The scale of the crisis became public only recently, when Gov. Ralph Northam (D) acquiesced to demands from families, advocates and lawmakers to identify facilities with known infections after months of refusing to do so.
The data showed that nursing homes and assisted-living facilities have reported more than 6,200 infections and 889 deaths — 55 percent of all fatalities in the state — with many of the worst outbreaks concentrated in Northern Virginia.
And those tallies are likely to increase as the state health department works to complete universal testing at all facilities — and as families demand access to their elderly loved ones even though they are most vulnerable to the virus.
“Reopening will 100 percent add to new cases — it’s inevitable,” said Mike Williams, chief executive of English Meadows Senior Living, which operates eight facilities in Virginia.
The stakes are high for these facilities, said April Payne, a vice president at the Virginia Health Care Association, as Virginia, Maryland and the District ease restrictions on restaurants, fitness centers, stores and public gatherings. Many nursing homes and assisted-living centers are in intense “planning mode” for how to walk this tightrope, Williams said.
Some are constructing ventilated tents to allow outdoor visits. Others are stocking up on gloves, which restaurants and shops are buying in bulk to reopen.
“What’s happening in the community is very, very different from what is still occurring in nursing homes,” Payne said. “We’re not over dealing with the outbreak. We’re still in it.”
In the state’s data, 121 facilities have the classification of “outbreak closed” or “pending closure,” which means that 28 days have passed without a new case of covid-19, the disease caused by the virus. Sixty-two facilities have outbreaks “in progress.”
Laura Forlano, Virginia’s deputy commissioner of population health, said Virginia, in conjunction with the National Guard, plans to finish testing all residents and staff at Virginia’s 280 nursing homes by early July and at the 580 or so assisted-living facilities by mid-August.
Forlano said that the state has made “good progress” on this front, though some critics point out that Virginia lags behind Maryland, where the state health department finished conducting testing of all nursing home residents and staff in early June and continues to test staff members weekly, said a spokesman for Gov. Larry Hogan (R).
Hogan recently announced that limited outdoor visits would be allowed at nursing homes in his state. On Friday, he said assisted-living facilities that have not experienced new cases in 14 days can began accepting indoor visitors.
Outdoor visits at D.C. nursing homes are allowed as part of the city’s second phase of recovery, which began June 22. There must be weekly testing of staff and residents before such visits can begin.
Virginia has adequate resources to test all facilities at least once, Forlano said. But she did not address whether the state will be able to keep up regular testing of residents.
“I’m not saying it’s not challenging,” she said of the guidance to secure weekly testing. “I know it’s a heavy lift for these facilities. . . . But this pandemic requires extraordinary measures.”
Annandale Healthcare Center has had the worst outbreak in the state with 156 infections and 51 deaths. Fred Stratmann, a spokesman for the facility’s parent company, CommuniCare, said the company bought 1,000 tests in April to deploy to nursing homes in Virginia and Maryland, adding that the ready availability of testing will determine how quickly these facilities can reopen to visitors.
For the past four months, testing at long-term care facilities in Virginia has been a “disjointed situation,” said Rob Liebreich, chief executive of the nonprofit provider Goodwin House. He said the state helps to conduct baseline testing but provides little support for the ongoing, repeated tests needed to assess whether a facility is rid of a virus or experiencing a resurgence.
Goodwin House, which operates retirement communities in Alexandria and Baileys Crossroads, has spent more than $2 million procuring test kits and protective equipment, as well as compensating employees who normally work at multiple facilities but now can work at only one to limit the risk of exposure. These expenses will continue until a vaccine is found, which may take more than a year.
Northam last week announced a $246 million funding package for long-term health facilities, including $56 million dedicated to testing. Liebreich and other industry advocates say it’s a good start but not enough.
“Without additional resources, you’re going to see a number of operators having to make really hard choices,” Liebreich said.
Del. Patrick A. Hope (D-Arlington) said he blames the federal government for the lack of testing in nursing homes and long-term care facilities but noted that he also worries about a second wave of deaths from the deterioration of residents who have been isolated for an extended time.
He and state Sen. Scott A. Surovell (D-Fairfax) were among the lawmakers who called on Northam to release the data on nursing homes earlier, saying increased transparency might have helped policymakers and the public understand the scope of the problem.
“No one knew how bad it was,” Hope said.
At Skyview Springs Nursing Home in Luray, where the state reported 151 infections and 21 deaths, a longtime resident fed up with the restrictions recently approached administrator Jill Irby and demanded to have her son come pick her up. Irby said she called the woman’s son, who said that he wished he could bring his mother home but that he works full time and cannot afford home care.
“We allow window visits — but that is not the same as seeing them in person or being able to hug and kiss them,” Irby said. “It’s been very depressing. Not only for residents, but for staff as well.”
For Marta Cakert, one of the most difficult parts of the situation has been not being able to see her aunt Maria Arango, a resident at Leewood Healthcare Center in Annandale, who was among the first of the 115 positive cases reported at the facility.
The family started making funeral plans as Arango’s condition deteriorated in April, but the woman has recovered, Cakert said.
“We can’t selfishly want to see her and possibly pass something on,” said Cakert, a nurse practitioner. “I personally would not be able to live with myself.”
At some facilities that did not experience outbreaks, leaders have been waiting for weeks to lift restrictions and seized the opportunity to do so when Northam issued his reopening guidance.
At English Meadows Senior Living, which had no cases at seven of its eight locations, residents have begun to resume communal — but distanced — meals together, and facilities have arranged outdoor visits.
“The emotional and mental toll [the shutdown] was taking on them was getting to a point of being counterproductive,” said Williams, the chief executive.
But as Virginia further lifts restrictions on social and commercial activity, Williams said, he is also concerned about the possibility of caregivers interacting with more people, especially over the July Fourth weekend, and potentially bringing the virus back into the facility.
He has urged his employees to avoid large gatherings and offered masks for them to use when they are off work.
“Caregivers go home at night, they go do things, then they come back,” he said. “It’s the tough X-factor in this situation.”