When a long-term care facility, like a nursing home or assisted living location, alerts the state health department about a positive COVID-19 case, Michelle Hofmann’s team leaps into action. They talk to the facility and walk them through how to isolate patients and can even bring mobile testing to the facility.
“At times during our pandemic, [the death toll at long-term care facilities] represented 50% of the state's total deaths in cumulative numbers,” Hofmann said. “Currently, we're at 36% of the state's total deaths. And so when you see that coming down, that tells us that we're doing what we hope to be doing, which is ... we're preventing death in long-term care facilities.”
Her team’s job has gotten more difficult since the COVID-19 surge that began in September. Since then, the number of long-term care facilities that have five or more active COVID-19 cases have increased from just four to almost 40. But Hofmann’s team hasn’t gotten any bigger.
She said that has led to “a lot of burn out” and is “very difficult to sustain.”
“When you assign an infection preventionist to each facility, they're their lifeline,” she said. “Facilities are calling with all kinds of things and all kinds of needs. And so that means working on weekends and catching up in the evenings and not taking holidays off.”
In addition to burnout, they’ve been falling short of their goal to keep 90% of outbreaks below five cases.
“Now the numbers of events that we're experiencing overwhelm our response,” Hofmann said.
Her team has used grant money from the Centers for Disease Control and Prevention, the federal CARES Act and other programs to hire more staff. It’s about five times the size it was at the beginning of the pandemic, but hasn’t received any new grants in the past three months.
Facilities themselves are also facing staffing challenges, according to Allison Spangler with the Utah Health Care Association.
“Long-term care is already facing a growing workforce shortage and crisis due to staff members getting sick, lack of priority, testing for staff [and] school closures,” Spangler said.
In some facilities with outbreaks, she said, staff with COVID-19 are working with patients who have also tested positive. If staffing challenges get worse, workers with the virus could interact with residents who are suspected to have the disease, or even with residents who don’t have it.