By Katy Seiter
As Arkansas records a resurgence in COVID-19 cases and a rising death toll, state and federal data show that nursing home residents amount to at least one of every three COVID-19 deaths in the state.
This high death toll in nursing homes comes as Gov. Asa Hutchinson loosened visitation restrictions, a move prompted by federal guidelines, but one coming despite the alarming rates of community transmission across the state. On Thursday, for example, the state reported 1,278 new COVID-19 cases, an all time record for one day.
Between Sept. 21 – Sept. 27, 23% of Arkansas nursing homes reported at least one new resident COVID-19 case, and 5% reported at least one new resident COVID-19 death, according to the Oct. 4 White House Coronavirus Task Force Report.
Charlotte Bishop, the Long-Term Care Ombudsman for Arkansas and a public advocate for nursing home residents, said that as long as facilities follow proper protocols and screenings of visitors, she does not believe the easing of visitation restrictions will pose a higher risk of COVID-19 exposure for residents. “The residents deserve to see their families. The families deserve to see the residents,” Bishop said.
Arkansas Department of Health (ADH) data shows any elderly people, even those not in nursing homes, are at high risk for death and serious illness from COVID-19. On Oct. 12, 75% of all COVID-19 deaths in the state were people age 65 and older.
With elderly at such a high risk, nursing home conditions are important since these facilities, like schools and prisons, can witness a rapid spread of disease. In a review of infection control survey summaries, conducted by the Centers for Medicare and Medicaid Services (CMS), some nursing homes facilities with high COVID-19 resident deaths revealed deficiencies with proper infection control.
A Sept. 28 survey found Hot Springs Nursing & Rehabilitation, A Water’s Community noncompliant with infection control regulations and had not implemented the CMS and Centers for Disease Control and Prevention (CDC) recommended COVID-19 practices. As of Oct. 12, Hot Springs Nursing & Rehabilitation had the highest COVID-19 resident deaths in the state.
Tonya Brown, administrator of Hot Springs Nursing & Rehabilitation, said “The safety and well-being of our residents and staff is our top priority, and we are following the recommended preventive measures until the virus has been eradicated from our community.”
Determining death totals for each facility in Arkansas has been difficult. The ADH releases daily reports on new positive cases in nursing homes, but death figures are only updated once a week. The ADH reports do not provide a comprehensive list of facilities. Facilities are only included if there have been new or additional positive cases, by resident or staff member, in the last 14 days. The Centers for Medicare and Medicaid, by contrast, provides more comprehensive details of deaths and cases by facility over time.
After Arkansascovid.com made multiple requests for a comprehensive listing of nursing home deaths, and pointed out the more detailed data provided by the federal government, the ADH provided a list of the total COVID-19 resident deaths by facility as of Oct. 12. Details are provided in the interactive chart above.
Nursing home experts say facilities are trying to balance the prevention of COVID-19 spread in the facilities against the mental health and well-being of the elderly, some of whom have been isolated from friends and family visits for months.
“They’re requested to remain in their rooms for as much as possible. One friend of mine made reference to seeing a high level of depression among the residents because of that,” said Holly Felix, an associate professor and public health researcher at the University of Arkansas for Medical Sciences (UAMS).
Small changes, such as the shift from communal dining to private dining, has had a negative impact on the well-being of nursing home residents. For some, the lack of communal gatherings, along with not being able to leave the center or see visitors, including family, has taken a toll on the residents’ health.
Nursing homes face the additional challenge of maintaining the safety of the staff and the safety of the broader community, said Mark Williams, Ph.D., Dean of the UAMS Fay W. Boozman College of Public Health.
“An institution within a community is not divorced from that community, even if the [institution’s] population is, as you might say, isolated,” Williams said.
Williams added that nursing homes are porous because support staff, such as nurses, cooks and cleaners, travel back and forth into the community, leading to a high likelihood of community transmission.
Because ADH data did not provide information on when resident deaths were reported, Arkansascovid.com examined CMS data for weekly reports, which were obtained through the CDC’s National Healthcare Safety Network (NHSN).
This federal program requires nursing homes to manually submit data and includes COVID-19 suspected resident deaths, as opposed to ADH only reporting confirmed COVID-19 deaths. This is one of the discrepancies in death totals between Arkansas and federal data. Arkansascovid.com has found one facility incorrectly entered data into the federal system. Dermott City Nursing Home is listed in CMS data as having the most nursing home deaths, but upon checking this, Arkansascovid.com determined the data to be inaccurate. Indeed, the ADH reported Dermott City had 8 total COVID-19 deaths as of Oct. 12. Dermott City Nursing Home declined comment.
ADH reported 566 COVID-19 nursing home resident deaths out of a statewide total of 1,586 deaths on Oct. 12. By comparison, the CMS, with its broader accounting of nursing home deaths, reported 584 resident deaths on Sept. 27. Comparing the Oct. 7 federal nursing home totals to overall deaths in the six border states, Arkansas has the second highest ratio behind Missouri.
According to ADH data, Hudson Memorial Nursing Home in Union County, had an outbreak in September resulting in at least 39 new resident cases and 14 resident deaths by Oct. 5. As of Oct. 12, 14 residents have active COVID-19 infections. Hudson Memorial Nursing Home declined to comment.
Beebe Retirement Center, located in White County, reported 64 new cases between Aug. 12 – Oct. 12, totaling at 71 cases. Out of the 64 cases, 17 residents have died, 50 have recovered, and four remain active. Beebe Retirement Center declined to comment.
Pleasant Manor Nursing & Rehab, located in Little River County, reported 52 new resident cases in August. As of Oct. 12, there have been 16 resident deaths. Pleasant Manor Nursing & Rehab declined to comment.
Arkansas continues to experience one of the highest per-capita rates of COVID-19 in the country, according to the White House Coronavirus Task Force. Health professionals and experts urge the public to consider the impact it has on entire communities, especially those considered most vulnerable because of age and existing health conditions.
“I’ve heard the argument that people don’t die of COVID-19; they die of other things while they have COVID-19. That’s an erroneous argument,” Williams said.
He added that many elderly people in nursing homes have underlying conditions and COVID-19 exacerbates these problems. “Without that spark” of a COVID-19 infection, Williams said, “then nothing else would happen. The patient would essentially go on as usual, and that’s oftentimes pointed to with people who are in nursing homes or over the age of 75.”