An expanding coronavirus pandemic continued to devastate the long-term care sector on numerous fronts throughout the end of March and April, even before stories of massive numbers of deaths in facilities started to emerge.

Operators found themselves being pushed as never before to deliver care while underequipped, understaffed and pressed to admit infected patients, a pair of McKnight’s Flash Surveys in late March and mid-April revealed.

An initial McKnight’s survey was released March 30, painting a picture of an industry at the precipice of disaster in many locations, and a general state of heightened anxiety amid shortages of personal protective equipment.

A second McKnight’s survey  two weeks later found that the percentage of provider respondents with COVID-19 detected in their buildings had nearly doubled (to 34%).

In addition, the latter survey, released on April 16, found that nearly 1 in 6 (16%) had had a resident or worker die due to COVID-19, while more than 1 in 5 (21%) had had residents move out due to COVID-19 fears.

Extrapolating the statistics to a nationwide total of about 16,000 skilled nursing facilities, the numbers indicated that more than 5,400 nursing homes could have had COVID-19 detected in their buildings at that point. In addition, 2,600 facilities might already have experienced at least one coronavirus-related death and more than 3,300 might have had at least one resident leave due to COVID-19 or fears of the virus.

There was no national strategy or mandate for reporting nursing-home related COVID-19 infections or deaths at the time of either survey. On April 19, federal health officials announced a nursing home infection surveillance strategy involving direct reporting to the Centers for Disease Control and Prevention.

McKnight’s collected survey results from respondents following emails sent to the publication’s readers. As an incentive for each survey, McKnight’s offered participants the chance of being entered in a drawing for a $50 gift card. There were 350 respondents in the first round and 631 in the second.

Staff frailties

Results of the latter survey showed a profession facing far more workforce challenges than usual. Two-thirds of respondents (67.4%) said they had staff call in sick or quit due to COVID-19 concerns, up from 45% in the survey two weeks earlier.

More than 83% said they were using homemade or reused personal protective equipment, significantly up from 55% in the first survey. 

Also in the mid-April survey, a total of 19.8% of respondents said they felt pressure from hospitals to admit patients who had been treated for the coronavirus, up by nearly half from 14% two weeks earlier. This was shortly after providers started experimenting with COVID-only units and buildings.

Toughness growing 

The trait of resilience, however, also revealed itself in the second survey’s responses. Just under 65% of participants said they were equipped to handle COVID-19 patients, up nearly 15 percentage points from two weeks previous.

The percentage of those reporting PPE shortages actually fell slightly (to 71% from 75%), perhaps a reflection of the huge rise in the use of homemade or reused equipment.

Overall facility mood 

The general attitude levels among respondents at nursing facilities seemed to remain steady from survey to survey, a period when the number of cases and deaths climbed sharply in the U.S., and in the long-term care population in particular. 

As of April 16, COVID-19 deaths connected with long-term care facilities reportedly totaled around 5,500, which didn’t include statistics from many states that said they didn’t keep them.

Given the option of checking as many choices as applied at their facilities, the vast majority of respondents described the mood in their facilities as “Coping day to day” (63%) or “A little shaky but confident overall” (55%). That tracked closely with two weeks earlier, when the numbers were 59% and 46%, respectively.

Third in line for both surveys was “Fingers crossed” (24% in the second survey, down from 26%), while the more confident choices of “A model of efficiency and pride” (18%) and “Almost business as usual” (17%) grew from 14% for each two weeks earlier.

Respondents on the least confident end of the spectrum lessened with time. “Panicked” fell to 6% from 13%, while “Chaos/Near chaos dropped to 2% from 3%.

All of this was measured just before the toughest weeks of the pandemic were forecast to hit in numerous geographic areas, according to many experts. 

It was also a time when protests against stay-at-home orders started to occur in various states where infection and death rates may have been below average and some members of the public were calling for the loosening of restrictions and the ability to start gathering in public again.