What Would Northam’s Proposal Mean For Virginia’s Nursing Homes?

The governor proposed several budget changes earlier this week.

BRIDGEWATER – When Gov. Ralph Northam proposed 10 amendments to Virginia’s budget on Thursday, Bridgewater Retirement Community didn’t flinch.

Currently, nursing homes and assisted living facilities have priority when it comes to COVID-19 testing. Instead, Northam wants the Virginia Department of Health to determine what gets priority status.

Northam’s proposed amendment “removes priority testing for residents and employees of nursing facilities or assisted living facilities for COVID-19. This will allow [the Virginia Department of Health] to rely on their current process for planning and prioritizing COVID-19 vaccines and treatments that already includes nursing facilities and assisted living facilities.”

Crista Cabe, BRC director of marketing and sales, expressed that the change wouldn’t likely have a noticeable impact on their residents or staff.

“We don’t have a position on this. We have generally not had to rely on the VDH to do testing for us or to source testing supplies. In addition, we – and all nursing homes throughout the state – are working very closely with the VDH during the pandemic,” Cabe said. “Accordingly, they have the information necessary to make sound, well-informed decisions. We’re confident that VDH will continue to prioritize congregate senior settings.”

Taking the reins

For several nursing homes, assisted living facilities and senior living communities, the amendment could’ve caused panic.

The reason it didn’t at BRC is because they’ve taken the reins on the situation for a while now.

“BRC’s [vice president] in charge of the supply line has been on top of things since the beginning,” Cabe said. “For us right now, fortunately, that means that we have ample testing supplies to test residents and team members according to [Centers for Medicare and Medicaid Services] guidelines, to go beyond CMS guidelines to do surveys and individual tests of residents or team members as recommended by our clinical leadership, and to test any resident or team member who presents with symptoms associated with COVID-19.”

Keeping everyone safe

Since the beginning of the pandemic, BRC took necessary precautions.

Some of the extensive protocols BRC put into place since March include requiring masks even before the mandate, regularly sanitizing surfaces, educating team members, residents and families, testing regularly and whenever someone presents minor symptoms and screening team members and visitors daily upon arrival. 

BRC initially suspended guests from coming to the campus, but now allows no-contact visitations for residents in the nursing households, assisted living facility and memory support facility. It’s by appointment only and takes place as a window visit or in a safe setting with plexiglass dividers. 

BRC previously restricted visitation in independent living quarters, but now allows visitors outside and in personal residences. However, visitors cannot go in common areas, dining venues, the fitness center or similar areas where BRC residents interact communally. Areas that lent themselves toward communal living also closed at first, but now adhere to strict protocols for physical distancing and masks. The neighborhood follows the same state guidelines as restaurants, salons and gyms and often goes beyond minimum requirements.

COVID at a minimum

So far, the neighborhood’s precautions paid off well. Currently, one staff member has COVID-19, out of an approximately 420-person team. One independent living resident was in isolation due to potential virus exposure, but tested negative on Friday. That’s out of approximately 550 residents.  

Before any individual who tests positive or had exposure reenters the hustle and bustle of the senior living community, they will go through an extensive health process.

First, the facility isolates COVID-positive residents and keeps COVID-positive team members at home for a recommended quarantine period. Then, they must test negative before moving out of isolation or returning to work. The team also performs contact tracing and isolates or releases from work anyone with exposure. They also follow all recommended personal protective equipment guidelines by CMS, VDH and other available data for team members working with COVID-positive patients or those with exposure.

Limiting exposure 

Like similar congregate care facilities, BRC tests staff and residents on a fairly regular basis. The frequency of testing depends on a couple of COVID-related measures from the surrounding community – not just the senior living neighborhood.

“We follow CMS guidelines for our nursing households, which recommend specific testing schedules based on several criteria including the positivity rate in the local community as well as how recently there has been a positive test result for a resident or team member,” Cabe said. “Currently, that means we are testing all team members working in nursing households once a week. This does not include team members who support residents in other levels of living at BRC, those of us who work in administrative positions and the like.”

In households with COVID-positive residents, the facility immediately steps up pandemic precautions. They test all residents two times per week in that household until they have 100% negative results. That means there are zero new cases for 14 days.

“We have twice offered testing for any independent living residents who chose to be tested,” Cabe said. 

Slashing a stigma 

Over the past several months, congregate setting facilities received an unfortunate nickname: super spreaders. That’s because Virginia long-term care facilities counted for 38 outbreaks since they started reporting numbers seven months ago. A total of 19 outbreaks occurred from Oct. 1 to Thursday. 

Cabe noted that in that time, people learned much more about the virus and how it spreads.

“We all know a lot more about how to prevent infection than we did back in March and April. It’s clear that close exposure, particularly without masks or other PPE, leads to communication of this virus. And we know that duration is also a factor,” Cabe said. “In congregate settings, people spend a lot more time together or in the same areas. The risk is elevated when the set-up is such that it’s difficult to isolate those who may have been exposed, and also when there is not sufficient PPE.”

A working plan

Some facilities struggled more than others, especially at the beginning of the pandemic. Factors included short staffing needs, having insufficient supplies and experiencing widespread community complications with the virus. 

“Not all nursing homes and assisted living facilities are the same. Physical configuration, access to PPE, staffing resources and capacity to do rapid testing – all these things play a role in preventing infection,” Cabe said. “At BRC, we have six separate nursing households with about 20 residents each. By keeping these separate, we avoid risk of infection of the larger group. We also have been able to set up isolation areas so that when someone comes back from the hospital – or if they test positive – we can keep them isolated from other residents for a sufficient period of time and do testing to make sure that they do not have COVID before allowing them back into areas where they might expose other residents. And we have had sufficient staffing and PPE from the beginning.”

Return to normal

As autumn approached, Virginia did away with strict state guidelines for nursing homes and assisted living facilities. The state granted each facility its own path toward visitation.

While visitors may come to BRC’s campus, limitations still persist. The senior living neighborhood continues looking at several factors before lifting current restrictions.

BRC considers what’s going on in it’s own senior living community with test results. It also looks at the positivity rate in Rockingham County. Another factor hinges upon the number of new cases per week in the local community. The campus also heeds guidance from the Centers for Disease Control and Prevention, VDH, CMS and other public health agencies.

Amie Knowles reports for The Dogwood. She can be reached at [email protected]