Care facilities account for 29 percent of local COVID cases

Wednesday, July 22, 2020

Bentonview overcomes wave, Lacoba managing 57 positives

As COVID-19 (coronavirus) cases in Barry and Lawrence counties near 300 total, some of the hardest hit areas have been nursing homes and other long-term care facilities.

As of Tuesday, Barry County had 180 cases, and Lawrence County had 117 for a total of 297. Between both counties, at least 86 of those cases (29 percent) have been in nursing homes or other long term care facilities.

Lacoba Homes in Monett is the latest to battle an outbreak, facing 57 positive tests (40 Barry County residents and 17 Lawrence County residents) since an employee’s positive test was announced on July 6.

David Compton, director of the Barry County Office of Emergency Management, said local residential care facilities have been keeping up with Centers for Disease Control and Department of Health and Senior Services guidelines, which include screening temperatures, masking, hand-washing and social distancing.

“Very early on, they all cut visiting hours, and they halted use of community dining areas,” Compton said. “They took a lot of precautions because there was such great concern about infection in [nursing] homes.

“However, you can do everything possible and just one momentary lapse can change everything.”

For Lacoba, that moment came when, due to contact tracing from another case outside the facility, an asymptomatic employee tested positive.

The positive triggered a number of steps. First, all staff and employees had to be tested. On July 7, results showed three additional employees tested positive, all of whom were asymptomatic. All residents were negative at that time.

Three days later, a second round of testing was initiated, and by 7 days later, the number of positive cases in the facility ballooned to 55 total.

“The first few residents that came back positive were retested through a local lab and did come back negative on the retest,” a statement on Lacoba’s Facebook page said. “All positive staff and residents were not retested because of the availability of tests, and even with negative retests, it would not change how we are handling things. As per the guidelines set out by the CDC, Health and Senior Services, and the Health Departments, we are required to test each employee and resident weekly until we are COVID-19 free.”

The outbreak within the facility led to even more safety precautions. According to the Facebook post, a COVID-19 area was designated in the new addition, allowing for a separate entrance, dining area and support areas for employees and residents. The unit is staffed by asymptomatic employees.

Lacoba also took other steps mentioned in the post, such as installing UV light systems in the air conditioner units to combat the spread of microdroplets.

All negative residents and staff were tested again on Friday, and another round of testing will take place on July 24.

“If we come away from those rounds of testing with no new positives, then we can move into the next phase,” Lacoba’s statement said. “Once we have two rounds of negative tests, we will begin ongoing bi-monthly (twice a month or approximately every two weeks) testing of a minimum of 10 percent of staff. The Center for Medicare and Medicaid Services announced on July 14 that they will begin next week sending one diagnostic test instrument and associated tests to nursing homes to help accommodate these ongoing testing practices.”

Compton said per health department guidelines, a facility must test entirely negative two consecutive weeks before it can return to normal operations.

“When we have positives in nursing homes, the state is notified and they track everything,” Compton said. “Generally, the nursing home nurses do all the testing themselves, as they have access to test media and nurses on staff can do the nasal swabs. They are usually sent to private labs, then the labs report to the state.”

Another Monett facility that has dealt with an outbreak is Bentonview Park Health and Rehab, which took a different approach to the situation, utilizing its partnership system with other nursing homes throughout the state.

Craig Workman, with Workman Communica-tions Group and representing Bentonview, said 10 staff members and nine residents at the Monett facility tested positive after an initial two positive cases among staff were announced on June 25.

“Those nine residents who tested positive were initially housed at Bentonview in an area where we could isolate and treat them,” Workman said. “But, Bentonview is part of a statewide network of facilities, about 15 other homes, so all nine of our positives were moved to a sister facility in the Kansas City area. One of them, so far, has returned.

“No one at our Monett facility has tested positive since they were moved. We are not at the threshold yet to declare we are COVID-free, but we have had no other positives at this point.”

