Nursing Homes account for approximately one-third of coronavirus related deaths in the United States.

Nursing Homes account for approximately one-third of coronavirus related deaths in the United States.

One month ago, Maryland Governor Larry Hogan ordered mandatory universal coronavirus testing at all nursing homes. The order came in the wake of hundreds of coronavirus related deaths in nursing homes across the state, accounting for approximately half of Maryland’s coronavirus fatalities. Despite the mandate, Maryland’s long-term care facilities continue to struggle in the fight against the coronavirus.

Meanwhile, Virginia’s Governor Ralph Northam has declared nursing homes a “top priority” in the state’s battle against the coronavirus pandemic. This comes as nursing homes struggle to source personal protective equipment and uncertainty looms over the number of coronavirus infections being reported by these facilities in Virginia.

How effective have local jurisdictions been in curbing the impact of the coronavirus in nursing homes and what needs to be done to protect residents and workers alike?

Produced by Kayla Hewitt


  • Rebecca Tan Local reporter, The Washington Post; @rebtanhs
  • Dana Parsons Vice President and Legislative Council, LeadingAge Virginia, @leadingageva


  • 12:00:03

    KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. I'm broadcasting from home, so welcome. Later in the broadcast what your workplace is likely to look like when you return to it if you return to it. But first accounting for approximately one-third of coronavirus related deaths in the United States, nursing homes have been extremely vulnerable to the effects of the coronavirus pandemic.

  • 12:00:29

    KOJO NNAMDILast month, Maryland Governor Larry Hogan ordered mandatory coronavirus testing at all nursing homes in the state. Meanwhile, Virginia Governor Ralph Northam has declared nursing homes a top priority in the state's fight against the coronavirus. So how are local nursing homes handling the coronavirus pandemic and what needs to be done to prevent the spread of infection within long term care facilities? Joining us now is Rebecca Tan, who is a Reporter for The Washington Post. Rebecca, thank you for joining us.

  • 12:00:58

    REBECCA TANThank you, Kojo.

  • 12:01:00

    NNAMDIRebecca, a month ago Governor Hogan ordered mandatory universal coronavirus testing in nursing homes across the State of Maryland. How effective has that order been?

  • 12:01:12

    TANSo I think when he announced that order a lot of family members of nursing home residents were really excited, because they thought the testing was going to happen immediately. And, you know, in the week, two weeks after that government officials had to come out and clarify that, you know, the testing wasn't going to happen immediately. Governor Hogan's office told one of our colleagues last week that by the end of this Friday all residents and staff would have been tested. But that's a month after his executive order. And so that's left some family members feeling a little bit confused and a little bit frustrated.

  • 12:01:50

    NNAMDIAlso joining us is Dana Parsons, the Vice President and Legislative Council for LeadingAge Virginia. Dana Parsons, thank you for joining us.

  • 12:01:59

    DANA PARSONSThank you so much for having me. Appreciate the opportunity.

  • 12:02:01

    NNAMDIDana, what exactly is LeadingAge Virginia?

  • 12:02:05

    PARSONSLeadingAge Virginia is an association that represents not for profit aging services providers. We are an organization that represents the entire continuum of aging services.

  • 12:02:21

    NNAMDIHave long term care facilities in Virginia been able to attain the amount of PPE, personal protective equipment, they need, Dana Parsons?

  • 12:02:31

    PARSONSWell, if I may give you a little bit of background about a system that we have here in Virginia and then comment on that.

  • 12:02:37


  • 12:02:39

    PARSONSIn Virginia we have a healthcare emergency management program that's a partnership between the Department of Health as well as the Virginia Hospital and Healthcare Association. And this is a program that aims to address and close gaps in the healthcare systems. Each healthcare coalition through this program is located around the state and design to communicate and coordinate response activities during a disaster such as the COVID-19 pandemic.

  • 12:03:10

    PARSONSSo our nursing home members work through their coalitions to obtain the PPE that they need. It's been challenging. PPE is cyclical. So in the beginning our members needed masks, then gowns. Then became their most needed supply and so forth. But they are working through their regional healthcare coalitions for their PPE.

  • 12:03:37

    NNAMDIAny assistance being provided by local health departments?

  • 12:03:41

    PARSONSAbsolutely. Each of our members are working through their local health departments for testing. For PPE that's really through the regional healthcare coalitions. If they're having difficulty obtaining what they need they are working through some venders. And members have coordinated to work with other nursing homes in their area to share materials and supplies that are needed for PPE.

  • 12:04:11

    NNAMDIDana, LeadingAge Virginia as well as two other organizations in Virginia have released a joint statement saying the public data released by the Virginia Hospital and Healthcare Association, VHHA, represents only a partial picture of the needs of long term care facilities in Virginia. What makes this data incomplete?

