SIOUX FALLS, S.D. (KELO) — While much of South Dakota appears to be living an open life during COVID-19, residents of nursing homes remain in lockdown.
“Nursing homes are taking it in the pants when it comes to changing lifestyles,” said Laura Wilson, the administrator of Tieszen Memorial Home in Marion. Nursing homes are living under restrictions while it appears much of the state is living normal lives despite the pandemic, Wilson said.
“I just need people to think about others,” Wilson said. The others means parents and grandparents or other relatives who are living in nursing homes.
Nursing home residents are considered to be among the most vulnerable to COVID-19 because of their age and underlying conditions.
Right now, residents of Tieszen can’t attend chapel together or do group activities. Visitors see their relatives through a window or outdoors with six feet of space and masks between them, Wilson said.
“Residents may eat in the dining room with a limited number of people at each table and social distancing at least six feet apart as long as they do not have any symptoms,” Heather Krzmarzick, the Regional Vice President of Good Samaritan Society, said in an email response to questions.
Tieszen created outdoor visiting so residents can see relatives and friends but those also require social distancing.
“Outdoor visitation is generally allowed and indoor visits are generally reserved for compassionate care visits,” Krzmarzick said. “Each nursing home or assisted living needs to monitor the community spread and make adjustments in order to prevent the spread of COVID-19 into the building.”
Meanwhile, people can go into bars and restaurants which, for the most part, have no or few restrictions, Wilson said.
The South Dakota Department of Health has guidelines for how long-term care facilities in the state should re-open during the COVID-19 pandemic. There are three phrases with the third being back to normal and full re-opening.
Phase I is for when there is moderate or substantial community spread in the county where the nursing home is located. It’s also the phase where there is no suspected or confirmed case in the nursing home. Phase II is when there is minimal community spread and in the nursing home, there is no new onset and it’s been 14 days since the last positive or suspected case.
“Currently, the State of South Dakota Back to Normal Long-Term Care Reopening Plan states that a nursing home or assisted living center would need to remain in Phase I if there is more than minimal to moderate community spread (based upon the Department of Health website) or if there is a suspected or confirmed case of COVID-19 in facility residents or staff,” Krzmarzick said in an email response to questions.
During the Aug. 24 news briefing, DOH Secretary Kim Malsam-Rysdon said protecting the vulnerable population in the nursing homes continues to be priority. She also cited the DOH’s plan for re-opening nursing homes.
The Center of Medicare and Medicaid Services (CMS) has guidelines for how nursing homes can re-open in a three phase plan. The phases depend on the level of COVID-19 transmission in the community and the nursing home. The number of new daily COVID-19 cases, cases over a 14-day period and the percentage of positive cases are part of the considerations to re-open.
President Donald Trump and the U.S. Health and Human Services in late July issued an order that nursing homes in states with a 5% COVID-19 positivity rate must do weekly COVID-19 testing on staff.
“For us, it’s totally the key to re-opening,” Wilson said of the COVID-19 percent positive rate and transmission rate.
“We are located in Turner County. Turner County has substantial (community) spread,” Wilson said. “There is no way we will move out of phase I with community spread that high.”
The prevalence of the spread of COVID-19 has an impact on long-term care facilities, said Mark Deak, the executive director of the South Dakota Health Care Association.
South Dakota’s positivity rate was 9.4% over the past 14 days as of Aug. 26. Turner County had 70 COVID-19 cases and community spread was listed as substantial as of Aug. 26.
How the general public impacts nursing homes
Keeping COVID-19 out of long term care facilities takes its toll, Deak said.
“It’s an incredible challenge…,” Deak said.
Actions by the general public contribute to the transmission of COVID-19.
Those same actions can also directly impact a nursing home.
While Wilson said nursing home employees are curbing their personal activities outside of work, in mid-July, a COVID-19 positive person “came in contact with eight different employees.”
Wilson said the nursing home has not had a COVID-19 case in residents and only recently had its first two employees test positive but they had not been at work before being tested.
Recently, 138 staff and residents tested negative for COVID-19, she said.
But it has had those who have had to quarantine for 14 days because of close contact, Wilson said.
And the longer the COVID-19 percent positive rate is high and community transmission is high, the longer nursing home staff have to maintain a lifestyle to protect themselves, their family and nursing home residents, Wilson said.
She goes to work. And after work, “we just stay home,” Wilson said.
Now, many schools are starting with in-person learning.
There are students in the Marion Schools that are associated with the nursing home and its employees.
A COVID-19 positive case in school could wipe out a portion of her workforce, Wilson said.
“Those are the things that keep me up at night,” Wilson said.
Malsam-Rysdon said the state will continue with sentinel testing at nursing homes, which is weekly randomly testing asymptomatic staff and residents to identify COVID-19 cases.
“The Good Samaritan Society locations in South Dakota have been doing weekly sentinel testing of one resident and two team members each week,” Krzmarzick said.
As to the testing implications from the president and the CMC’s 5% requirement, We have been participating in calls with the South Dakota Department of Health to learn more about future testing for staff,” Krzmarzick said.
Malsam-Rysdon has said in at least two recent news briefings that the DOH is working with federal officials to try and have the 5% testing requirement apply to communities since the positive rate will vary in communities across the state.
What additional help is needed?
Wilson praised the DOH for its help during the pandemic but said the state could provide additional help by providing more details on city-specific locations of COVID-19 cases.
Early in the pandemic, restrictions in parts of the state, closing schools and practices by the general public were working, Wilson said. “Everything was looking good and then, the weather got nice,” Wilson said.
Events that attracted large groups started happening and the COVID-19 numbers increased, Wilson said.
“I need people to wear their masks. I need people to stay home when they can,” Wilson said.
In the end, Wilson said, it’s not about what we may want as individuals, “it’s about our grandparents and parents.”
As it is now, even if things improve, Wilson said visiting a resident inside a nursing home as it was in pre-pandemic won’t likely happen until 2021.
Keeping COVID-19 out of a nursing home takes money.
Deak said long term care facilities were dealing with a $42 per resident per day shortfall in Medicaid reimbursement when the pandemic started.
“If we’re going to stay committed to serving those that we care for…they need to give us resources,” Deak said.
They is the state and federal government, he said.
Two prior legislative sessions ago, South Dakota increased Medicaid reimbursement, which was greatly appreciated, Deak said. Even with that increase the reimbursement rate is falling behind costs, he said.
“Over 50% of nursing home residents are on Medicaid,” Deak said.
The existing shortfall in reimbursement combined with the “horrible virus” means “We need to step it up as a state,” Deak said of increasing funding for nursing homes.