Omicron surge stretching long-term care in Oregon

Omicron is stretching thin those already stretched by the pandemic, and long-term care facilities are no exception. Staffing shortages continue to affect the quality of care at nursing homes around Oregon. And while vaccination rates among residents and staff have gone up at many long-term care facilities, some are still not reporting this data at all. We get an update on long-term care in Oregon from Fred Steele, the state’s long-term care ombudsman.

The following transcript was edited for clarity and length.

Dave Miller: So broadly speaking, what has omicron meant for long term care facilities in Oregon?

Fred Steele: Prior to the omicron variant entering the state and becoming the dominant variant in the state, care facilities had been seeing the number of covid cases decreasing pretty significantly. As of yesterday, there are over 500 care facilities that have a covid connected case. In Oregon and we only have about 690 of these licensed care facilities total. In many instances there are numerous cases between staff and residents among those 500. Even with some of the largest waves previously, that number had never risen above about 350 facilities. So just with the case numbers, the impact on the number of facilities and then therefore the thousands of residents and staff living and working in these settings, they’re all being impacted.

Dave Miller: One of the hallmarks of this omicron wave is that people who have been vaccinated are still getting sick. Are you seeing that in nursing homes and other long term care facilities in Oregon?

Fred Steele: Absolutely. The Oregon Health Authority posts the number of vaccinated or the percentage of vaccinated residents and staff. Those numbers are around 90% at least with the facilities that have reported. Not all have still, even though it’s been a requirement for seven months. But for the large number of facilities that have reported, you have a large number that are vaccinated and in the last three weeks, the outbreak data that’s being publicly reported shows significant number of cases. And so where even through the delta variant, we were seeing maybe 3 to 5 cases. In many instances it was limited to a single individual with covid connected to a care facility. Where now we may be seeing 10-20 individuals with covid. So I don’t know the specific breakthrough information, but it seems very obvious that there are a number of breakthrough cases just mathematically.

Dave Miller: I want to go back to something you said. For seven months now, these facilities have had to report the vaccination rates for residents and staff to the state. And you’re saying that some not insignificant number of these facilities are still not even reporting those numbers to state officials?

Fred Steele: Correct. And when I’ve asked about it recently in the last couple of months to understand why a requirement and a mandate can go unchecked in that way, the information I have received back that is that there didn’t seem to be an enforcement mechanism in place. So just yesterday I learned that there are plans at the Department of Human Services to put forward what they call an administrative rule, but it’s an agency law, that they can put in place to actually allow for enforcement of the requirements. It’s unfortunate it’s taken this long, but I’m glad that they’re getting there and to really start following up on these supposed mandates.

Dave Miller: What is staffing at these facilities looked like during this wave?

Fred Steele: What we would always generalize as insufficient staff at care facilities has been significantly heightened throughout the course of the pandemic of these last two years. But it seems to be even more significant just in the last month or two. So if you think about it from that individual resident perspective, the care that’s being provided in a nursing home or memory care is oftentimes very personal care - assistance with bathing and dressing and that assistance that somebody may need to help care for themselves. And so when you have significant staff turnover or even worse, significant vacancies in staffing at any given facility,

it gets to the point of being quite detrimental to that individual who needs that support. So the numbers that we’re seeing - and I just learned these yesterday - out of our 690 congregate care settings, there are thousands of vacancies. We’re talking close to 400 nurses, over 1,200 CNA positions, close to 3,000 direct support. And that was with about 70% of facilities reporting that information. It is significant.

And again, when you get it down to that resident level, it’s even more significant. You have a caregiver trying to assist one individual but then you have three others that need assistance as well. You get these caregivers that have very unfortunate difficult decisions to make just spur of the moment and it can be a day of the week any minute of the day.

Our call volume has definitely been increasing. Just yesterday we had 30 case-related complaints which is a significant volume for our office in a single day.

Dave Miller: Can families of residents visit right now? And if so, what are the state or federal rules regarding those visits, and from the advocate standpoint?

Fred Steele: Previously, if a facility had a covid case connected to it, no visitors were allowed. But in November, the center for Medicare and Medicaid Services changed it back to what should be a norm for visitation under the laws. The law ensures that they have a right to visitors, that they have a right to see their family, and their friends in the facility. So now the burden has been shifted to the facility to ensure that visitors have to be allowed, but to do so in a safe manner. For these last two years, there has been effectively emotional trauma on too many residents not being able to have that direct access to family and friends

Dave Miller: Finally, just to go back to the numbers, you’re were talking about the beginning of a huge increase in the cases once again in these facilities. Are you also seeing a rise in hospitalizations and deaths stemming from those cases?

Fred Steele: Fortunately not yet, and hopefully not at all. What I understood from public health is that with the omicron variant the serious and significant outcomes seem to be less. That does seem to be so far the case here in Oregon. But the data I have available to me is about a week and a half old.

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