Residents, staff of Florida's elder homes still struggling to get tested, despite elevated risk
One assisted living facility director has called the state's coronavirus testing policy "an unmitigated disaster" for the elderly population
By Mary Ellen Klas and Kevin G. Hall
MIAMI — On March 12, three days before state officials took any formal action against the emerging coronavirus pandemic, Doug Adkins put his 155-bed assisted living facility on full lockdown.
Twelve days later, he had hired a lab to test every patient and staff member for the novel coronavirus and required any contractor or vendor to submit to a test and prove they are COVID-19-negative before they set foot in his facility. On April 21, he tested again.
The massive surveillance testing plan worked. For nearly two months, Adkins kept the residents and staff of Dayspring Village, a mental health ALF just south of the Georgia line, free from the viral infection — until last week. That's when he broke his own rule.
"A fine young man applied for a maintenance job and I hired him," Adkins said. "He's as healthy as an ox, a very talented fellow. He's also a big mental health advocate."
Adkins put him to work right away instead of waiting for the coronavirus test results and two days later — despite his being asymptomatic — his test came back positive. His unwitting exposure to three staff members at the home, who had been within three feet of contact with the new employee for more than six minutes, meant they all had to be quarantined for two weeks and then tested again.
Every room the man entered had to be disinfected, yet Adkins is feeling good.
Our testing protocol worked because we caught an asymptomatic carrier when I least expected it, and nobody has any symptoms," he said. "This is what should be happening across the state. Instead, it's an unmitigated disaster."
For weeks, COVID-19-related deaths and positive cases have been on the rise at nursing homes and elder-care facilities across the state even though those same facilities have been off-limits to visitors since March 15 because of an executive order by the governor. The latest death toll: 577, more than one in three of all COVID-19 deaths in Florida.
There is little mystery behind what is considered the main culprit in this grim statistic: asymptomatic carriers — many of them long-term care staff members, who are getting tested infrequently or too late.
Despite state efforts to ramp up testing, administrators at nursing homes and assisted living facilities told The Miami Herald and Tampa Bay Times it is a piecemeal program that is failing to identify risk and completely contain the virus among the state's most vulnerable.
'broken testing policy'
Gov. Ron DeSantis has tried to accelerate the testing at long-term care facilities and the Department of Health has altered its guidance to give workers at long-term care facilities new priority. The governor has ordered the National Guard to conduct on-site tests at elder-care homes.
On Wednesday, the state launched a mobile testing lab equipped with a rapid diagnostic testing machine that will travel to long-term care facilities, test residents and staff, and produce test results in 45 minutes.
The state is also testing for antibodies for some healthcare workers in Miami and Orlando. And on Tuesday, the governor did what long-term care facilities have been seeking for nearly two months: he ordered hospitals to test patients for COVID-19 before transferring them to long-term care facilities.
"All of this is great, but way too late," said Doug Fresh, CEO of the senior care community St. Mark Village in Palm Harbor, where nine of his residents have died of COVID-19. "If the testing is as available as they say, where is it? I have tried everywhere."
Adkins, whose wife, Janet, is a former Republican state legislator from Fernandina Beach, says that as his experience proved, the state should be focusing its resources on testing everyone, not just those with symptoms.
If you are not testing for asymptomatic infection you are exposing people to potential risk. It's as simple as that," he said. "The Department of Health has a broken testing policy ... . It lacks the insight that asymptomatic carriers are the biggest threat to a population of vulnerable adults."
On Thursday, he got an update from the maintenance worker, who sought a second test at Baptist Medical Center-Nassau. This time he tested negative, relieving Adkins but raising new questions.
"The presence of faulty tests is also a concern for many of us, and test reliability," he said. "I am glad our situation turned out to be a false alarm. It put us through the steps of a live drill and we are better for the experience."
Residential Plaza at Blue Lagoon, where Rosa Zamanillo died of COVID-19, was scheduled to be the first stop for the mobile testing lab on Thursday. Employees at the 350-bed facility had sought testing at drive-up sites in Miami and the National Guard arrived last week to test everyone on staff, but was taking too long to get results, said Juan Sanchez, a spokesman.
"Looking at the 269 initial test results we have received in the past month, lag times are averaging just over seven days," he said. "Half of these took nine or more days and up to 15 days. At one point, we had pending test results for 29 residents who had been tested more than three weeks earlier and for three who had been waiting for over four weeks."
The value of the tests is to give administrators a guide so they know where to direct their resources to contain the virus, Sanchez said. "But if you've got a blind spot of seven to nine days and the virus could kill someone in two, there's no real clear benchmark."
At a news conference in Miami Wednesday, DeSantis noted "just the extra day or two to get the results could be the difference in preventing a significant spread and saving lives and so we're happy to be able to do it."
But National Guard officials refuse to discuss why some homes are tested in full and other places only partially, or how the determination is made to test any given nursing home. They referred questions to the Florida Division of Emergency Management, which asked for questions in writing and then did not answer them.
Martin Goetz, chief executive officer of River Gardens Senior Services in Jacksonville, has written to the governor asking for immediate, regular and rapid testing at all elder-care facilities, including his own.
"Anything short of that places residents and staff in immediate jeopardy," he wrote. He has received no response. He doesn't hold back when talking about his disappointment with the administration's approach.
"It's been a shit-show from the very beginning," he said.
