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N4T Investigators: Impact on long-term care facilities after COVID-19 ‘holiday spike’ 

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TUCSON (KVOA) - Long-term care facilities across Arizona have been hit hard by the COVID-19 pandemic. People with loved ones receiving care went months without visitation, now many again are going without visitation as cases spike following the holidays.  

The week started with grim news for Arizona - the seven-day outlook, as of Tuesday, showing that the Grand Canyon State had not only the highest rate of transmission in the U.S., but the world. And those numbers were reflected in rising cases at long-term care facilities. 

There are few things like the bond between a mother and daughter. Mary Joyce has memories of the good times and the bad times. 

“My mother got ill about a year ago,” Joyce said. 

Mary was set on taking care of her 90-year-old mother. But then things got even worse.   

“Before I could decide to move her into my house she fell and cracked her hip so we had to put her in a rehab facility,” Joyce said. 

Infinity Assisted Living, on Wilmot in Tucson, became her mother’s new home. Mary wanted to make sure her mother was well taken care of.  

“We were going over there every day [before the pandemic],” Joyce said. 

Then the COVID-19 pandemic hit and those daily visits stopped. 

“She was not doing well and started to decline memory loss, memory problems, just not doing that well because we weren’t able to see her,” she said. 

A story like so many other families has told since the pandemic began. Eventually, the visits returned on a weekly basis outdoors. While her mother’s condition improved, Mary is still worried, seeing cases surge after the holidays.   

“We’re real concerned hopefully she can get a shot soon or something, or all of us, so we can visit safely," Joyce said. "We want it to be over with we want to be able to start visiting like we normally would.”  

But “over with” may be far away, since the beginning of the pandemic long term care facilities have been ground zero for deaths.

More than 92,000 residents in specialized care facilities have died nationwide more than 860 of them in Arizona, according to the Center for Medicare and Medicaid Services. 

Right now, the nation is seeing a surge in cases and deaths after the holidays. Arizona making national records in several categories no one wants to be leading in.  

“One percent of the population lives in a long-term care facility but 40 percent of the deaths have happened with people who live in those long-term care facilities," Dana Marie Kennedy, director of AARP Arizona said. "When we have more Covid spread in the community, the workers are more at risk as well and that makes residents more at risk.”

She said once again some facilities are batting down the hatches.  

“We’ve seen some families able to visit with their loved ones and some facilities have locked down where there were visitations before,” Kennedy said.  

Something that has her very concerned.   

“It’s critical that we allow visitation so they are testing people in long-term care facilities more frequently than they were in the very beginning and that’s really important each resident is allowed two essential visitors," Kennedy said. "And that essential visitor and that visitor will be tested as frequently as the staff in the facility.” 

But knowing the real scope of cases in local facilities is unattainable for many families. Throughout the pandemic, the state has not released data from long-term care facilities. Despite opposition from many, it hasn’t changed.   

“The only thing that has changed is skilled nursing facilities have to report to CMS. but then, there’s a delay in reporting out that information so families can go and look online," Kennedy said. "If a person lives in a skilled nursing facility, they are releasing that information, but we know we have 22 assisted living facilities that do not have to report that information,”

The CMS database currently is reporting results up to Dec. 20. Across Pima County, more than a quarter of reporting facilities had resident deaths. 

Sapphire of Tucson, a specialized nursing facility reports the highest number of cases and 40 deaths.

We reached out to the facility and a spokesperson sent us answers to several questions. The responses are below: 

1. How many residents in your facility have tested positive in total since the beginning of the pandemic? 
 
Sapphire Estates Rehab Centre was the first SNF (Skilled Nursing Facility) in Tucson that opened a dedicated COVID-19 Special Care Unit to serve our community and Hospital partners back when the pandemic started hitting Arizona in April. We were pioneers at the time and have not looked back in terms of providing COVID-19 care to serve the needs of the community. Although many other SNFs were eventually forced to accept COVID-19 patients months later due to governor’s orders and eventually developed their own COVID-19 units, we were the first in Tucson to voluntarily open a unit and serve the community’s needs at the time.  We therefore do not feel that a current number would accurately reflect the facilities performance or infection control protocol in relation to total number of historical cases. We continue to submit updated COVID-19 data to the CDC and CMS who make this data available to the public. 

2. How many are positive right now? 
 
As we are a high volume admission and discharge facility unlike most other SNFs in Tucson, this number changes frequently. We admit over 100 patients a month and are exclusively a short term facility. The fact that we have a 50 bed COVID-19 unit, that every patient admitted is a PUI (persons under investigation) during their first 14 days post-hospitalization, and the fact that the vast majority of residents that test positive in the facility during their PUI period and exposure to community spread and hospital environments, it further complicates the data and totals for COVID-19 positivity rates.  Our current positivity rates therefore would not provide an accurate representation of data. Once again, we continue to submit updated COVID-19 data to the CDC and CMS who make this data available to the public. 

