Editor’s Note: Dr. William Miller, Chief of Staff at Adventist Health Mendocino Coast Hospital, writes weekly reports regarding the COVID-19 situation on the Mendocino Coast. We are happy to bring his health column to life, with details on the medical fight against the pandemic. The opinions shared in this weekly column are those of the author, Dr. William Miller, and do not necessarily represent those of The Mendocino Voice or Adventist Health..
Sherwood Oaks is a local, private nursing home in Fort. Bragg. As the only qualified nursing facility here on the Mendocino Coast, it is licensed for 79 beds and currently has 45 residents. He experienced a COVID outbreak in July and August of last year. Unfortunately, he is currently experiencing another epidemic. For about two weeks, 3 staff and 4 residents have been affected. They all did well and are now in isolation, which has once again introduced the virus to the nursing home population. The establishment immediately began to take the necessary measures to limit the spread. As of this writing, there are 15 new active cases among residents and two new cases among staff, bringing the total for this outbreak to 24 residents and staff to date. Last year, the outbreak ended at a total of 32 with 24 residents and 8 staff infected. There were 8 deaths as a result of the outbreak last year.
There are now significant differences compared to last year. On the positive side, all but five of 45 residents (89%) and 85% of staff are now fully immunized. Remember that vaccination does not prevent a person from becoming infected and therefore becoming positive, but it does go a long way in reducing the risk that a person will develop into serious illness. So we expect that we won’t see people getting so sick this time around. So far, none of those infected appear to be seriously ill.
The high vaccination rate in Sherwood Oaks compares quite favorably with national statistics and is a credit to the management of Sherwood Oaks. According to the Center for Medicare and Medicaid Services (CMS), the average vaccination rate in skilled nursing facilities in the United States is 84% ââof residents and 64% of staff.
In contrast, the nursing home staffing problems are worse than before. This is essential because each of these new COVID cases must be isolated and it increases the need for staff that the facility simply does not have at this time. Last year, the hospital was able to step in to help by accepting COVID-positive residents of Sherwood Oaks, relieving staff stress and helping to limit additional exposures at the facility. Now, however, our county’s three hospitals are at full capacity due to the increasing number of COVID cases in the county and are themselves experiencing a staff shortage.
To solve this problem, there has been good collaboration between the administration of Sherwood Oaks, the management of the hospital, the county health officer and officials of the California Emergency Medical Services Authority (EMSA). Our frequent meetings have included Dr Dave Duncan, the medical director of EMSA. As a result, EMSA has sent 6 nurses (RNs and LVN) and 4 nurse aides (CNA) to Sherwood Oaks for the next 4-6 weeks to help with the staff crisis. This support allowed Sherwood Oaks to avoid the unwanted alternative, which would have been to start transferring residents to other nursing homes. Considering that most northern California nursing homes themselves are understaffed and full, that would have meant sending residents to central and southern California.
EMSA also dispatched a mobile team to visit COVID hotspots across the state to assist with the administration of the monoclonal antibody, Regen-COV, which has been shown to reduce the risk of progression to hospitalization (see the Miller report of September 6e for more information on this treatment). As of this writing, 12 of the residents have received it.
It appears that a crisis like the one we experienced last year can be avoided with state-provided support staff and the high rate of vaccination among residents. Great appreciation is given to the State EMSA team for their help. However, this highlights several critical challenges we face locally for our healthcare system and nursing homes. The most important of these is the lack of staff.
Even before COVID, there was a nationwide shortage of healthcare workers. This shortage affects all areas, from nurses to highly qualified personnel such as laboratory and radiology technicians, to support personnel such as housekeepers, to primary care physicians and specialists. Rural communities are particularly affected by these shortages. We’ll look at this national and local dilemma in more detail in next week’s Miller report, along with specific information about local healthcare vacancies and how to apply.
America’s nursing homes have struggled for nearly two decades with what can best be described as a perfect storm. As baby boomers age and therefore need more health services including long term care in nursing homes. Payments to nursing homes by Medicare, MediCal and private insurance have steadily declined while at the same time the cost of doing business has increased. This has led to a reduction in the beds available in nursing homes just when we need more to accommodate an increasing number of elderly people. The design of almost all SNFs in the United States tends to promote overcrowding. The Miller Report for the week of October 5e will take a more in-depth look at these nursing home issues nationwide and discuss how this affects the future of local facilities like Sherwood Oaks.
Finally, it will be an interesting test of the effectiveness of vaccines in reducing progression to serious disease since so many cases here have been fully vaccinated.
You can access previous Miller reports by visiting www.WMillerMD.com.
The opinions shared in this weekly column are those of the author, Dr. William Miller, and do not necessarily represent those of the publisher or Adventist Health.