CAPITAL REGION — As COVID-19 cuts another cruel swath through New York nursing homes, the facilities are on the verge of pulling ahead in their race against the virus.
The last of the 613 nursing homes in New York state are expected to complete first-round vaccinations Sunday.
That doesn’t mean 100 percent vaccination — some residents are ineligible for the shot, some have refused it and all still need the second round of the two-shot treatment. But even the first shot is believed to improve immunity, and some facilities have already begun administering the second round, which further boosts immunity.
Gov. Andrew Cuomo announced the milestone Friday, a bright spot in an otherwise glum update that began with news that the short supply of vaccine will be even tighter this coming week, as the federal allocation to New York was reduced.
The frail elderly in group living facilities are among the most vulnerable populations to COVID-19 and have suffered a doubtlessly huge (but still not fully counted) death toll in the pandemic.
State and federal agencies both list numerous facilities statewide with dozens or scores of deaths.
The latest federal estimate is that 101,970 nursing home residents and 1,313 employees have died of COVID nationwide as of Jan. 3; the feds placed the overall COVID death toll at 330,000 on Jan. 2, which would mean nearly 1 in 3 deaths were associated with a nursing home.
As recently as 2015, only about 1 in 250 Americans lived in a nursing home.
For that reason, nursing home residents and employees were given top priority when the vaccine began shipping in December. The campaign to vaccinate nursing homes began in New York through a federal program on Dec. 21, then accelerated this month with state assistance.
“Congregate care settings are a microcosm of a community,” state Department of Health spokesman Gary Holmes said Friday. “When the virus spreads in a community it can easily, and often unknowingly, enter a facility. However, continued strong infection-control practices and the quick administration of a safe and effective vaccine will help this community through the unimaginable hardship brought on by this horrible virus.”
The promise of the vaccine is great, but so is the irony of its timing: Just as the first supercooled doses were working their way through the distribution chain, many nursing homes were battling new infection clusters.
The vaccine came just a few weeks too late for more than 1,000 elderly New Yorkers: The state’s official nursing home COVID death toll was 6,514 on Oct. 13 and 6,609 on Nov. 13. It jumped to 7,134 on Dec. 13 and 8,280 on Jan. 13.
In the current second wave of the pandemic, just as in the first wave last spring, some Capital Region nursing homes have been hit hard while others have seen few or no infections. Notably, some of the facilities with the worst death tolls in the spring have been all but virus-free in the autumn, and vice versa.
- After New York’s first COVID case was confirmed March 1, the Glendale Home in Glenville had just a handful of infections for most of 2020, then had a cluster in December. The first resident death occurred Dec. 9, and there have been five more since.
- Shaker Place Rehabilitation & Nursing in Latham lost 15 residents to COVID, all of them before May 22; there have been zero deaths since and just one infection since Aug. 31, even as the positive test rate in the surrounding community soared.
- The facility with the highest reported first-wave death toll in the area — Fulton Center for Rehabilitation and Nursing in Gloversville — suffered 27 deaths by the end of July and none since.
- The local facility with the highest reported death toll in the second wave — Wesley Health Care Center in Saratoga Springs — was infection-free until Nov. 9 and has suffered 26 deaths between Dec. 13 and Jan. 14.
So much has changed since the pandemic hit in March.
More New Yorkers are testing positive but fewer are dying, as better treatments have been developed. More tests are being done than ever before to identify those who are COVID-positive. On state order and on their own, nursing homes are running several hundred thousand tests a week on staff and residents. Visitation is all but banned.
But one thing remains the same: When COVID finds a way into a group of frail elderly people, it can spread quickly and do great damage.
“We tried so hard to keep the monster out of the building,” said Lori Tambasco, administrator of the Glendale Home, a 200-bed nursing and short-term rehabilitation facility owned and operated by Schenectady County.
“We went 10 months. We got our first positives the night before Thanksgiving,” she said.
Six deaths is six too many, of course, but it could have been much worse. The staff was able to halt the spread quickly. By Jan. 15, just four residents were still COVID-positive, no longer sick but still showing traces of the virus in their systems.
Tambasco expects they’ll start to test clear this week and be able to rejoin the general population.
What succeeded? Tambasco credits an excellent staff, a relatively new building with good ventilation, few shared rooms and the luxury of time to educate staff and study what was happening in other nursing homes as they battled COVID in the spring.
