The state public health lab is organizing mass COVID-19 testing in nursing homes over the next month—starting in communities with substantial spread of the virus.
Long-term care facilities in the state face two overwhelming challenges. Their residents are some of the most vulnerable to COVID-19. In fact, more than half of the state’s COVID fatalities are older patients. The pandemic is also exacerbating existing financial challenges.
Most nursing homes in the state closed their doors to visitors nearly two months ago. That’s one of many steps to reduce the spread of the virus to residents. Staff members are screened for fever and other symptoms at the beginning of each shift, all employees wear masks, and residents who test positive are isolated. They’re cared for by staff who can’t pass through any other part of the building.
Dr. Greg Johnson is the Chief Medical Officer for the Good Samaritan Society, one of the largest senior living organizations in the country. He says the pandemic has changed nearly everything about how they provide care.
“There’s masking for residents, there’s generally a desire to have residents remain in their room as much as possible,” he explains. “That runs a little counter to my fiber as a geriatrician. We’re always trying to get people out of their rooms and get them socializing more, but right now it’s a bit safer to have them have less contact.”
Despite prevention measures, the virus has infected residents at several long-term care centers in Sioux Falls. The Good Samaritan Society’s Sioux Falls Village has seen the worst of it.
Dr. Johnson says the facility is currently on its second round of mass testing for all residents and employees. As of Wednesday morning, 44 residents and 13 staff members had active COVID-19 cases. Twenty residents have died from related complications—more than half of the state’s total deaths.
Dr. Johnson says the facility has instituted regular group meetings to help staff deal with the emotional strain of the pandemic.
“Dealing with the struggle of a changed workflow, how [much] harder it is to deliver care with all these extra checks and restrictions and personal protective equipment. But most of all, these patients that are like their family members…you know, there are deaths associated with this.”
The pandemic is having a significant impact on all long-term care facilities—even those without COVID-19 cases. Loren Diekman is the administrator of the Jenkins Living Center in Watertown. It’s one of the state’s largest skilled nursing facilities. He says they have fewer residents now because referrals from non-emergency hospital procedures are down. As a result, some rehab facilities have seen a revenue drop of 25 to 40 percent. Despite having fewer patients, Loren Diekman says his facility is cautious about bringing in new residents.
“We’re being very selective on admissions and do require someone has been tested for COVID first before we accept them as a resident,” Diekman says, “and I think a lot of facilities are probably doing that.”
But that’s not the only financial burden for nursing homes. They were facing a funding crisis even before COVID-19. The South Dakota Health Care Association’s executive director Mark Deak says in the past two years, six South Dakota nursing homes went out of business.
“We have that Medicaid gap that is very significant,” he explains.
On average, about half of all nursing home residents pay for their care through Medicaid. States determine how much they reimburse facilities for that care. South Dakota continues to have one of the lowest reimbursement rates in the nation. Even with increases over the past two legislative sessions, Mark Deak says South Dakota nursing homes lose an average of $42 a day for every resident on Medicaid.
“So we’re coming into this under enormous financial strain,” says Deak.
The pandemic is straining other aspects of long-term care, like staff shortages. Tammy Hatting is the VP of Post-Acute Care with the South Dakota Association of Healthcare Organizations. She says some facilities have to shift around staff to cover for a worker who may be showing COVID-19 symptoms.
“You’re paying the staff person who’s home for 14 days in quarantine and you’re paying an additional staff to come in and cover that shift. So their staffing costs are going through the roof along with supplies,” says Hatting.
Most facilities have an infectious disease nurse on staff and a stockpile of supplies, but Hatting says none were prepared for a situation of this magnitude. It’s especially difficult for smaller rural facilities.
“Just finding the supplies and amount of money and time they’re spending,” Hatting says. “In fact, we had one person, they literally go to the dollar store to look for paper towels.”
Earlier this week, state Secretary of Health Kim Malsam-Rysdon announced the supply chain is showing improvement. She says the state will help distribute more personal protective equipment throughout South Dakota.
In the meantime, facilities look to local sources to fill the gaps. Trista Bates is the administrator of the Walworth County Care Center in Selby. She says it’s important to reach out to existing support networks.
“For example, the emergency management coordinator here in Walworth County,” she says. “Reaching out to her, and she’s been really good about getting us masks and checking in to see if we need anything.”
In Selby and many other communities, sewing groups are donating masks for care providers and looking for other ways to help. Dan Biel is president of the board for the Walworth County Care Center. He says people want to do what they can.
“I know I had a call the other day where someone had their stimulus check and said, “I really don’t need it. How can I get it to the care center?’ Things like that.”
There has been financial assistance for some facilities from federal relief spending packages, but a drop in state sales tax revenue will create a long-term effect on South Dakota’s nursing homes.
Governor Noem says she wants more flexibility in how the state can use that federal relief money.
Mark Deak with the South Dakota Health Care Association wants the same thing.
“I understand there may be restrictions on some of those, but it’s my understanding some of those funds have been used in other states, so we’ll certainly continue to reach out to the governor, to her staff, to talk about how we could do that here.”
Without that flexibility, Noem has threatened to cut the state reimbursement rates.
For now, most long-term care providers are focused on one day at a time. As businesses loosen pandemic restrictions, Dr. Greg Johnson with the Good Samaritan Society says the danger of infection is still top of mind.
“In the absence of a cure or a vaccine, you really have prevention and isolation to protect people from contracting COVID when there is community widespread,” he says. “Every time we open the doors, so to speak, we have to consider that risk of exposure.”
Loren Diekman with the Jenkins Living Center in Watertown has this prediction for the future:
“Even as the state begins to open up and the country, I think nursing homes—we might be one of the last ones to really allow visitors and things in. And I just say that because again, we have this vulnerable population. We want to make sure they’re safe.”
Diekman says that’s one thing that hasn’t changed: their mission to keep residents safe and healthy every day.
