COVID hits a new set of nursing homes, as cases and deaths surge again in South Bend region

More cases,

new homes

As COVID-19 cases and deaths have spiked in recent weeks, the virus continues to hit long-term care residents in the South Bend region especially hard, driving new facility outbreaks.

Nearly 7,000 people living in nursing homes and assisted living across Indiana were infected, and 1,820 died, over the pandemic’s first five months, according to state figures. In that time, there was an average of about 350 new cases and 91 deaths a week.

Over the past seven weeks, new cases in the state’s facilities have grown at about the same rate, with 2,438 contracting the virus, while the death rate has declined to about 55 weekly.

But during that time in St. Joseph, Elkhart, Marshall and LaPorte counties, the increase has been more severe. Here, over those seven weeks alone, the virus has infected at least 468 long-term care residents — compared to 520 cases over the pandemic’s first 20 weeks.

The recent surge has struck a different group of facilities than those suffering outbreaks this summer.

As of mid-August, there were 11 homes that had case numbers exceeding the state average, led by Cardinal Nursing & Rehabilitation in South Bend with 100 cases and 25 deaths. It was followed by Millers Merry Manor in Plymouth, with 61 cases and 20 deaths; Greenleaf Health Campus in Elkhart, with 48 cases and 20 deaths; and Hamilton Grove in New Carlisle, with 40 cases and 16 deaths.

But only three of those 11 homes have seen any new cases since Sept. 1.

Since that date, the exceptions have been Millers Merry Manor in Wakarusa, reporting 54 new cases and at least nine deaths; West Bend Rehabilitation in South Bend has had 11 new cases and one death; and Healthwin in South Bend reported seven new cases and no deaths.

Among the facilities reporting the most new cases since Sept. 1 are Holy Cross Rehabilitation & Wellness, listed in state records as the “Sanctuary at Holy Cross,” in South Bend with 84 cases and 25 deaths; Trailpoint Village in South Bend with 62 cases and less than five deaths (to protect patient privacy the state does not specify a facility’s numbers when they are below five); Golden Living Center Elkhart with 58 cases and eight deaths; and Creekside Village in Mishawaka with 51 new cases and 13 deaths.

“I hate to compare it to this, but it reminds me of the game of Whack-A-Mole,” said Lynn Clough, Indiana’s nursing home ombudsman, who heads the office that represents the interests of long-term care facility residents when complaints arise. “I wish I had an easy answer for you. We’re finding that kind of phenomenon all over the state. There are a lot of facilities that go through a period where there are increased cases in the facility and then as those residents recover it moves on to another facility.”

The state, following guidance from the U.S. Centers for Medicare and Medicaid Services and Centers for Disease Control, has advised homes to place newly admitted residents in quarantine for 14 days.

Clough said one factor identified in nursing home spread, especially since visitation has been largely cut off since early March, has been staff who work in multiple facilities. Homes are trying to screen staff for the virus, such as taking their temperatures before shifts start, but “it still makes its way through,” she said.

Since the pandemic began, 11 of the 14 facilities ranking among the top 10 in the region in resident cases also rank in the top 10 for infections among staff. Millers Merry Manor in Plymouth, for example, has reported 38 infected staff, followed by Sanctuary at Holy Cross with 37, Creekside Village with 36 and Healthwin with 32.

The newer cases at long-term facilities have helped drive a rising number of deaths locally. As of Thursday, St. Joseph County was reporting 181 deaths from COVID-19 — 49 of which have come in October alone, with another week left to go. Prior to October, the county had averaged about 20 coronavirus deaths a month.

Of those who have died since March, 56% have been people ages 80 and older. People ages 70 to 79 have accounted for 21% of deaths, with those ages 60 to 69 accounting for 16%.

Dr. Mark Fox, St. Joseph County’s deputy health officer, said the game of “Whack-A-Mole” could be a troubling sign for the coming flu season and as temperatures drop, bringing more people into closer contact with one another.

Fox said many nursing homes need more than 300 employees to cover three shifts. Because both the flu and novel coronaviruses share some symptoms, more staff who develop them will seek COVID-19 tests. They will then self-isolate while they await test results – there’s currently about a two-day turnaround on tests locally – forcing nursing homes to bring in temporary workers who might not have been tested, Fox said.

Another troubling possibility, he said, is that staff members, fearing the loss of income, either won’t get tested or won’t self-isolate while their tests are pending.

State focus

Staffing levels already are so low at some facilities that Indiana Gov. Eric Holcomb announced last week that he was sending National Guard members to help with employee screenings, data entry, testing and infection control practices, an effort intended to let employees “focus on what they do best, and that’s directly caring for the residents.”

