As restrictions eased on W.Va. nursing homes, ‘substantial community spread’ remained undefined

This week, the Justice administration highlighted alarm about how coronavirus spreading through West Virginia communities has endangered the fragile residents of nursing homes.

Governor Justice

“This situation just shows us over and over and over how vulnerable, especially, our nursing homes are,” Gov. Jim Justice said during a Monday briefing.

But the administration has left unresolved its own clarification of how nursing homes should take greater precautions when starts spreading more frequently from person to person in communities.

On June 17, the Justice administration issued guidance to loosen restrictions at West Virginia nursing homes but left to be determined a key factor to assess their safety.

The administration came up with color-coded guidelines allowing nursing homes to loosen all the way to green if conditions were stable. The status could back up to blue or red if a facility had a case of coronavirus — or if there was “substantial community spread” as defined by the state.

The system was not unlike the color-coded maps proposed to let communities know if it’s safe to open schools. For that plan, West Virginians are waiting for a “metric” that would signal whether the spread of virus is stable or getting out of control.

And, similarly, the nursing homes for weeks have been awaiting the state’s definition of “substantial community spread.”

Nursing homes are back in the spotlight because coronavirus has swept through several in West Virginia, resulting in fatalities and lockdowns.

Governor Justice said this week said all nursing homes in the state need to go through another round of covid testing, except he expressed doubt about testing capacity. And he also suggested nursing homes may again need to be restricted from any outside visitors.

“Absolutely, we should absolutely be more concerned, have a broader approach,” Justice said, describing nursing home deaths in facilities across the country.

“This thing attacks the old, and we absolutely need to protect our old and know that is the number one target of this killer.”

West Virginia locked down and completed mass testing of all nursing homes early in the coronavirus response as Justice publicly recognized the vulnerabilities of residents.

On June 17, as part of the loosening of stay-at-home orders, the administration allowed for more comings and goings from facilities around the state.

The guidance released by the administration allowed nursing homes to advance toward looser restrictions represented by color — red with the tightest restrictions and green with greater openness for activities like communal dining, group activities and visitation.

The designation depended on the facilities themselves being free of confirmed coronavirus cases as well as “no substantial community spread.”

So, for example, a nursing home that had been relatively calm as yellow or green might have to roll back to “Phase Blue” if residents tested positive or “if it is determined that there is substantial community spread as defined by the Bureau for Public Health.”‘

The complication is, it’s not clear if the Bureau for Public Health ever stated what constitutes “substantial community spread.”

Cathy Slemp

The state health officer, Cathy Slemp, was forced to resign on June 24. That was a week after the nursing home guidelines were introduced.

A new state health officer, Ayne Amjad, was named on July 10. Amjad has been getting up to speed right as the pandemic has picked up, stretched in her duties because she is also serving as interim director of the Mercer County Health Department.

Ayne Amjad

Speaking today on MetroNews “Talkline,” Amjad said the re-entry plan for nursing homes is being revisited.

“In some counties they had sort of self-implemented that where if they had a lot of viruses in the nursing home, they had stopped visitation already,” Amjad said.

“Most of them had already implemented it on their own, and we are revisiting that as we speak to see if we need to implement throughout.”

The Department of Health and Human Resources this month published a “revised reopening plan” for nursing homes that provides greater definition for strategies like quarantine or isolation and guidance for residents who need to leave facilities for ongoing medical treatment like dialysis or chemotherapy.

There is now a section on “community status,” directing facilities to follow guidance from the Bureau of Public Health “once this guidance is released.”

The section has a hyperlink directing people to where the guidance will eventually be displayed at DHHR’s coronavirus response landing page. 

DHHR spokeswoman Alison Adler confirmed today that the guidance on what degree of community spread would affect nursing home policies is still to come.

“Yes, that is still being defined and developed,” Adler responded in an email to MetroNews.

The West Virginia Health Care Association, which represents long-term care facilities, agreed that guidance would be helpful.

Marty Wright

“As several counties around the state are experiencing a surge in coronavirus cases, approaches may need to be adjusted to combat the threat,” stated Marty Wright, chief executive officer of the organization.

“Our facilities continue to work closely with state agencies as well as local health departments to discuss and assess community spread and the need to implement additional restrictions on visitation.”

About 30 West Virginia nursing homes are experiencing outbreaks right now, state officials said Monday, although that can mean as few as one resident with a confirmed case.

Among the most serious outbreaks as described by state officials are at Pine Lodge in Beckley, Grant County Rehabilitation and Care Center, Trinity Healthcare Services in Logan County and Princeton Health Care Center in Mercer County.

The situation in Princeton has been particularly tragic, with 33 active cases among residents, 16 among staff and at least 13 deaths. The facility’s medical director contracted the virus, had to be put on a ventilator and was flown to Ruby Memorial Hospital in Morgantown.

State officials have said, generally, that someone carried the virus into the nursing home following a trip to Myrtle Beach.

When coronavirus starts spreading in a community, it can get into a nursing home as staff goes back and forth from work to their homes or when family members come to visit.

“You hear us talking about community spread, so that’s the biggest concern throughout the state,” Amjad said. “Our nursing home population, they pretty much stay in the nursing home. It’s the population going in and out of the nursing concern that’s our biggest concern.”

Jeffrey Pack

Delegate Jeffrey Pack, leader of the House Health and Human Resources Committee, said nursing homes would benefit from better clarity on when community spread presents a danger.

“The guidance, to the extent available, seems murky,” said Pack, R-Raleigh.

“My suspicion is that nursing homes may be relying on local health departments for guidance. To the extent that’s true, I wonder how much consistency exists from county to county on that guidance.”

Barbara Fleischauer

Delegate Barbara Fleischauer, D-Monongalia, a longtime member of the House health committee, agreed.

She wondered who is left with responsibility to decide how much community spread of virus should prompt tight visitation restrictions for nursing homes. That decision would affect the ability of families to see their loved ones.

“Is it state DHHR that decides?  Is it the local health department?  Is it the nursing home?” Fleischauer asked.

“Families have choices. Where can they find out the color rating of a particular nursing home?  Are the decisions different in every county? That’s the way it appears.”

Fleischauer noted how long it has been since DHHR said it would define “substantial community spread.”

“These are hard decisions. I don’t envy those who must make them,” Fleischauer said.

“But it’s been nearly two months since DHHR said they would clarify this.  One has to wonder about the timing,  whether finalizing the definition of concepts like ‘hotspot’ and ‘substantial community spread’ is something that got lost in the shuffle when our state health officer was dismissed right in the middle of a global pandemic.”

Nursing Home COVID19 Reopening Plan Revised August 2020 (Text)

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