A steady supply of protective gear helped, too.
“I was scurrying around,” Tambasco said. “I would go to a paint store and say, ‘Do you have any masks?’ ”
There was probably, she said, some blind luck involved, too. That ended in November, when an infected employee came to work.
A few other employees had been infected over the previous months and not spread the virus. But this one did.
Asymptomatic infection is a real threat, Tambasco said, and can slip between the scheduled weekly (now twice-weekly) rounds of employee testing. Knowing that it’s hard to detect doesn’t ease the feelings of guilt in an employee who brings it in, she said.
In the current tally, 93 percent of Glendale residents have gotten their first shot. Of the remainder, just three have refused. The others are either short-term rehab patients who can’t be vaccinated in-house or are long-term residents who were infected recently and will wait for a future round of vaccination. About 60 percent of the 250 employees have been vaccinated.
Three other nursing home operators around the region told The Daily Gazette via email about the challenges they’ve faced fighting COVID and what has worked for them.
- The Wilkinson Residential Healthcare Facility in Amsterdam, part of St. Mary’s Healthcare, had a brief but intense outbreak in the past two months that left 15 residents dead. There had been zero positive tests from May through late November, and the last two positives were cleared this past week — as of Thursday, Wilkinson is COVID-free again. Dr. Emily Etzkorn, a member of the St. Mary’s Board of Directors, said: “We are hopeful, as our residents and staff complete their vaccinations, we will see declining levels of infection and fewer infections, which will mean fewer deaths. We know that our best way to protect our residents is to decrease the community level of disease, which will in turn decrease the spread into the congregate care settings.”
- Shaker Place, operated by Albany County, was hit first and so far hardest among the three Capital Region public-owned nursing homes. But it engineered an effective response. Executive Director Larry Slatky explained the turnaround: “We started testing our staff before it was mandated and continue to test our residents weekly, and our staff are tested twice a week per the state mandate. We have other safeguards in place and are aggressive when it comes to infection control and tracing within the nursing home. If a staff member tests positive, even if it’s a false positive, we have precautions in place that are more stringent than regulatory requirements. We do our own tracing of staff, tracking back a minimum of seven days. Anywhere that staff person has worked becomes a restricted or isolated unit which is treated as if everyone there were positive. This means that gowns, goggles, face shields and masks are all used on the unit as an extra layer of infection control. It should also be noted that all resident admissions, even though they are negative upon admission, are quarantined for 14 days before they are assigned their permanent room/unit.”
- Van Rensselaer Manor, operated by Rensselaer County, was another nursing home that was nearly COVID-free for several months. It later developed an infection cluster that killed four residents. “The fall brought what we believe is a more contagious strain of COVID-19, and we started seeing an increase in cases in October. There were sadly several deaths also during November,” said Richard Crist, the county’s director of communications. “The seniors at the VRM have been largely isolated from friends and family. Being kept from loved ones is difficult for anyone, especially seniors. We think the isolation has been a factor and possibly made residents more vulnerable.”
THE DEATH TOLL
Exactly or even approximately how many nursing home residents have died due to COVID is impossible for the general public to know at this point.
The state Department of Health each day updates an online roster of the number of deaths in each nursing home in New York.
The federal Centers for Medicare & Medicaid Services each week updates an online database of resident infections and deaths at each nursing home in New York and the other states.
State total: 8,280 dead — 5,507 confirmed and 2,783 presumed.
Federal total: 6,076 dead.
But neither is accurate.
The state tally doesn’t include nursing home residents who die outside their facility, defeating one of the purposes of having such a list — to assess what went wrong and how to fix it. The operator of the Fulton Center, for example, told The Gazette on June 5 that 24 residents had died. The state lists just 12 cumulative deaths there from March 1 through Jan. 13.
The federal list lags by more than a week, but beyond that, some numbers are just wrong. The feds report 17 deaths at Shaker Place, which had 15, and list 13 deaths but only seven infections at Our Lady of Mercy in Guilderland.
Also, the federal total is much lower than the state total, and the state total by the state’s own admission undercounts the actual death toll.
Finally, these official death tolls are out of sync with the national trend. Federal data show 31 percent of those killed by COVID to be nursing home residents nationwide but just 15 percent in New York. Counting both confirmed and presumed deaths, state data show 25 percent of New York COVID deaths happening in nursing homes.
