COVID-19 spreading to rural nursing homes

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As the coronavirus surges to more and more rural counties, it is threatening to spread to the nursing homes in those areas.

Nursing homes and other long-term care facilities house many elderly with underlying medical conditions, a population that is at the highest risk of death from COVID-19. About 30% of nursing homes are in rural areas.

Coronavirus cases in long-term care facilities appear to be on the rise nationwide. Research from the American Health Care Association/National Center for Assisted Living, a trade association of long-term and post-acute care providers, found that in late September cases rose slightly from 6,135 to 6,290, the first increase since July.

While data on rural areas is sparse, reports from the Montana state government suggest that virus cases are increasing in rural nursing homes. An Oct. 7 report showed that 55 long-term care facilities and assisted living facilities had ongoing cases of the virus. That had increased to 84, an increase of 53%, two weeks later. The number of actual residents and employees with the virus jumped more than doubled in that same two weeks, from 375 to 927.

Nursing homes also account for a large share of COVID-related deaths. According to the New York Times, about 38% of coronavirus deaths are linked to nursing homes. The rural states of Wyoming and Montana have lower rates of 12% and 23%, respectively. But Kansas, Nebraska, and North Dakota have at least 40% of virus deaths linked to nursing homes, while Idaho is one of the highest in the nation, at 53%.

The spread to rural nursing homes seems inevitable to some.

“We’re experiencing an overall spike, and nursing homes would be part of that,” said Keith Mueller, head of the Department of Health Management and Policy and director of the RUPRI Center for Rural Health Policy Analysis at the University of Iowa. “If you have an overall spike that means we are all at risk of exposure any time we are in any type of group situation. And employees of a nursing home are at risk even when they are not at the nursing home.”

As most long-term care facilities have limited contact between residents and their family and friends, employees are the main conduit for the virus to enter a nursing home.

“Rural facilities have a more difficult time maintaining sufficient staffing,” said Richard Mollot, executive director of the Long Term Care Community Coalition.

Jobs at nursing homes are often demanding, and the pay is often low. Estimates vary, but annual turnover among staff at nursing homes range from 45% to 66%.

Additionally, staff are not always well trained in safety procedures.

“It comes down to sufficient staffing and staff that has sufficient training in infection control and prevention,” Mollot said. “We have seen throughout the pandemic problems with staff taking appropriate safety protocols.”

An analysis by Kaiser Health News found that nearly 10,000 nursing homes fell short on at least one infection control measure, such as adequate hand-washing, in the last four years.

The reopening of colleges in rural towns is considered by some experts to be a major factor in the recent coronavirus surge in rural areas. It could also be connected to increases of cases in rural nursing homes.

“One possible explanation is that college students may interact with a long-term care employee at the grocery store or out in the community, and that long-term care employee will go to work and unknowingly spread the virus,” the AHCA/NCAL said in a statement to the Washington Examiner.

The AHCA/NCAL points to another reason why staff at rural nursing homes may be at higher risk for contracting the virus.

“Rural areas are seeing higher COVID rates, and unfortunately, many individuals in these communities are not following CDC guidance on wearing masks and practicing social distancing,” the AHCA/NCAL said.

According to self-reported data collected by the Delphi Group and Carnegie Mellon University, fewer than 80% of residents in rural states like Idaho and Montana wear masks while in public. In states such as South Dakota and Wyoming, it is less 65%. In more populous states like New York and California, mask-wearing exceeds 85% in most areas.

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