With roughly 45% of Los Angeles County’s coronavirus deaths occurring in institutional settings like nursing homes, the Board of Supervisors voted unanimously Tuesday to strengthen protections for residents and workers.
Supervisor Mark Ridley-Thomas recommended calling for the county’s legislative advocates to work with Gov. Gavin Newsom and state health officials to expedite testing for nursing home staffers and residents, issue standard protocols for dealing with coronavirus cases and set staff-to-patient ratios.
The motion also calls for additional pay, overtime and sick leave for nursing home employees during the crisis and paying a higher rate to workers caring for residents who have tested positive for the virus, among other measures.
Ridley-Thomas also recommended that skilled nursing homes be required to re-admit patients once they are no longer acutely ill with the coronavirus. All of these measures must be supported by state officials who license such facilities.
Separately, county health officials have expanded testing for COVID-19 to include all residents and staff at nursing homes with outbreaks, regardless of whether they show any symptoms. County workers are also conducting “surveillance testing” at centers without any positive cases.
Department of Public Health Director Barbara Ferrer told the board that 210 skilled nursing facilities have at least one employee or resident with a confirmed case of coronavirus.
Of the 423 deaths that have occurred in skilled nursing facilities, assisted living facilities, shelters, jails and prisons, the vast majority of them have occurred at skilled nursing facilities, she said.
Of the 11 health care workers who have died of coronavirus in Los Angeles County, eight were working in skilled nursing facilities, Ferrer told the board. More than one-third of all cases among health care workers countywide are employees in nursing homes, she said.
“Last week, we distributed millions of pieces of personal (protective) equipment” to skilled nursing facilities, Ferrer told the board, saying that each center received about 8,000 masks.
Dr. Christina Ghaly, who leads the county’s hospital system, highlighted the importance of working with state officials to impose additional requirements.
Ghaly, director of the Department of Health Services, said there are more than 40,000 patients in skilled nursing facilities, as compared with 22,000 hospital beds countywide — about 2,000 of which are open on an given day.
“It’s easy to see from these numbers how patients from skilled nursing facilities could overwhelm” the system and threaten the health of the rest of the community,” Ghaly told the board.
During a Monday briefing, Ferrer said it was not known in the early stages of the crisis that people without symptoms could spread the virus.
“Early on in this pandemic, we were all unaware that COVID-19 could be spread by people who were infected but did not have any symptoms, and this unfortunately has resulted in the spread of the virus even where everybody has been doing their very best to implement infection-control measures with the information that we had at the time,” Ferrer said. “So I apologize on behalf of all of us for not knowing enough at the start of this epidemic to take additional steps in our congregate living facilities to make sure we were doing everything possible to protect residents and staff.”
On Tuesday, she told the board, “Now that we do know that there is asymptomatic transmission, it makes sense for us to be extraordinarily aggressive.”
On Friday, a county health order was issued barring non-essential visitors and suspending all communal dining and activities at nursing homes. It also requires staffers to wear surgical masks at all times and residents to wear masks or cloth face coverings outside of their own room.
Supervisors Janice Hahn and Sheila Kuehl co-authored a separate motion asking the relevant health authorities to quickly detail their plan for expanded testing at nursing homes to the board, and to come up with a way to keep nursing homes from sending patients who don’t need hospitalization to acute care hospitals.
“Our data indicate that there are now well over 1,000 confirmed cases of COVID-19 amongst the staff of nursing homes, homeless housing sites, and other institutional settings,” according to the motion.