Beyond all this, the accurate larger picture may not easily be accessible. The early days of the COVID crisis were chaotic, with more than 600 New York nursing homes, many of them overwhelmed at the time, gathering and reporting information on a daily basis with varying techniques, terminology, timeliness and degrees of accuracy.
Nursing homes themselves aren’t much help, either. Of all the facilities in the Capital Region, only Wesley posts a daily online dashboard with a cumulative death toll. The Diamond Nursing and Rehabilitation Center in Troy and the nursing homes operated by Centers Health Care have online COVID dashboards that are updated daily but make no mention of deaths.
The rest are basically mum on the subject, on their websites and on their Facebook pages. The county-owned facilities disclose developments as they arise and will discuss the situation with journalists, but some private nursing home managers won’t even take calls on the subject.
This could be construed as careful marketing, but there’s likely also a significant element of compassion involved — nursing homes often function as communities and present themselves as such. In the past several months, these communities have lost a lot of members.
Even as they were providing daily public updates online, managers of the Wesley declined to discuss the situation further with The Gazette in December, citing sensitivity for those who’d died and those still living who loved them.
The larger picture, though — the total statewide death toll — is still sought by some people, relentlessly, whether for scientific or political reasons. The state has refused to quantify off-site deaths of nursing home residents. It has the data but says it wants to be sure the numbers are accurate before releasing them.
State Health Commissioner Dr. Howard Zucker was grilled for details at a legislative hearing last summer and refused to budge.
Nursing home deaths remain a political football. The charge often repeated in mid-2020 — that Cuomo and his aides caused the death toll to soar by moving infected seniors into facilities in March — appears to have been discredited by the fact that the death toll soared again in late 2020, long after the practice was halted.
The Empire Center for Public Policy has been trying without success to force release of full nursing home death data since the summer. On Wednesday, the state Department of Health delivered its latest refusal to the Empire Center, saying it would need until March to review the records requested.
The organization is officially nonpartisan, but its philosophies place it well to the right of Cuomo. The governor’s staff dismisses it as partisan, just as it has dismissed the Republican critics who’ve raised the issue.
Empire’s senior fellow for health policy Bill Hammond said: “The lengths they’re going to to deny the public the information and way they’ve spun and quoted misleading statistics, it’s making me wonder what we’re going to find out when we finally see those numbers. It could be worse than I think. It could be a lot worse than I think. I just don’t want to jump to conclusions.”
Even the now infamous March 25 state memo ordering nursing homes to admit COVID-positive residents — or more precisely, not deny them admission just because they had COVID — has been removed from public view but is still in force and has never been disavowed, Hammond said.
He said he never believed that directive caused the high nursing home death toll last spring, and he said the recent spike in deaths pretty much disproves it. But the pattern of spinning and obfuscation surrounding that memo is repeated elsewhere, he said.
The Empire Center has sued for release of the full nursing home death toll and has been joined with an amicus brief filed by state Sen. James Tedisco, R-Glenville, who has tried several other approaches to bring release of the numbers, all of them unsuccessful.
“This just continues to be a black mark on the governor as a public servant, as a leader,” Tedisco said. “I know the real numbers are going to be disappointing to him and I know they’re probably going to be embarrassing. It’s important to know.”
At the Glendale Home, the staff set up an isolation area for COVID-positive residents, which served as a mini-hospital for those who were sickest.
“I’m very proud of how the staff has taken care of the residents,” Tambasco said. The fear they might have felt at the beginning of the pandemic was absent when they were finally called to action in November, she said — the nurses and nursing assistants knew how to protect themselves and care for their patients at the same time, and some worked double shifts doing it.
She hopes to close the COVID wing this coming week, but said it can be reopened on short notice if needed.
It might not be, with the vaccination program progressing rapidly.
“Hopefully we get almost to 100 percent, which will be in three weeks from this weekend,” Tambasco said.
At that point, Glendale will look to the state for guidance on how to return a degree of normalcy to the lives of residents shut off from their families for most of 2020 and so far all of 2021. The residents can’t even mingle with one another at this point — they hang out in their doorways, people-watching in the corridors and waiting for an aide to stop by with the activity cart.
“Unfortunately, it’s not a hug from their family or that type of interaction yet, but hopefully that will come soon enough,” Tambasco said.
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