State's Aggressive Stance Toward COVID-19 Limited Spread in Nursing Homes

As the COVID-19 pandemic hit the United States, the virus seemed to sweep through nursing homes and long-term care (LTC) facilities leaving, as of June 24, more than 50,000 residents and staff across the country dead from COVID-19. This accelerated rate makes up for 40 percent of all deaths related to COVID-19, which is alarming because nursing home residents make up only 1 percent of the population.

New Mexico follows this trend with 198 residents of New Mexico nursing homes and LTC facilities dying due to COVID-19, making up 40 percent of the state’s 493 deaths as of Monday, June 29. However, state officials believe early steps, in partnership with nursing homes and facilities, and other organizations, have kept this figure from being worse. Everyone involved in combating the virus knows there is more to do to protect our state’s most vulnerable residents.

AARP New Mexico sat down with Secretary Katrina Hotrum-Lopez, cabinet secretary for the New Mexico Aging and Long-Term Services Department, and Linnea Forsythe, State Long-Term Care Ombudsman, to talk about what has been working well and where there are opportunities for improvements.

Hotrum-Lopez credited Gov. Michelle Lujan Grisham’s knowledge as former secretaries for both the New Mexico Department of Health and the New Mexico Aging and Long-Term Services Department, and her decisive action in tackling the virus in its early stages, for the lower fatalities and numbers.

“The governor understood quickly a COVID and what that could mean for us in terms of a pandemic and in terms of its spread. So when we first started to do testing and the first announcement came that there was COVID in our state, she quickly took action, and that action was no more visitation and really trying to concentrate and get our arms around what was happening with our most vulnerable populations,” Hotrum-Lopez said. “I think her aggressive stance to us in that direction has really served us well throughout this time.”

The state also began widespread testing for COVID-19 so that people infected would know sooner if they were indeed positive and then limit their contact with other people.

“Widespread testing benefits us in every way, shape and form in our long-term care facilities because of the rate of infection. If you have somebody on the outside that is testing positive, you don’t know who they are coming in contact with that could actually be working in a long-term care facility and so the aggressive steps we’re taking, I think, is more aggressive than most states have taken in terms of the response,” she said.

Forsythe said that agencies coming together once the first positive case was identified was also a key component for limiting the spread in long-term care facilities.

“Our aggressive and immediate response to how this was affecting New Mexico was essential as well as the partnership between the Department of Health, the Ombudsman program, the New Mexico Health Association, and others, in communicating with facilities and pushing out that these are the new orders, this is the guidance from the Centers for Disease Control and Prevention, CDC, not just to nursing homes, but also to assisted living facilities, and making sure everybody was on the same page about what they were supposed to be doing,” she said.

Forsythe said this also resulted in the Department of Health going out right away and visiting facilities to check on their infection control protocols.

Although New Mexico might have sidestepped early rates of infection, officials know that their work is far from over and improvements and adjustments will need to be made going forward, especially since a vaccine likely won’t be available in the immediate future.

One area that the state plans to focus on improving is surveillance and rapid response testing.

“In every nursing home, they get a certain amount of tests each week to do surveillance to make sure there is no COVID in their facility. Right now we are testing at 15 percent and soon we’re ramping up to 20 percent staff and 25 percent of residents,” Hotrum-Lopez said.

She said the goal is to reach the CDC recommendations of 100 percent of staff and she is confident the state will get there.

It is no surprise that one of the challenges the state and LTC facilities face is how to provide meaningful communication and contact between residents and their family members.

Family visits also provide more than just interaction for residents. They are often a safe guard to ensure that residents are getting the care and attention they need.

“Just as the Long-Term Care Ombudsman program does, families are the eyes and ears of things that go on in these long-term care facilities. We rely on family members and staff to tell us what is going on and since people haven’t been allowed in, it has been a challenge for family members to feel comfortable that residents are receiving the care and treatment they need and so we need to improve on those things,” Hotrum-Lopez said.

The state has provided facilities with tablets so people can have a virtual visit and increased the number of cameras in facilities to monitor more activities.

New Mexico resident Patriciaagrees that the facility that her mother calls home is doing a lot of things right. She has virtual visits with her mother three times a week, says that the facility has adequate protective gear but a staffing shortage has led to problems with keeping up with her mother's care and Patricia has had to repeatedly ask for help with small things like reminding her mother to brush her teeth. In addition, the facility is supposed to provide a weekly update to Patricia but rarely does.

“My mother has some dementia, so she keeps forgetting why I'm not coming to see her,” Patricia said. “It's so difficult. She has been uncooperative with caregivers, who don't have much training to deal with her, and has refused to bathe, brush her teeth, or change her Depends.”

“My brother and I have had multiple conference calls and email exchanges with the head of the facility and the nurse offering suggestions. There has been little change. It is very disturbing as this creates a health hazard for my mother. We finally put my mom on Hospice as she gave us a scare with an oxygen, heart rate, and blood pressure drop a week or so ago. Since Hospice has gotten involved, there is a marked improvement (in her care). Thank God for them,” she said.

Hotrum-Lopez said many facilities are having staffing challenges and the state is trying to assist with how to bring staff on in a pandemic as well as how to work with facilities to push out meaningful communications that is standard to all families.

She said that families understandably want to know if there is enough staff; and that their loved one is being taken care of; and they want ways to verify and confirm that, since they can’t be there to see it happen in person. Families are worried that the only indication they get on their loved one’s well being is by looking into a window and going back and forth with the facility.

“We don’t have an easy answer for that but some of the things in the guidance that will be coming out quickly will be how do we improve visitation and how do we do better visitation than going through a window, trying to look in and have some interaction,” Hotrum-Lopez said.

“We have to improve in this area and we’re trying to find creative solutions to do that,” she said.

Forsythe said the Ombudsman program has also been receiving concerns that communication between facilities and family members is an issue.

“I think (communication) has been especially challenging for assisted living facilities as well. Nursing home do have federal guidance and directives to mandate communication on a weekly basis with families as any COVID developments occur. Our assisted living facilities don’t have that mandate, and they may have more limited resources and staffing,” Forsythe said.

She said the same expectation for improving communication with families should be applied across the board and that the Ombudsman program can help find solutions to improving family communications. In some instances, the program has helped facilities develop communication plans using e-mail, telephone calls and even using Zoom, a video platform.

“We help set that up – whatever works for them to keep people informed. The Health Care Association has been helping create template letters for facilities to use so they don’t have to reinvent the wheel,” Forsythe said.

“What we’re working toward is really engaging these facilities in a conversation on what is your plan for communication with families – when something changes or even just on a weekly basis,” she said.

If an individual has a loved one in a long-term care facility but are facing challenges getting information on that person or have concerns with the care they are receiving, Forsythe encourages calling the State Long-Term Care Ombudsman Program at 1-866-451-2901.

To learn more about what the New Mexico Aging and Long-Term Services is doing related to New Mexico nursing homes and long-term care facilities, and other COVID-19 responses, view the full video at https://youtu.be/QrbuMIJPxtg