Nursing home residents now account for 15% of all deaths in Indiana from the COVID-19 pandemic, and state officials on Wednesday ordered long-term care facilities to report any deaths or positive cases within 24 hours to try to protect elderly and confined Hoosiers.
The Carmel mayor is also taking action to ensure nursing home residents in his city are tested.
Dr. Kristina Box, the state health commissioner, said 31 deaths have occurred in 12 long-term care facilities, representing a significant share of Indiana’s 203 deaths so far.
The new order requires any residential facility, jail, prison “or any other congregant setting” to report to local and state health departments if they have residents or employees with a known or suspected case of COVID-19, if an individual dies of the disease, or if any employee tests positive.
In addition, the state is ordering laboratories to report all negative COVID-19 test results for Indiana residents to the state within 24 hours of completing the tests. Currently, only positive results must be reported.
Outbreaks at nursing homes and other long-term care facilities are serious, because they can quickly spread through a confined space, often with elderly people who are at high risk of contracting the disease.
“This disease creates the potential for a perfect storm in a long-term care facility,” said Dr. Daniel Rusyniak, chief medical officer of the Indiana Family and Social Services Administration, which oversees funding of nursing homes. “Large groups of vulnerable people living together, and a highly transmissible virus that may not cause symptoms, and those who care for them.”
Indiana has 735 nursing homes and standalone residential facilities that house about 65,000 people. As of Wednesday, the state’s “strike teams” of health workers have tested nearly 600 people at 200 facilities.
The strike teams, originally set up in 2017 to help slow a hepatitis outbreak, were adapted last month to deal with the coronavirus pandemic, Rusyniak said.
The state has 12 strike teams, each consisting of a coordinator, nurse surveyor, infection-control expert and an epidemiologist. Their job is to respond to the pandemic in waves, he said.
The first wave is to go into a facility that has reported a COVID-19 problem and test all residents and staff thought to be ill. They also drop off masks, gowns and other personal protective equipment and assess the facility’s COVID-19 readiness plan, he said.
The second wave begins if positive cases are confirmed at a facility. In that case, the nurse surveyor assesses the facility’s plan and a specialist reviews the infection-control practices.
The third wave begins if additional cases are identified in a new area of the facility.
“In those facilities where there are multiple deaths, we will often go back numerous times to assist them in mitigating the spread,” he said.
On Friday, Carmel Mayor Jim Brainard announced the city would begin coordinating COVID-19 testing at local assisted living facilities and nursing homes through Aria Diagnostics, a local lab.
On Monday, Brainard sent an email to his police chief, asking an officer to deliver a note to one nursing home that was being “obstinate.”
The note said, in part: “I do not have the authority to order you to do testing. I do believe, however, that failure to test your staff on a weekly basis now that the tests are readily available constitutes extreme negligence as well as putting you personally at risk for reckless homicide if someone dies as a result of you not testing your staff.”
He pointed out that reckless homicide carries a prison term.
A city spokesman said that nursing home in question changed its mind on Tuesday and agreed to conduct testing.