with underlying medical conditions are vulnerable populations to this virus and it spreads quickly in institutional settings, the Centers for Disease Control and Prevention (CDC), Center for Medicaid and Medicare Services (CMS) and Ohio Department Aging (ODA) issued guidance for long-term care facilities to protect their residents and staff.  

Long-term care facilities received guidance and checklists from the CDC as early as March 13, providing them with strategies to keep unrecognized COVID-19 cases from entering the facility; identify infections early and take actions to prevent spread; assess the current supply of personal protective equipment (PPE) and initiate measures to optimize supply; and quickly recognize and manage severe illness reduce the spread of infection. The CDC also provided facilities with a letter template to be sent to residents, friends and families to outline steps being taken to protect residents from infection including restriction of visitation, monitoring of staff for symptoms and limiting all activities within the facility.  

In addition to recommending facilities follow CDC guidelines and recommendations, CMS also provided guidance on April 2, that they would begin targeted inspections of long-term care facilities “in areas the virus is likely to strike next.” Regular CMS inspections have been suspended in order to focus on these targeted inspections and to put full attention on infection control. CMS also recommended long-term care facilities use separate staffing teams for COVID-19 positive residents and if possible, designate separate facilities or units within a facility to separate COVID-19 positive residents.  

On April 13, the ODA provided a checklist for Ohio long-term care facilities that included language from an ODH order that suspended visitation to long-term care facilities. The order makes an exception for end-of-life care and allows only for personnel who are necessary for facility operation. Facilities were also ordered to keep a log of all people granted access to the facility. The checklist also includes a number of recommendations to reduce feelings of isolation among residents, to implement screening procedures among staff, to cancel communal gatherings and to increase the frequency of cleaning among other recommendations.  

Another order issued on April 15, outlined stipulations related to notifying those associated with facilities of positive and probable cases of COVID-19, including the following language: “All nursing homes and residential care facilities in the State of Ohio shall notify the residents, the residents’ sponsor and/or the residents’ guardians of positive or probable cases of COVID-19 within the facility. This Order applies to both residents and staff who test positive for COVID-19 or have a probable diagnosis of COVID-19.” On the same day, the number of cases that originated in long-term care facilities was added to the ODH COVID-19 Dashboard, however as noted above, the data was removed due to inconsistencies and reinstated on April 22.  

The state does not recommend removing residents from long term-care facilities, as often the person resides in the facility because they cannot receive the same level of care within a home or community-based setting. Instead the state recommends residents and their families monitor residents’ health closely and ask the facility the following questions:

  • What are you doing currently to protect residents from COVID-19?
  • What precautions do you take when you identify a person who is symptomatic of COVID-19?
  • How are families kept apprised of changes related to your infection control policies?Even with all of the recommendations, guidelines and checklists from the CDC, CMS and ODA fully implemented, it is still true that long-term care facilities, by the very nature of what they provide to those who need a nursing home level of care, are likely to have and increased number of identified cases. With a population of older adults, and those with underlying medical conditions, necessarily in close proximity with others so they can receive needed care, the residents of long-term care facilities are at a higher risk to be infected infection and experience severe symptoms than those in the general population. With this population already at risk of experiencing feelings of social isolation and loneliness, we, as the general public, should take great measure to not isolate them further through stigmatization related to COVID-19. Public health officials have advised that is both safe and necessary to continue provide deliveries and supplies to long-term care facilities.
Download Fact Sheets

Ohio Statewide Data

Download

Wood County

Download

Wyandot County

Download

Williams County

Download

Washington County

Download

Vinton County

Download

Wayne County

Download

Warren County

Download

Van Wert County

Download

Union County

Download

Tuscarawas County

Download

Stark County

Download

Summit County

Download

Trumbull County

Download

Shelby County

Download

Seneca County

Download

Scioto County

Download

Ross County

Download

Sandusky County

Download

Richland County

Download

Putnam County

Download

Huron County

Download

Portage County

Download

Preble County

Download

Pike County

Download

Pickaway County

Download

Perry County

Download

Noble County

Download

Paulding County

Download

Ottawa County

Download

Morrow County

Download

Muskingum County

Download

Morgan County

Download

Montgomery County

Download

Meigs County

Download

Monroe County

Download

Miami County

Download

Mercer County

Download

Marion County

Download

Madison County

Download

Medina County

Download

Mahoning County

Download

Lucas County

Download

Lorain County

Download

Logan County

Download

Licking County

Download

Lawrence County

Download

Lake County

Download

Holmes County

Download

Jackson County

Download

Knox County

Download

Jefferson County

Download

Hocking County

Download

Henry County

Download

Highland County

Download

Harrison County

Download

Hancock County

Download

Hardin County

Download

Greene County

Download

Geauga County

Download

Guernsey County

Download

Hamilton County

Download

Gallia County

Download

Fayette County

Download

Fulton County

Download

Franklin County

Download

Fairfield County

Download

Erie County

Download

Darke County

Download

Defiance County

Download

Coshocton County

Download

Delaware County

Download

Cuyahoga County

Download

Crawford County

Download

Columbiana County

Download

Clinton County

Download

Clermont County

Download

Clark County

Download

Champaign County

Download

Carroll County

Download

Athens County

Download

Ashtabula County

Download

Brown County

Download

Butler County

Download

Belmont County

Download

Auglaize County

Download

Ashland County

Download

Allen County

Download

Adams County

Download

Lake County

Download

Geauga County

Download

Cuyahoga County

Download

All Municipalities Geauga County

Download

All Municipalities Lake County

Download

All Municipalities Cuyahoga County

Download

Thompson

Download

South Russell

Download

Russell

Download

Parkman

Download
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Download report

Subscribe to our newsletter

5 Things you need to know arrives on Mondays with the latest articles, events, and advocacy developments in Ohio

Explore the fact sheets

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique.

No Related Fact Sheets

Explore Topics

Browse articles, research, and testimony.