Experts fear for elderly amid virus surge in state with most nursing homes

The senior citizens who populate Texas nursing homes were not jammed into bars or packed onto beaches on Memorial Day, but officials there now fear that coronavirus that began spreading among younger people over the past month is imperiling the lives of the state’s most vulnerable.

It was a grim but predictable development for a state with more nursing homes – 1,218 – than any state in the nation, experts told ABC News. Some said they already suspect a link between the recent spread of the virus and a rise in deaths in the state's nursing homes over the past weeks, and said they fear the worst could be yet to come.

Back in mid-May, nursing homes in the state had reported 561 deaths from COVID-19, according to an ABC News review of state data. By last week, that number had nearly doubled at 1,035 deaths.

“As [the infections] continue to grow in numbers in the community, we would expect it to continue to grow in numbers in nursing facilities,” said Amanda Fredriksen, the Associate State Director for Advocacy for AARP Texas.

While nursing homes nationwide are continuing to experience casualties from the virus, some states that have seen decreases in their case rates are also seeing fewer nursing home deaths. Connecticut, for example, was reporting over 80 probable deaths in congregate care facilities daily in April, when the state was at its peak number of coronavirus cases. Now, Connecticut is reporting fewer than five deaths in these facilities daily as case counts decline.

Derrick L. Neal is the executive director of Williamson County and Cities Health District in Texas, near Austin. That district is home to Trinity Care Center, the facility in Texas that has reported one the highest number of fatalities to the federal government. In mid-June the facility had reported 32 resident deaths.

The region has also seen a rise in cases in the wider community, which he attributes to the state’s late-April opening and Memorial day festivities. Now, Neal said, he’s fearful that what he described as a continued failure by residents to adhere to social distancing guidelines could have a devastating impact on those living in congregate care facilities.

“The overarching concern is really a community, not everyone, but a large segment of society refusing to care for their neighbor by masking up and social distancing,” Neal said. “The same things that kept me up in March keeps me up in July.”

Since the beginning of the pandemic, nursing homes have been at the epicenter of the coronavirus crisis. Nationwide, those who’ve died in nursing homes account for nearly a third of all COVID-19 deaths, according to a recent survey of state-by-state data by ABC News – a figure that advocates believe may actually be undercounted.

In part, that is because national statistics have not fully accounted for some of the fatalities during the early days of the pandemic. Local news outlets in Texas also report that nursing homes in Texas have been among the worst in reporting conditions to federal officials tracking the outbreak.

The official count of the federal agency responsible for regulating nursing homes and tracking coronavirus cases in nursing homes says that 35,517 nursing home residents have died nationwide.

That number has continued to grow despite an evolving toolkit of preventative measures that began in March with the federal guidance to nursing homes to restrict visitors, isolate the sick, and require staff wear protective equipment.

In June, Texas followed the lead of Maryland and other states in forming “strike teams,” which could mount a rapid response when a nursing care facility showed the early signs of an outbreak.

Representatives for the Texas Department of State Health Services did not immediately respond to ABC News' request for comment for this report. The Texas governor has previously stated that protecting seniors in nursing facilities is a priority and earlier this month encouraged nursing homes to apply to receive parts of over $9 million in federal funding being allocated to Texas nursing homes.

"We know that older Texans are more susceptible to COVID-19, and Texas is committed to ensuring that nursing facilities have the tools they need to keep their residents and staff safe,” Abbott said in a press release. “We must continue to protect our most vulnerable populations, mitigate the spread of COVID-19 in Texas, and protect public health.”

But last month, when the state started seeing a rise in infection among young people, advocates for the elderly began to worry that their defenses would not be strong enough to prevent the virus' spread into nursing homes. That, said Patty Ducayet, the State Long-Term Care Ombudsman for the Texas Health and Human Services Department, appears to be happening now.

“We are still seeing new cases identified in both our nursing facilities and assisted living facilities,” Ducayet said.

Neal said he’s also concerned that staff, many of whom are low paid and lack the luxury of social distancing in their own living situations, are proving to be a vulnerability in the chain of transmission.

“It's really extremely difficult to stabilize a group of patients when you have a lower pay individual going in there to support them,” Neal said.

Organizations that advocate on behalf of nursing homes are urging that the rise in cases be met with a surge in testing and personal protective equipment for nursing homes. According to a survey by the Association for Health Care Associations, nursing homes report that they are still struggling to get tests processed in a timely fashion, and many report they do not have adequate access to protective equipment.

Testing is once again becoming a challenge nationwide as some facilities report being overwhelmed by the recent surge in cases. Jo Lynn Garing, a spokesperson for a leading high-volume test manufacturing company Roche Diagnostics, said the company is focusing on vulnerable states like Texas.

Garing said the company not only has been expanding its production capacity but also continues to be “very intentional” on its allocation and distribution of supplies, “prioritizing labs with the broadest geographic reach and highest patient impact.” Garing said the current priority areas are the same areas seeing surges, including Florida, Arizona, Texas and California.

On Friday, Governor Abbott announced a new partnership with Omnicare, a CVS health company, to provide COVID-19 point-of-care testing for assisted living facilities and nursing homes throughout the state. A release states that this partnership will help the state meet its goal of processing up to 100,000 tests in the first month it is operational.

"Our collaboration with public and private entities is crucial to ramping up testing in Texas and mitigating the spread of this virus—especially among our most vulnerable populations," Gov. Abbott said in a statement provided to ABC news after an inquiry for this report.

Aggressive use of preventive measures now could help, advocates say. But while community spread continues, nursing homes remain vulnerable.

“As long as those cases keep rising and as long as they're active in the community where these facilities are, it's going to be a concern for all of these nursing home residents,” Fredriksen said.

Editor's Note: This report has been revised to correct the number of reported deaths at the Trinity Care Center. As of mid-June the home had reported 32 fatalities related to the coronavirus.

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