Hartford Business Journal

www.HartfordBusiness.com • June 15, 2020 • Hartford Business Journal 19 they examined prior to June 3. There is also a lack of clarity over why Con- necticut facilities with more black and Latino residents have been hit harder by the outbreak compared to those where the population is mainly white. Finding answers to those ques- tions could be the key to readying Connecticut for the next public health emergency, officials say. The good news, though, is that death and infection rates at long- term care facilities have slowed in recent weeks, allowing some nurs- ing homes to begin loosening visitor or other restrictions. "As we prepare for the possibility of a second wave, we must be proac- tive in analyzing what occurred, what needs to be improved, and how we can ensure the quality and safety of facili- ties that some of our most vulnerable residents call home," the governor said in announcing the third-party review of senior-care facilities. Mitigation playbooks As The Retreat started to learn more about the severity of the COVID-19 outbreak, it implemented the Centers for Disease Control and Prevention's mitigation plan for nursing homes on March 10, instead of waiting for the state's guidance that came weeks later. CDC's infection prevention and control program offers low-, me- dium- and high-risk response plans for sites as needed. The Retreat, Lubetkin says, took the urgent step of selecting the high-risk level right away because that was being used as a blueprint for nurs- ing homes, which are regulated more tightly by federal and state govern- ments and have more access to PPE. "It helped to give us guidance because [assisted-living facilities] un- fortunately are still not guided as best as we can be," she said. "So it was kind of up to us to come up with this plan." The high-risk plan forced The Retreat, which provides behavioral health and addiction services to cer- tain fixed-income residents ages 65 and older, to reconsider visitation, food service, sanitation, ventilation and even laundry service. New rules included making sure employees aren't working at mul- tiple sites, and that they had enough PPE to protect themselves outside of business hours. The Retreat has shut down commu- nity dining areas for several months and instead delivers food directly to residents' rooms twice a day to limit exposure from outside environments. It also sterilizes mail before it enters the building; provides tem- perature checks for residents and visitors; uses staggered shifts; holds outdoor staff meetings; uses tele- health and modified laundry services; and provides videoconferencing and limited outdoor seating for residents to visit with family and friends. "We try to have as much fun as possible because it's a marathon and it's not ending anytime soon," Lubetkin said. Vernon Manor, an independently owned and privately managed nursing home in Vernon, is another long-term care facility that recently reported all of its 100 or so residents and 180 em- ployees tested negative for COVID-19. The two-story nursing home, serv- ing mainly Medicaid recipients origi- nally from eastern Connecticut, also took immediate action following CDC guidelines in mid-March, according to Administrator Angela Perry. For example, Perry said it required universal face-coverings for staff, secured a three-month supply of PPE and completed so-called point preva- lence surveys that involved testing all residents. State health and nursing home officials say this is a vital data- collection tool that can be used to con- trol the potential spread of infection. Other precautions include install- ing small, portable air filtration sys- tems in high-traffic common areas; hiring an outside vendor to boost in-house cleaning services; limiting community activities; supplying PPE to staff; and collaborating with other facilities on best practices. Residents were even educated on the health benefits of social distanc- ing during the pandemic. "I think what really led us to not having any cases to date is we imple- mented practices early on," Perry said. Looking for answers It's still not fully clear why the virus transmits more at certain nursing homes or assisted-living fa- cilities, said Matthew Barrett, presi- dent and CEO of the Connecticut Association of Health Care Facilities (CAHCF), which represents assisted- living facilities and for-profit nurs- ing homes in the state. Barrett said a lack of nationwide understanding about asymptomatic transmission of COVID-19 earlier this year played a key role in cases spiking at senior-care facilities. The lack of testing capacity and PPE early on also contributed to the country's late response, he said. But that still doesn't fully explain why some nursing homes have zero cases and others have been hit hard, including the Arden House in Ham- den, which has reported 171 resi- dents with COVID-19, said Barrett, who recently supported Lamont's call for an independent review. With the majority of facilities implementing symptom-based strategies and regulations, he said many of CAHCF's nursing home and assisted-living facility members have wondered whether density of population and the presence of COVID-19 within that group is a driving force behind a spread. "Everyone has implemented a se- vere visitor restriction, temperature checking, and limited entry into the building for anybody who could be an asymptomatic carrier," Bar- rett said. "But we weren't catching anyone between January and March who was an asymptomatic carrier." Following the governor's recent executive order mandating that nursing homes start testing their workers every week, Barrett said the industry will dramatically improve its ability to identify and isolate infections from both asymptomatic and symptomatic carriers. "Going forward we will achieve much better outcomes with a test- ing strategy in place, where we didn't have that in February, March, April and a good part of May," he said. " … And it wasn't because Connecticut nursing homes were wrong — the science, medical and academic community studying CO- VID didn't understand that it was transmitting through asymptom- atic carriers. We believe that will tell a big part of this story." CT nursing homes with the most COVID-19 cases Cumulative data as of 6/3/20 Licensed Residents with Laboratory-confirmed Probable COVID-19 Nursing Home beds COVID-19 COVID-19 associated deaths associated deaths Arden House (Hamden) 360 171 35 7 Riverside Health & Rehabilitation Center 345 152 39 20 (East Hartford) Litchfield Woods (Torrington) 160 127 38 2 St. Joseph's Center (Trumbull) 269 122 27 8 Silver Springs Care Center (Meriden) 159 121 15 3 Statewide total (170 of 213 nursing homes) 21,509 8,517 2,015 527 Source: Connecticut Department of Public Health Individuals receive temperature checks before entering The Retreat in Hartford.

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