Just as state declares COVID-19 outbreak at NC nursing home over, more test positive

Just as state officials declared one of the biggest outbreaks of the novel coronavirus in a Triangle nursing home was over, more staff at the facility tested positive, according to newly released data from the state Department of Health and Human Services.

In the first outbreak at Springbrook Nursing and Rehabilitation in Clayton, back in early April, 86 people caught the virus, including 28 employees, and 22 residents died, the data show. Now, four employees have confirmed infections.

The disclosure comes as nursing homes push for access to timely and repeated testing for staff, who are the likeliest source of infections in facilities housing people at high risk of severe complications if they get the virus.

More than 700 North Carolina nursing home residents have died, nearly half of the deaths in the state attributed to the pandemic. The state reports that 125 residents of residential care homes also have died due to the virus.

North Carolina officials consider a congregate care facility to have an outbreak when two or more people test positive for the coronavirus. An outbreak is deemed over 28 days after the last symptomatic person first showed signs of sickness or the last asymptomatic person was tested, whichever is later. Updated information is released twice a week, on Tuesdays and Fridays.

State officials recently agreed to fund one-time testing for nursing homes that have not tested all residents and staff since May 18, but they have not committed to pay for the subsequent rounds of widespread testing, which experts say is essential. People who are infected don’t always show symptoms, but they can still transmit the virus to others.

It’s especially important to repeatedly test staff who live and work in areas with rising cases, experts say, because they may be exposed to the virus out in the community and unknowingly bring it into the workplace. Close living quarters and shortages of personal protective equipment such as masks and gowns have made it easy for the virus to spread once it’s inside a nursing facility.

Both the U.S. Centers for Disease Control and Prevention and the U.S. Centers for Medicare and Medicaid Services recommend weekly testing for nursing home staff, though they provide leeway based on the prevalence of the virus in the surrounding area. North Carolina officials recommend staff be tested once every two weeks.

So far, that hasn’t been happening at many nursing homes in North Carolina. The reasons, people in the industry say, have to do with cost and lab capacity.

Tests cost on average $100, said Adam Sholar, president and CEO of the N.C. Health Care Facilities Association, in a recent interview. Medicare and Medicaid generally pick up the tab for nursing home residents, but the bills for routine tests for nursing home staff have typically fallen to nursing home companies, partly because many workers lack insurance and partly because private insurers have balked at paying for tests that are part of a disease surveillance program.

Nursing homes have gotten extra money from both the state and federal government to cover increased costs associated with the pandemic, but trade groups and some experts say it hasn’t been enough. A round of staff testing can cost a nursing home $10,000, Sholar said. The legislature recently allocated $100 million that could be dedicated in part to covering long-term care testing costs.

Test results have also been slow to come back, making it harder for nursing homes to separate infected residents from those who have not caught the virus. The Society for Post-Acute and Long-Term Care Medicine says results need to come back within two days to be useful. But turnaround times of five days or longer are common.

Nearly 9 in 10 of the nursing homes and assisted-living facilities recently surveyed by the biggest national trade group reported that test results were taking two days or longer, and almost a quarter said results were taking five days or longer. A survey of 76 North Carolina nursing homes in the last week of June found similar proportions. Only 14% reported results coming back in less than two days, according to figures provided by the North Carolina Health Care Facilities Association. Jennifer Hollar, who has a family member at Wake Assisted Living, said in an interview that she was told that results from a round of testing conducted Monday would probably not come back for at least a week, if not two.

The local trade group’s survey found that roughly half of nursing homes had tested all residents and 43% were conducting ongoing testing of residents. About 45% of the nursing homes in the survey said they had tested all staff or were in the process of doing so, and 39% said they were conducting ongoing testing of staff.

Data was not immediately available about testing patterns in assisted-living facilities. The state’s promise to pay for widespread testing does not currently extend to them. Jeff Horton, executive director of the N.C. Senior Living Association, said in an interview that he wasn’t sure that universal testing in residential care homes was the best use of state funds and that testing sometimes causes staff to quit, exacerbating worker shortages.

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Berger faults Cooper for lack of mass testing

Senate President Pro Tempore Phil Berger slammed North Carolina’s long-term care testing program Tuesday in a news release sent out in response to recent reporting by the NC Watchdog Reporting Network, of which The News & Observer is a part. The network quoted a top state health official saying, “(Testing) is not a solution to prevent infection, really, it’s a mechanism to detect infection.” Dr. Susan Kansagra explained that the state had focused on consulting with nursing homes and providing training on infection prevention methods.

In a written statement, Berger said: “Gov. Cooper has failed to stand up a mass testing program four months into the pandemic. As the virus wreaked havoc on nursing homes in other states months ago, the Cooper Administration should have made this the top priority.”

