South Florida Senior Long-Term Care Facilities Brace For Coronavirus Challenges

Mar 20, 2020

South Florida became the focus of Florida’s fight against COVID-19 this week. About half of the confirmed cases in the state are in Miami-Dade and Broward Counties.

At least 19 nursing homes and other long-term care facilities have suspected cases of the coronavirus. The governor imposed visitation restrictions to protect residents.

The virus has been fatal at an assisted living facility in Fort Lauderdale.

On the South Florida Roundup, host Tom Hudson talked about the challenges faced by facilities that care for seniors. He was joined by The Miami Herald’s Carol Marbin Miller; Elaine Bloom, CEO of Plaza Health Network, a South Florida group of nursing homes; and Dr. Olveen Carrasquillo, chief for the Division of Internal Medicine at the University of Miami’s Miller School of Medicine.

Here’s an excerpt of their conversation:

TOM HUDSON: What what do the supply closets look like at the Plaza Health Network facilities?

ELAINE BLOOM: We thought we were in good order a few weeks ago when we started this process. But by this time, we, like every other entity that's facing what's going on, we're part of the group that's asking for more masks, more gowns, more face shields and more gloves. But we have what we need. I'm not complaining for us, but it's really very outrageous that we have not organized the supply chain in order to make sure that the hospitals and other health care facilities have access to this.

Dr. Carrasquillo, what about exit testing on the part of hospitals as they move some of these seniors into rehabilitation or skilled nursing facilities?

DR. OLVEEN CARRASQUILLO: Any patient who comes in with symptoms that are respiratory in nature, we have to triage them to see whether it's either COVID-19 or another likely. We do a whole host of tests to try to diagnose exactly what respiratory condition they have.

That diagnosis, is really done orally, right, in terms of conversation? And have you been to China, South Korea, Iran or Italy? Or are you displaying active symptoms of the virus?

CARRASQUILLO: That's the outpatient screening. In patients, when they're admitted for respiratory conditions, we do a whole bunch of respiratory panel tests. We test them for the flu. We just had a patient who had regular bacterial pneumonia. It wasn't COVID-19. We still have all these other respiratory conditions. When we cannot rule out one of the other common etiologies, that's then when we go on to screening them, when they have a respiratory condition that's undiagnosed. And then we'll screen them for COVID-19 and then they go on isolation until we get the test results back. If it's positive, it's about a two-week window for symptom resolution.

Carol, what are you watching for in the next few days as this story is going to continue to develop for months? What is front of mind right now for you?

CAROL MARBIN MILLER: What I am concerned about is is a kind of collateral problem from this. Two things occurred in short order that I think affect elders who are in long-term care. The first thing that happened is that the federal government suspended all inspections that were not of an emergency nature, which takes out a good bit of surveillance inside these facilities. Then the second thing that happened, which I think is a very good thing, a necessary thing, is that the governor suspended visitation.

Now you have elders who are basically on an island in nursing homes and assisted living facilities. Some of these homes are marvelous places. My father lived in an ALF and was extremely well cared for. But some of them operate on a margin because the reimbursement rate is low and they do the best they can. What protected elders in some of the marginal places was visitation from family members and friends. It also protected the individual elders. It kept them from becoming lonely.

The concern that I have, and what we're writing about as we speak, is, what about these folks who have no contact with the outside world. One home that we spoke with was censoring and monitoring what their residents could watch on television. And that was well intended. They don't want elders to panic. But there's this darkness that has enveloped a good number of these frail elders. And it's not a good thing.

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