Iowa Gov. Kim Reynolds’ press conference Tuesday, Nov. 24, demonstrates her failure to listen to professionals within the long term care community. In March of 2020 all Pottawattamie County nursing homes came together to ask for the tools to prevent outbreaks: rapid testing, more PPE, dedicated facilities for COVID care and the use of Critical Access Hospital beds all to reduce the redundancy of dedicated staff and the spread of the condition to health residents.
The Department of Inspection and Appeals, the Department of Public Health, the local county health department and the Governor’s office all refused to address the very specific concerns of Iowa nursing facilities. Now we see staff shortages in every facility in the area including hospitals and assisted living. We see facilities reaching outbreak status that are still only checking residents and staff a few times each week, rather than daily during the outbreak. Potentially infected staff are allowed to work with residents without knowing their actual status between testings due to the lack of available tests.
The outbreak status of 140 of 440 Iowa long term care facilities and the death of more than 1,000 nursing home residents was preventable. This outbreak was not an unpredictable result, it had been demonstrated in Washington and New York well before it happened in Iowa. The outbreak in Oakland, that was met with such disdain for the facility, is now, as predicted, commonplace in Iowa. It was seen in rural Iowa first because staffing and under payment of the cost of care by the state’s Medicaid program are felt deeply in these area. COVID did not create the rural crisis, it just unmasked what has been simmering below the surface for years.
Rather than prepare for the worsening of this outbreak, the governor continues to look for opportunities to expose long term care residents and staff rather than to protect them. By requiring facilities to allow families into the facilities without assuring they brought no risk, the governor is responsible for the spread of this disease and the death of our residents.
For the facilities with outbreaks, it is too late. Best practices have shown to fail repeatedly. For facilities bracing for the inevitable, there is hope. The governor could turn the tide by providing for transfers of patients who test positive to another facility. She could stop all in person visitation and mitigate the isolation with video technology based interactions. Staffing could be temporarily addressed using Critical Access Hospitals as transfer points from both nursing facilities and post-acute hospital patients. All of these actions would support the healthcare industry and keep people working safely while protecting high risk populations.