The governor is also getting pressure from the biggest industry trade group. The American Health Care Association and National Center for Assisted Living sent a letter to the National Governors’ Association on Tuesday asking for help getting expedited test results and more personal protective equipment, also known as PPE. North Carolina industry groups and resident advocates have been making similar requests for months.

The most recent federal data, from the week of June 28, shows that about 21% of North Carolina nursing homes reported having less than a week’s supply of N95 masks and about 15% said they lacked a week’s supply of gowns, though a local industry group say that’s likely an undercount due to confusing definitions. “PPE supplies continue to improve over time, but remain a concern,” Robert Brown, a spokesman for the North Carolina Health Care Facilities Association, said in an email.

Some federal help speeding up test results may be on the way. The Centers for Medicare and Medicaid Services announced its intention Tuesday to give all nursing homes “point of care” testing devices that can do as many as 20 tests an hour. This type of test, however, may miss up to 20% of infections, NPR has reported.

“We look forward to learning more about the details of this program and when North Carolina nursing homes might receive these devices,” Sholar said in an emailed statement. Lauren Zingraff, executive director of Friends of Residents in Long Term Care, an advocacy group, also welcomed the news.

In the past week, some of the biggest and deadliest nursing home outbreaks in North Carolina were declared over, including outbreaks at The Citadel Salisbury, where 168 people caught the virus and 18 residents died in the three months since the first infection was detected, and Aston Park Health Care Inc. in Asheville, where 135 people tested positive and 30 residents died.

All the while, infections continue to spread in other facilities. According to the latest data, there are currently outbreaks in 136 nursing homes and 60 residential care facilities. Here’s a rundown of ongoing outbreaks in the Triangle based on the state’s most recent report.

Wake County outbreaks

▪ Capital Nursing and Rehabilitation Center in Raleigh, with four staff cases, eight resident cases and one resident death. This is the facility’s second coronavirus outbreak.

▪ Cary Health and Rehabilitation Center, with two staff cases

▪ Hillside Nursing Center of Wake Forest, with eight staff cases and 47 resident cases, nearly twice the number reported on Friday

▪ Litchford Falls Healthcare and Rehabilitation Center in Raleigh, with 13 staff cases, 21 resident cases and one resident death. The number of staff cases was reported as 16 on Friday. It was not immediately clear whether that was an error.

▪ PruittHealth-Raleigh, with three staff cases

▪ Raleigh Rehabilitation Center, with two staff cases

▪ Sunnybrook Rehabilitation Center in Raleigh, with 14 staff cases, 34 resident cases and six resident deaths

▪ The Laurels of Forest Glenn in Garner, with six staff cases, 43 resident cases and one resident death. The number of resident cases more than doubled since Friday’s report, but the number of reported resident deaths fell from three to one. It was not immediately clear whether that was reported in error.

▪ The Oaks at Whitaker Glen-Mayview in Raleigh, with two staff cases

▪ Tower Nursing and Rehabilitation Center in Raleigh, with two staff cases

▪ UNC Rex Rehabilitation and Nursing Care Center of Apex, with 14 staff cases, 26 resident cases and four resident deaths

▪ UNC Rex Rehabilitation and Nursing Care Center of Raleigh, with 10 staff cases, 13 resident cases and one resident death. The number of resident cases was 13 on Friday. It was not immediately clear whether that was an error.

▪ Wellington Rehabilitation and Healthcare in Knightdale, with 41 staff cases, 40 resident cases and 14 resident deaths

▪ Windsor Point Continuing Care Retirement Community in Fuquay Varina, with six staff cases, 13 resident cases and five resident deaths.

▪ Brookdale Wake Forest, with one staff case, 12 resident cases and three resident deaths

▪ Brookridge Assisted Living in Apex, with two staff cases and nine resident cases

▪ Heartfields at Cary, with two resident cases

▪ Sunrise at North Hills in Raleigh, with one staff case and two resident cases

▪ Wake Assisted Living, with one staff case and one resident case

▪ Waltonwood Cary Parkway, with one staff case and one resident case

Wake County has disclosed one additional outbreak. Two residents and two staff members have tested positive at Universal Healthcare at 5201 Clarks Fork Drive, according to a news release from the county.

Durham County outbreaks

▪ Carver Living Center in Durham, with 28 staff cases, 80 resident cases and 10 resident deaths

▪ The Cedars of Chapel Hill, with three staff cases

▪ Treyburn Rehabilitation Center in Durham, with 26 staff cases, 79 resident cases and 23 resident deaths

▪ Brookdale Durham, with one staff cases and one resident cases

Orange County outbreaks

▪ Parkview Health and Rehabilitation Center in Chapel Hill, with three staff cases and two resident cases

▪ Signature HealthCARE in Chapel Hill, with 21 staff cases, 63 resident cases and 20 resident deaths

▪ The Stratford in Chapel Hill, with six staff cases and 16 resident cases

This story was originally published July 15, 2020 at 4:15 PM.