Some administrators said states like Maryland and Ohio have made the right call to test all residents and staff in elder-care facilities for coronavirus, even if asymptomatic. Some are feeling helpless. Others are adopting Adkins' approach and are finding their own solutions.
State was unprepared
With decades of experience, Fresh of St. Mark Village was as prepared as he could be for the coronavirus.
A U.S. diplomat in Thailand who had a family member at St. Mark warned Fresh that a deadly virus was running rampant in Asia and would surely hit U.S. shores. By Feb. 28, Fresh had met with his leadership team, staff and residents to warn of what was ahead. The Lutheran Church-sponsored non-profit provides retirement housing ranging from independent and assisted living to skilled nursing and hospice operations.
We immediately canceled all group activities on property and all trips outside of our community involving large venues," Fresh said. "We monitored social distancing in our dining room before it became the way of living and offered take-out and delivered meals."
Hand sanitizer stations arrived. Residents were given masks to wear and temperature checks in the skilled nursing areas. As the national crisis grew, St. Mark began limiting visitors and soon went into protective lockdown.
So while Fresh prepared, he didn't count on the state of Florida being so unprepared.
As he started seeing COVID-19 infections in a medical wing of the nursing facility around April 10, Fresh desperately sought testing of all residents. He couldn't get it. Every day for a week, a resident in the skilled nursing area where residents need medical care and are thus more at risk would show symptoms for COVID-19 and every day he kept trying to get everyone tested so he could contain its spread, but the tests were limited to those already sick.
In all, nine staffers and 23 nursing care residents tested positive for the respiratory disease. Nine residents died. After more than seven weeks of trying, Fresh last week managed to arrange his own tests for more than 100 members of his staff through AdventHealth, a local hospital.
However, while he was told the results of tests done this Monday would be returned in 24 to 48 hours, he is now told they won't be available until next Monday.
"How can I make decisions without information? That data will be too old to use," he said. "Testing turnaround needs to be improved along with testing availability. Pinellas County appears to be the worst. We are now looking for more tests."
Fresh also hasn't been able to get all his residents tested. He said he often learns of an infection when a patient is taken to a hospital and tested. By then, the virus may have spread or at minimum threatened the safety of staffers.
He added that it bothers him to hear DeSantis boasting that widespread testing is available and being done efficiently.
"I hear him on the news. If he has got plenty of tests and great turnaround times, I haven't seen it," Fresh said.
Goetz, of River Garden in Jacksonville, has tried to get his staff tested but with no one showing symptoms, he can't. "In a campus like mine the only people coming and going are staff and they go home with their families," he said.
"The state keeps chasing the fire," he said. "The only way to get ahead of this fire is deal with it at the front end and test all the staff in a place like mine, identify anybody who is silently carrying this virus so we can (isolate) them from the herd."
Under pressure from media lawsuits, Florida health officials recently began providing fuller data on infections of staff and residents at long-term care facilities statewide and a death count where applicable. But there is no data released yet on how much testing is happening at nursing homes.
It is widely presumed that places hardest hit are left short-staffed as caregivers must undergo two weeks of quarantine and testing before being able to return but the state has offered no information about how facilities are handling the challenge.
For some families, the lack of transparency is haunting.
A woman whose parents live in the South Port Square senior living community in Port Charlotte, which has had two deaths linked to coronavirus, says after infections spiked there, the Florida National Guard arrived to do testing but administrators would not discuss fatalities or why all residents were not tested.
"It's kind of maddening. If they are right there and they don't test all the elderly in the place, it's kind of stupid in my opinion," she said.
She agreed to speak to the Herald/Times providing she not be identified for fear of retaliation against her parents, who are in an independent living section and doing fine. The lack of broader testing and reliable information about results is troubling to her, especially given the silent nature of COVID-19.
"I would like to know what's going on everywhere in Florida," she said.
9% of all staff tested
Kristen Knapp, spokesperson for the industry trade group the Florida Health Care Association, said the National Guard has told the group it has tested 90 of the 3,800 facilities in the state, about 2%, and 13,000 of all residents and staff.
The association estimates that, based on the number of positive cases reported at long-term care facilities by the Department of Health, the total number of tests administered to the 155,000 long-term care residents in Florida is about 38,250. Of the 200,000 total staff at long-term care facilities, about 19,200 — 9.6% — have been tested.
"We welcome testing," Knapp said. "It gives us information from a clinical perspective and a staffing perspective, so the more testing that we have, the better." But, she acknowledged each test is a window into a fleeting moment and repeated testing will be needed.
"We haven't even had the conversation about second testing," she said.
What's the answer? Several administrators say rapid testing machines such as those produced by Abbott Laboratories should be deployed to every healthcare facility in the state to regularly test staff and residents. National leaders could use the Defense Production Act to have them manufactured.
Last week, Families for Better Care, an advocacy group for long-term care residents, proposed using some of the $225 million in federal fines collected for nursing home violations to fund onsite rapid testing machines, including $13 million collected in Florida.
Fines levied for abuse and neglect are already redistributed through Medicare's Civil Monetary Penalty Reinvestment Program, and the group proposes streamlining the application and approval process so some facilities nationwide can acquire the point-of-care testing machines.
And Adkins, the director at Dayspring, suggests Florida should use its leverage as a top purchaser of pharmaceutical drugs from Abbott Labs to demand the company sell the state thousands of rapid testing machines, which he estimates cost about $6,000 apiece.
"That is essential to restoring public confidence," he said.
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