After the coronavirus swept through A.G. Rhodes’ three nursing homes in metro Atlanta last year, residents were largely confined to their rooms. Deke Cateau, CEO of A.G. Rhodes, watched the crushing toll of isolation and loneliness.
The measures were meant to be temporary, designed to prevent the spread of a virus especially dangerous for older adults. But there appeared to be no end in sight, as the virus raged. In December, 109 residents of the three homes became infected and four died; in January, another 32 residents were infected and seven died.
Then in February, a dramatic change: Among the three homes there was only one new case and no COVID-19 deaths.
New infections are plummeting at many other Georgia long-term care facilities, as hundreds of nursing homes, assisted living communities and personal care homes reported no new cases in February. And while January was the deadliest month of the pandemic, in February deaths of long-term care residents plunged 68%. That is giving hope that the worst may be over and some of Georgia’s most vulnerable population may be able to inch back to normalcy.
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Many experts point to vaccinations as the major driver of the improvements. That’s the hope at A.G. Rhodes nursing homes, which in late December were among the first in the state to start receiving the vaccine.
“We are extremely optimistic the vaccination efforts are working,” said Cateau. “You can’t deny the connection.”
But other factors are also helping reduce infections. Among them, as the post-holiday surge of cases tapered out, the state as a whole saw fewer cases. That makes it less likely for workers to unknowingly bring the virus into the facilities. Case counts declined more rapidly, though, among residents at long-term care homes than in the state overall. They’re down about 74% among Georgia long-term care residents, compared with about 59% statewide, according to state data.
Another factor is that the virus ran so rampant at senior care facilities since the start of the pandemic, that survivors of the disease likely remain protected by infection-acquired antibodies, said Ben Lopman, an epidemiology professor at Emory University.
How care facilities manage the pandemic is also vastly improved since the first major U.S. outbreak at a nursing home in Washington in February 2020 resulted in dozens of deaths, said Dr. Ted Johnson, the chair of family and preventative medicine at Emory University.
State and federal governments supplemented supplies of personal protective equipment. What’s more, virtual training, like Zoom classes Johnson teaches in partnership with Georgia State University for staff at 180 care homes across the state, helped facilities improve screening, infection control and treatment plans.
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Still, there were Georgia senior care facilities reporting an uptick in infections in February, state data show. Some were facilities that admit COVID-positive residents from hospitals, said a representative for PruittHealth, one of Georgia’s largest nursing home providers.
By and large, though, the number of new cases appears tied to when vaccinations rolled out. Data nationally show the nursing homes that received their shots first saw their cases decline first, Johnson said.
“We are extremely optimistic the vaccination efforts are working. You can't deny the connection."
Nursing homes were the first priority for vaccine, and by Jan. 25, the first round of vaccinations was completed at the homes for anyone who wanted to be inoculated. Vaccines rolled out later to assisted living and personal care homes, with some still awaiting first shots in February.
Over time, as more residents get the booster shot and have more time to build up immunity, many expect the trend line will only get better.
“We are seeing vaccinations pay off huge and doing exactly what we had hoped,” said Ginny Helms, president and CEO of LeadingAge Georgia, which represents non-profit and mission-driven senior care organizations. “This will give residents their lives back.”
Concerns still loom
The sudden drop in cases in Georgia is mirroring a national trend of sharp declines in cases. The American Health Care Association and National Center for Assisted Living, representing more than 14,000 nursing homes and long term care facilities across the country, just released a report showing new COVID-19 cases at nursing homes declined by 82 percent since late December.
Yet challenges remain to make sure the COVID-19 picture continues improving.
Lopman said a concerted effort is needed to convince workers at long-term care facilities to get the shots.
While an estimated 80% of residents at long-term care homes in Georgia have gotten the COVID-19 vaccine, only around 40% of staff have been vaccinated, according to Tony Marshall, president and CEO of The Georgia Health Care Association and Georgia Center for Assisted Living.
At some facilities, the staff rate is even lower, he said.
Industry leaders have set an ambitious goal of getting 75% of staff vaccinated by June 30, Marshall said. Providers are holding more informational sessions about the vaccine, and offering other perks like more PTO days for those getting vaccinated.
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Even if that effort is successful, long-term care facilities will have to remain vigilant because of how vulnerable their residents are. The populations inside them also are transient. New residents move in often, and staff turnover can be frequent.
Now that the national pharmacy vaccination clinics at long-term care facilities are winding down, it will be up to care homes to either have their staff administer the vaccine or to find providers who can return often to vaccinate new residents, much as they do now with flu vaccines.
“That’s going to be a tricky thing to do,” said Amber Schmidtke, a public health researcher and former Mercer University professor who tracks Georgia’s epidemic on her widely read blog.
Another concern is that the number of new cases overall in Georgia has leveled off since mid-February, with the seven-day rolling average of new confirmed and suspected cases remaining at about 3,000 per day.
Nationwide, cases have started to increase in some states and the rolling average has flattened nationally, amid warnings from The Centers for Disease Control and Prevention that new, more infectious trains of the coronavirus are taking over.
It’s likely new booster shots will have to be developed to adjust as the virus replicates and alters its own defenses, experts say.
‘Weight has been lifted’
Haunted by the harsh toll of the pandemic, Georgia long-term care facilities acknowledge that it’s too soon for anyone to let down their guard. But administrators say that in light of the significant declines in cases and deaths, they will move ever so cautiously to ease restrictions, to allow some visitation and more communal activities, such as group exercise programs and cooking classes.
“I wouldn’t go as far as saying the nightmare is over, but I feel a lot better and I feel a lot of relief,” said Cateau, of A.G. Rhodes. “But we cannot take our foot off the pedal when it comes to vaccination and safety measures — social distancing, mask-wearing, and infection-control measures. We want this trend to continue and not only for a short period.”
Gwen Hardy, chief operating officer of Presbyterian Homes of Georgia, which includes six senior living communities including independent apartment living, said isolation has been as much of a challenge for senior facilities as the virus.
“As it relates to visitation, our cognitively impaired residents do not understand why their family is not visiting them, and this brings further confusion. And for those who are alert and oriented, they have a sadness about them, and even though the staff does everything they can to fill the gaps, there is still a void when family cannot be present... It has been heartbreaking for our staff and heartbreaking for our residents during this time of isolation.”
Meanwhile, Albert Maslia, a resident of The William Breman Jewish Home, said, for him, getting the COVID-19 vaccine, “means freedom.” The 90-year-old hasn’t left the building since moving in last August. His wife, Isabelle, lives in the same campus at an independent living community, separated by a breezeway. It’s been a long, difficult eight months.
He frequently connects with his wife and children by phone or by tablet, especially for Friday night Shabbat meals, which include challah, a traditional Jewish bread, and wine, both blessed before the meal begins.
“We do conference calls, but it’s not the same. I can’t smell anything. I can’t see the lines in their faces. Let’s just say it’s not as warm. It’s about to drive me crazy.”
But on a recent phone call, Maslia said he is hopeful about soon seeing his family — face-to-face.
“It’s what keeps me going,” he said.
Harley Tabak, president and CEO of Jewish HomeLife, which includes The William Breman Jewish Home, shares Maslia’s optimism.
“We feel like we are in a new day,” said Tabak. “As far as having the vaccine, a real weight has been lifted, and we haven’t felt this way in more than a year.”
The current number of active COVID-19 cases at The William Breman Jewish Home: zero.
