Nursing Homes Struggling to Get a Handle on COVID-19

This is the fourth story in a series by MedPage Today examining the impact of COVID-19 on vulnerable populations. Past stories reported on the homeless, immigrants in detention, and the undocumented.

Staff members at the Canterbury Rehabilitation and Healthcare Center in Richmond, Virginia, did everything they could to prevent the spread of COVID-19. Even before the first case arrived at Canterbury -- a 190-bed facility that includes units for long-term care, memory care, and rehabilitation -- visitors were banned and group dining was shut down.

After the first case of COVID-19 was identified on March 13, Canterbury's owner, Marquis Health Services, "brought in a lot of resources and spent a lot of money," said Jim Wright, MD, the facility's medical director, in a phone interview. Because the company owned several long-term care facilities, Marquis "also had the advantage of having PPE [personal protective equipment] at multiple facilities, and they were able to divert PPE to us." Marquis also paid staff members at double the usual rate to boost retention.

As more COVID-19 cases appeared, "we immediately set up part of our nursing home just for people with COVID-19," he continued. "We moved them into isolation rooms and followed CDC guidelines; we closed the door and had an isolation cart outside that everyone used to change into gowns and gloves" when they went into a COVID patient's room. Moving patients to the ward was difficult because "we had to take residents and their belongings out of rooms they had lived in for years and move them down the hallway to a different unit, which was most strenuous in people power and time."

In addition, Canterbury assigned specific nurses to work only on the COVID ward "so they wouldn't be going from a COVID ward to a COVID-free ward," Wright said. "We developed ingress and egress from those wards so they wouldn't be in another part of the facility any time during the day." The nurses even parked in a separate parking lot, and had separate showers they could use before they went home. The facility also tried to test patients and workers, but it had limited access to testing, and the tests that were available took 11 days to be returned, he said.

Cases, Deaths Still Rampant

Even with all of that, with a census of 165 residents, Canterbury had 130 infections and 49 deaths, said Wright. "When we were finally able to test our entire population, we found that almost half of those tested were asymptomatic carriers. So we had residents with no symptoms still shedding the virus, transmitting it, and infecting others."

COVID-19 has been especially devastating for the dementia patients, he added, "especially if they're isolated in their room and they used to have a common area to visit and see family members. When they can do that, they're reminded what time of day it is, and if they see someone next to them eating, they're going to eat, so we've had quite a bit of trouble in those people living with dementia" and the facility is working hard to reestablish eating and hydration patterns. As a result, reintroducing group dining to dementia patients "is a number one priority right now," he said.