Guard members will start Nov. 1 at homes that have had positive cases and then expand to all 535 facilities in the state.

“Slowing the spread of this infection and sickness inside these facilities,” Holcomb said, “there’s a direct correlation between how that also impacts our hospitalization rates. If we can prevent infections in our nursing homes, we will protect our hospital capacity and in turn our capacity to care for others as well.”

Holcomb said the state also will hire additional clinical staff, some of it coming from a “Health Care Reserve Workforce.” Early in the pandemic, the state asked those who are retired, not working or furloughed because of the pandemic to consider volunteering. After more than two months of no requests for help from the group, the state received 11 requests from long-term care facilities last week, the governor said.

Dr. Lindsay Weaver, the state health department’s chief medical officer, said care facility workers are “exhausted. They have been running a marathon at a sprint pace for eight months and the human body simply isn’t designed to sustain such a pace.”

In yet another effort, this one aimed at reducing admissions to nursing homes, Holcomb announced the state had won federal approval to speed up the process through which patients who are discharged from hospitals but still need rehabilitation can secure Medicaid coverage for in-home care. The program is being piloted in St. Joseph, Marion, Hamilton and Floyd counties, and their surrounding counties, and already has been used by 20 people.

Weaver also said the state is sending two million N95 masks, 400,000 face shields and 680,000 gowns to care facilities, its largest distribution of personal protective equipment since the pandemic began.

Community spread to blame?

The long-term care and assisted living industries are issuing regular news releases calling for more federal funding for protective equipment and Medicaid, while attributing a national uptick in nursing home COVID-19 cases in late September to increasing community spread.

“While the support we have received from Congress, the Administration and other public health agencies have helped our facilities fight this battle, we could still see another wave of COVID cases caused by the sheer volume of rising cases in communities across the U.S. given the asymptomatic and pre-symptomatic spread of this virus,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, said in a statement.

But poor infection control practices in the facilities are the true culprit, said Sam Brooks, spokesman for the National Consumer Voice for Quality Long-Term Care, a Washington-based nursing home watchdog.

“It is quite an amazing admission by the industry, if you think about it, especially in light of the fact that the only folks who have been in nursing homes since March 13 have been nursing home staff,” Brooks said. “If community spread was the reason homes had COVID-19, then all homes would have it in a certain area. Instead, and you are seeing it now in Indiana, only some homes do.”

Of the 65 state-licensed long-term care facilities in St. Joseph, Elkhart, Marshall and LaPorte counties, 21 haven’t had a resident become infected. Twelve of those homes have had from one to four staff members test positive. One of them, Holy Cross Village at Notre Dame, has had 16 employees infected.

Holy Cross Rehabilitation & Wellness in South Bend, whose 86 resident infections since the pandemic began ranks second-highest in the area, has had 37 employees test positive, also the area’s second-highest.

Saint Joseph Health System, which runs Holy Cross Rehabilitation, said the facility “follows CDC, state and local guidelines for providing care to our residents and we are reporting to the county, Indiana State Department of Health, and Health and Human Services Department as required. The safety of our residents is our top priority and we welcome continued collaboration with the Indiana State Department of Health.”

Officials with several other long-term care institutions contacted by The Tribune did not return messages or declined to be interviewed.

Sister Linda Kors, the nursing home ombudsman for the South Bend area, said corporations that run nursing homes have tried to implement and enforce policies and restrictions.

“They are, and that’s why I know when I’ve talked to some of the administrators or directors of nursing, they don’t know why they got it,” Kors said. “They thought they were being so cautious and all of the sudden, they have 30 residents that are now with the COVID. I think it’s just hard. This disease is such an odd disease.”

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These facilities have reported the most resident COVID-19 cases in St. Joseph, Elkhart, Marshall and LaPorte counties since Sept. 1:

Holy Cross Rehabilitation & Wellness, South Bend: 84

• cases
• Trailpoint Village, South Bend:

62

• cases
• Golden Living Center, Elkhart:

58

• cases
• Millers Merry Manor, Wakarusa:

54

• cases
• Creekside Village, Mishawaka:

51

• cases
• Golden Living Center Fountainview Terrace, LaPorte:

44

• cases
• Northwoods Village at Edison Lakes, Mishawaka:

19

• cases
• Southfield Village, South Bend:

17

• cases
• Golden Living Center, LaPorte:

13

• cases
• West Bend Rehabilitation, South Bend:

11

• cases

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