Long-Term Care Facilities (LTCFs) have been hit hard by COVID-19 across the nation and in our region – Arlington is no different.
- COVID-19 is still spreading in the region, including Arlington. It is not surprising that LTCFs have been affected.
- The majority of deaths from COVID-19 in the Commonwealth of Virginia have been associated with LTCFs, including Arlington.
- We are saddened by the deaths of anyone from COVID-19, especially residents in our LTCFs. Their age, their chronic medical conditions, and their setting put them at greater risk.
- This is why we place a special focus on residents and staff at these facilities.
Residents at LTCFs are often at greater risk for germ exposure, including COVID. Once exposed, these residents are at greater risk for complications from COVID.
- Residents of LTCFs are usually at greater risk for exposure to germs, such as flu, norovirus, and the novel coronavirus based on their care needs.
- Staff can bring in COVID into a facility; visitors, including family, can also bring in germs – however outside visitors to these facilities have typically been stopped.
- Staff can bring in germs when symptomatic and also asymptomatically – that is they can spread germs before they have symptoms. And spread can then occur between residents and staff in similar ways once the virus is in a facility.
- Residents are at greater risk for exposure to germs because they often require assistance with one or more activities of daily living (e.g., feeding, bathing, or toileting) which puts them in much closer physical distance or contact with their care givers, hence introducing a greater risk of germ exposure.
- Shared location of residents in one facility can increase the risk of germ spread once introduced.
- Residents of LTCFs are more susceptible to severe, potentially fatal effects of the novel coronavirus once exposure has occurred due to their chronic medical conditions or their age or both.
- Advancing age or chronic medical conditions or both are more likely conditions of residents of LTCFs.
- Residents of advancing age are more susceptible to severe, potentially fatal effects of coronavirus once exposed.
- Residents often have underlying medical conditions such as diabetes, high blood pressure, and heart, lung, and kidney disease. These chronic conditions make them more susceptible to severe and fatal effects of coronavirus, once exposed.
- Residents of advancing age and with chronic medical conditions are at even greater risk for complications from COVID.
Staff at LTCFs are essential workers unable to follow stay at home orders given their job function.
- These workers are typically low income, non-salaried employees without access to sick leave and health insurance.
- They frequently work across facilities to meet ends meet.
- These staff may inadvertently spread germs from one facility to another.
- Staff often provide care for residents who require assistance with activities of daily living which puts caregivers and residents in closer contact.
- This increases the risk of germ spread in either direction once germs are in a facility.
LTCF germ spread is a confluence of two problems – workers and residents at risk for exposure and/or exposing others to germs.
- Staff at these facilities are essential workers making low wages. These workers are not able to safely distance themselves because of their occupation or line of work. Additionally, these workers often living with other essential workers making low wages. This workforce is very much on the front lines of the pandemic. Low wage-earning essential workers are at greater risk to expose themselves and others to germs at home and work.
- Residents are at greater risk for exposure from closer contact with care givers and place care givers at risk for germ exposure once they have the germ, including asymptomatic carriage. These residents are at greater risk for complications from COVID-19, including death, given their advancing age, chronic medical conditions, or both.
Working with long-term care facilities is an ongoing priority for Arlington Public Health
- Public Health works with skilled nursing and assisted living facilities throughout the year to control and prevent outbreaks, such as norovirus and the seasonal flu, even prior to COVID.
- Providing infection control guidance is part of the division’s standard operating procedures.
- Staff proactively conduct general infection control outreach, providing guidance every year right before norovirus and flu season.
- Arlington Public Health works closely with Arlington Aging and Disability Services, who also works with the LTCFs year-round.
Arlington Public Health has been working with these facilities to implement CDC and VDH guidance for COVID-19 infection control and prevention measures, including
- Monitoring residents and staff for signs and symptoms of COVID
- Sending in staff as needed to collect lab specimens to confirm an outbreak
- Providing guidance on proper PPE to use
- Cleaning and disinfecting protocols including those for rooms and common area surfaces
- Restricting visitors, including family members
- Stopping new admissions
- Stopping group activities, including dining
Arlington Public Health is taking additional actions to protect residents and staff:
- Assigning a public health nurse to a facility with a confirmed case of COVID-19.
- The nurse reviews the status of a facility’s compliance with all of the recommendations listed above, and any barriers to implementing the recommendations.
- The nurse provides more education on PPE use and other infection control measures including isolation and quarantine, and cleaning and disinfection
- Sending trained county staff and MRC volunteers to make in person observations of infection control practices in facilities with outbreaks and re-educate facility administrators and staff as needed
- Providing PPE to facilities without these resources as Public Health inventory allows.
- Working with facilities to create an electronic resident and staff census.
- This will help Public Health better detect patterns of illness onset in each facility to identify potential breaks in infection control to work with a facility to correct them.
- Encouraging facilities to provide LTCF staff with sufficient hours and benefits to ensure that staff do not work across multiple facilities as recommended by the state.
- Recommending facilities participate in state sponsored point prevalence surveys (PPS) and to arrange for additional surveys for remaining residents and staff on an ongoing basis to detect asymptomatic spread of COVID-19.
- This is in addition to recommending continued testing for COVID-19 in residents with COVID related symptoms.
- The goal of PPS is to adjust infection control practices when breaks in infection control are detected based on PPS results.
- Identifying MRC volunteers who can do short-term assignments in facilities experiencing staff shortages because of LTCF staff being placed in quarantine or isolation after PPS surveys are conducted or from LTCF staff fears of COVID exposure.
The role of the local health departments including Arlington Public Health — as a part of the Virginia Department of Health – is to provide infection control and prevention guidance to LTCFs.
- If you are concerned that a friend or a family member who is a resident of a long-term care facility might have been exposed to COVID-19 or about their care, please contact the facility’s administrator or Arlington Public Health at 703-228-5200 option 1.
- The state agency which regulates skilled nursing facilities is the Virginia Department of Health’s Office of Licensure and Certification which may be reached at 1-800-955-1819.
- The state agency which regulates assisted living facilities is the Virginia Department of Social Services Division of Licensing Programs which may be reached at 1-800-543-7545.