Omicron surge stretches long-term care in Oregon

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Blanca Rokstad, CNA at Rose Villa in Portland, shows her vaccination record after receiving the Pfizer COVID-19 vaccine Monday, Dec. 21, 2020. The facility says it is the first long-term care facility in the Oregon to receive the vaccine.

Kristyna Wentz-Graff/OPB

Omicron is stretching those already dealing with the pandemic, and long-term care facilities are no exception. Staffing shortages continue to affect the quality of care in Oregon nursing homes. And while vaccination rates among residents and staff have increased at many long-term care facilities, some still aren’t reporting that data at all. Fred Steele, the state’s long-term care ombudsman, says the state’s 690 facilities face thousands of vacancies.

Steele spoke to Think Out Loud. The following interview has been edited for clarity and length.

David Miller: So, generally speaking, what has omicron meant for Oregon’s long-term care facilities?

Fred Steel: Before the omicron variant entered the state and became the dominant variant in the state, healthcare facilities had seen the number of COVID cases drop quite significantly. From [Tuesday], there are more than 500 healthcare facilities that have a connected COVID case. In Oregon, we only have about 690 of these licensed care facilities in total. In many cases, there are many cases between staff and residents among those 500. Even with some of the largest waves before, that number had never exceeded around 350 establishments. So just with the number of cases, the impact on the number of facilities and therefore the thousands of residents and staff living and working in these settings, they are all affected.

David Miller: One of the characteristics of this omicron wave is that vaccinated people continue to get sick. Do you see this in nursing homes and other long-term care facilities in Oregon?

Fred Steel: Absoutely. The Oregon Health Authority displays the number of people vaccinated or the percentage of residents and employees vaccinated. These numbers are around 90% at least with the facilities that have reported. Not all have done so yet, although it has been a requirement for seven months. But for the large number of facilities that have reported, you have a large number that are vaccinated and over the last three weeks the outbreak data that has been made public shows a significant number of cases. And so where even through the delta variant we were seeing maybe 3-5 cases. In many cases, it was limited to a single person with COVID connected to a care facility. Where now we see maybe 10-20 people with COVID. So I don’t know the specific information about the breakthrough, but it seems very obvious that there are a number of breakthrough cases just mathematically.

David Miller: I want to come back to something you said. For seven months now, these facilities have been required to report resident and staff immunization rates to the state. And you’re saying that a sizable number of those facilities still don’t report those numbers to state officials?

Fred Steel: Correct. And when I asked about this recently in the last two months to understand why a requirement and a mandate may not be controlled in this way, the information I received is that it did not seem be no enforcement mechanism in place. So just [Tuesday] I learned that there are plans in the Department of Human Services to put forward what they call an administrative rule, but it’s an agency law, that they can put in place to allow the application of the requirements. It’s a shame it took so long, but I’m glad they’re getting there and really starting to follow up on these supposed warrants.

David Miller: What did the staff at these facilities look like during this wave?

Fred Steel: What we would always generalize as understaffing in healthcare facilities has increased dramatically throughout the pandemic over the past two years. But it seems to be even more important over the past month or two. So if you think about it from the perspective of each resident, nursing home care or memory care is often very personal care – help with bathing and dressing and that help that someone one may need to help themselves take care of themselves. And so when you have a lot of staff turnover or, even worse, a lot of vacancies in the staff of a given facility, it gets to the point of being very detrimental to the person who needs that support. So the numbers we see – and I just learned them [Tuesday] – out of our 690 collective care establishments, there are thousands of vacancies. We are talking about nearly 400 nurses, more than 1,200 CNA positions, nearly 3,000 direct supports. And that was with around 70% of installations reporting this information. It is significant.

And again, when you go down to the resident level, it’s even more important. You have one caregiver trying to help one person, but you have three others who also need help. You have these caregivers who have difficult and very unfortunate decisions to make just on the spur of the moment and it can be any day of the week at any minute of the day.

Our call volume has certainly increased. Just yesterday, we received 30 case-related complaints, which is a significant volume for our office in a single day.

David Miller: Can families of residents visit at this time? And if so, what are the state or federal rules regarding these visits, and from the attorney’s perspective?

Fred Steel: Previously, if a facility had a connected COVID case, no visitors were allowed. But in November, the Center for Medicare and Medicaid Services rolled it back to what should be a standard for visits under the laws. The law guarantees that they have the right to have visitors, that they have the right to see their family and friends in the establishment. So now the onus has been shifted to the facility to ensure that visitors need to be permitted, but to do so in a safe manner. Over the past two years, too many residents have been denied this direct access to family and friends.

David Miller: Finally, just going back to the numbers, you were talking about the start of a huge increase in cases again in these facilities. Are you also seeing an increase in hospitalizations and deaths related to these cases?

Fred Steel: Fortunately not yet, and I hope not at all. My understanding from public health is that with the omicron variant, serious and significant outcomes seem to be less. That seems to be the case here in Oregon so far. But the data I have is about a week and a half old.

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