3. What is done to separate the positive from non-positive residents? 
 
As stated above, Sapphire Estates Rehab Centre has a longstanding COVID-19 Specialized Care Unit which has dedicated staff and its own exit and entry to the facility. In terms of new admissions, all patients are treated as PUI’s during their initial 14-day period in the facility as they are within the COVID-19 incubation period after possible exposure in community and hospital system settings. PUI patients are treated under isolation precautions per CDC and CMS guidelines. If a patient tests positive, they are immediately transferred to our COVID-19 Special Care Unit. We have continued to supply staff with an abundant amount of PPE as well, and throughout the pandemic never had a shortage of PPE. We were actually one of a few facilities locally that planned ahead and stockpiled PPE back in January and February which saved us from a nationwide shortage during the first few months of the pandemic. 

4. What measures are you taking to address a high number of positive cases? 
 
Sapphire Estates continues to follow CMS (Centers for Medicare and Medicaid Services) and CDC guidelines for infection control. AZDHS conducted a COVID-19 related infection control site survey in May 2020 and found zero deficiencies. Additionally, we invited the CDC into our facility to collaborate on best practices in June of 2020.  Sapphire Estates Rehab Centre also conducts additional infection control precautions beyond requirements from CMS and the CDC, such as the use of a Hospital grade, commercial size, UV-C Sanitizing Light which is used to provide additional disinfection when cleaning rooms and surfaces.  Our current positivity rates reflect the significant increase occurring in hospitals and in the community, and are not reflective of anything within our control as a short term rehabilitation facility that is meeting or exceeding all infection control procedures mandated by the CDC and CMS. 

5. Did the holiday season bring a spike in your numbers? 
 
Absolutely. Hospitals are getting slammed and are in high demand of placement of patients that can be cared for at a lower level of care. As of right now Arizona’s 7 day COVID-19 rates are not only the highest in the US, but are currently the highest in the world. Pima county as of yesterday has broken records in terms of single day cases, deaths, ventilator patients, and the highest number of COVID-19 patients occupying ICU beds. As a post-acute facility that can have days with up to 8 or 10 admissions directly from Tucson’s hospital systems, we are seeing a direct correlation between COVID-19 community spikes surges in both COVID-19 positive admissions as well as COVID-19 positivity rates in patients during their 14-day PUI period. 

6. Why do you believe you are seeing a higher number of cases than other LTC facilities in Tucson? Is there something different about your facilities operations? 
 
Unlike most other SNF’s in Tucson, we are not a long term care facility in the traditional sense, as our  facility does not accommodate long term care patients.  We are a skilled nursing facility that focuses solely on Post-acute rehabilitation. We admit over 100 patients per month which is unlike other Skilled Nursing facilities in Tucson. We have more traffic in and out of our facility which means more interaction with community spread. We expanded our COVID-19 Care Unit  and are accepting a higher volume of COVID-19 patients to serve community and our  hospital partners. Our concept was to better care for COVID-19 patients in a post-acute setting here and help hospitals by allowing them to open up more ICU beds for critical patients, thereby saving lives on both ends. 

7. Do you allow visitation? If so is that something you are considering getting rid of temporarily? 
 
We are not currently allowing in-person visitation due to increased rates in the community which are at their highest since the start of the pandemic. 

8. Where are you in terms of getting the vaccine? 

We will be receiving our first dose of the vaccine on January 19th and will receive the 2nd dose February 16th    

9. Are you expecting that to help? 
 
In a traditional LTC setting you have long term residents that will be protected once they receive the second dose of the vaccine. Unfortunately since we are exclusively a short term skilled nursing facility we will not be able to take advantage of those protections for our patients, as even the patients currently present to receive the vaccine will end up discharging back to the community and will be replaced by new short term patients within several weeks. Although our staff will benefit from vaccination, our patients will ultimately rely on the wider roll-out of vaccines to seniors and to at-risk populations in the community over the next several months. 

Sapphire said its residents will be receiving the first dose of the vaccine January 19thmany families like Mary Joyce are hopeful the vaccine could help lower the number of cases we’re seeing right now.  

If you have a story you’d like us to investigate, reach out to us at investigators@kvoa.com or call our tip line at 520-955-4444. 

Chorus Nylander

Chorus Nylander is the Chief Investigative Reporter for News 4 Tucson. He is focused on giving the voiceless a voice and holding the powerful accountable.

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