Workman said Bentonview had been following all the CDC guidelines since late March, and the facility is still not accepting visitors or has a timeline for when visitors may be able to return.

“We were screening residents several times per day and screening employees each time they entered the building, even if it was just to go to lunch,” Workman said. “We also closed the dining halls to meet social distancing rules.”

Workman said when the two employees did test positive, they were sent home to isolate for two weeks and had to test negative before they could return. In the temporary COVID area of the facility Bentonview created, staff members who cared for positive patients stayed only in that area, and another employee from another facility was brought in to manage and supervise the day to day activities of the area.

“We had the luxury of learning from all our sister facilities the best ways to manage an outbreak,” Workman said. “When people showed symptoms and tested positive, the decision was made to move them to another facility, and no one had to be hospitalized. The [Kansas City-area] has become our COVID-positive facility, and all the healthy residents from that facility were moved to others in our system. The CDC recommendation is to move all positive cases to one facility if you can do it.”

Another facility in the area, Countryside Care Center, has had fewer issues to deal with, something the retirement home’s manager credits to its smaller size. With only six or seven employees and 22 residents, Countryside has stuck with the reopening phases and is allowing some residents to go out into the community and some visitors in the building.

“We have been maintaining social distancing rules and only eat two per table or eat in rooms for dining,” said Rachel O’Donald, manager of Countryside Care Center. “We are allowing visitors, and we have some set questions we ask upon arrival, and we take their temperatures. It makes a difference that we are small, so we don’t have many visitors, and the ones we have generally stand at the door to drop stuff off, so they aren’t here for long.”

O’Donald said more mobile residents are allowed to venture out as needed, provided they wear a mask, social distance and wash their hands.

“Those residents are more able to take care of themselves and like to be on the move,” she said. “Our lower-functioning seniors are still getting help from staff to make sure they follow guidelines in the facility.”

O’Donald said staff of Countryside has also been urged to limit public outings to only basic needs as much as possible to prevent any exposures.

At Leisure Living, a congregate care facility for mostly patients dealing with mental health issues, things have been buttoned down. Jack Grigsby, owner of the facility, said Leisure Living is not allowing visitors, is keeping its residents on the property, is checking temperatures of residents every day and staff upon arrival, is sanitizing surfaces regularly, is offering hand sanitizer to residents throughout the day and has most residents eating in their rooms.

“Most doctor’s visits are by phone, and if someone has to go to the doctor, they wear a mask,” Grigsby said. “We also go shopping for the residents once a week. They make a list and we go get everything they need.”

Grigsby said the toughest part for his 18 residents and 6 staff has been the isolation, as many residents are frequent walkers about town.

“It helps us being small and having that lower chance for anyone to bring anything in,” he said. “We’ve been very cautious, but a lot of our patients walk downtown so it’s been a bit of a struggle with that. We’ve had a couple inservice sessions for residents and staff, and we put MSNBC on the TV so they can watch that and have an idea of what’s going on.”

Compton said when it comes to COVID-19 and the scale of the recent outbreak in southwest Missouri, anyone is susceptible to catching the virus.

“Anyone in the community who is working anywhere is at risk right now,” Compton said. “At the end of the day, the numbers in nursing homes, factories and other workplaces are indicators of how widespread COVID-19 is in the community.”

Editor’s note: Multiple calls were placed to Mike Baldus, executive director of Lacoba Homes in Monett, Thursday, Friday and Monday, and none were returned. Questions we intended to ask beyond Lacoba’s Facebook post, included:

• How exactly is the unit set up?

• Are the asymptomatic employees in the COVID unit employees who tested positive and are asymptomatic or who tested negative and are asymptomatic?

• What type of PPE are staff using in the COVID unit?

• What is the protocol when a positive case recovers? How is the room cleaned?

Calls placed to Roaring River Health and Rehab and Cassville Health Care and Rehab were not returned as of press time, nor was an email to a corporate COVID-specific address for Oak Pointe in Monett.

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