  • 12:04:32

    PARSONSWell, this data is voluntarily reported by long term care communities throughout Virginia and only shows a partial need. VHHA system is a very important benefit to our state during this time, but it only provides us an idea about the needs. It's not a complete picture since the reporting is based on voluntarily reporting.

  • 12:04:59

    NNAMDIRebecca Tan, how are nursing homes in Maryland sourcing their PPE? Is it all coming from the state?

  • 12:05:07

    TANNo. So it really depends. From what we've heard, right, the facilities that are part of big national parent companies are in a much better position to tackle shortages of PPE and testing, because they're able to sort of leverage resources nationally. Maybe redirect some from another state to Maryland. And those facilities are much better equipped to handle outbreaks within the buildings. There are also some facilities that have been able to get great assistance from local governments.

  • 12:05:39

    TANMontgomery County has distributed a bunch of masks and gowns to 80 or so nursing homes and assistant living facilities. But I'm sure that there are smaller counties, smaller local governments that don't have the resources or the ability to do that. And the state has provided some resources to limited extent. But, again, my colleague Erin Cox at The Post just wrote a story about how it really depends from jurisdiction -- it varies from jurisdiction to jurisdiction how much they're getting from the state.

  • 12:06:13

    NNAMDIHow about smaller or family owned nursing homes? How are they making out?

  • 12:06:20

    TANSo those nursing homes from our reporting are really the ones that are sort of suffering and struggling the most, because they can't rely on a large parent company to get resources for them, to get testing for them. And it's in these facilities where you are hearing of staff members sleeping over at the buildings, the facilities, in order to cover shifts. We're hearing of staff members, you know, really fearing for their lives in terms of -- because they lack the PPE and the right kind of protection.

  • 12:06:49

    NNAMDIHere now is Lorrie in Takoma Park, Maryland. Lorrie, you're on the air. Go ahead, please.

  • 12:06:55

    LORRIEHi. I have a 91 year old aunt with Alzheimer's, who I'm the power of attorney for and the responsible for her. And I placed her in assisted living in Baltimore County near where she lived in October. And her facility is amazing. I get weekly updates from the executive director. She lists the number of staff and associates, who, you know, if anybody has tested positive for COVID. As of the entire time, only one staff member has tested positive, and that person is recovering now.

  • 12:07:31

    LORRIEI've been able to do Skype calls with my aunt. It's a little challenging since she can't hear barely at all. And then this Thursday they just started opening up in face call -- in person visits. I'm sorry, outside. Like 20 minutes, you know, visits outside for family members. So, you know, they're just doing it right. And I'm very pleased.

  • 12:07:55

    NNAMDIAnd those visits outside work, because you can see your relative behind I presume a glass window or partition of some kind and communicate with your relative by phone?

  • 12:08:07

    LORRIENo. I think this one -- I haven't done it yet, but I think you are literally outside six feet apart from your relative.

  • 12:08:15

    NNAMDIOh, okay.

  • 12:08:16

    LORRIEYeah. Yeah. I'm assuming staff people are there to make sure nobody does something they're not supposed to do.

  • 12:08:19

    NNAMDIThat you're socially distancing. Okay. And then I'm assuming you have to wear a mask and maybe gloves.

  • 12:08:24

    LORRIEOh, absolutely. Yeah, that's a requirement. Yeah. And no hugging allowed obviously.

  • 12:08:28

    NNAMDIObviously. Well, thank you very much for your call. And good luck. Rebecca, are nursing homes in Maryland being inspected regularly to ensure that they're following guidelines to prevent the spread of coronavirus?

  • 12:08:40

    TANThat's actually a key part of the story. So it's pretty complicated, but basically the federal agency that regulates nursing homes, way back in March they stopped sort of routine inspections. So this is the centers of Medicare, Medicaid, CMS. And they usually -- through them, you know, local government agencies as well as some federal officials go in and do regular checks of nursing homes. So when coronavirus just started, they stopped all routine checks, because they didn't want to bring, you know, have a stranger go into these facilities. But that meant that sort of the regular tool that government officials are using to inspect and regulate these facilities wasn't there.

  • 12:09:21

    TANSo we heard, you know, a couple of weeks ago that Montgomery County that is the only jurisdiction in the state that actually has local officials inspecting and regulating and working with nursing homes on top of state officials that they weren't actually doing local inspections for several months since the coronavirus started.

  • 12:09:40

    TANAnd so even though we have heard from a bunch -- we have heard of a bunch of new regulations to increase infection control measures. It's very hard for local governments to ensure that these measures are actually being abided to. We've heard from a couple of facilities. We've heard from employees inside these facilities who say that, you know, administrators may be telling local government officials that, yes, you know, we are separating and we are cohering residents. But what they're seeing in the ground is that there are infection patients in all four wings mixed in with negative patients.

  • 12:10:14

    TANSo it's I think one of the big challenges with the nursing home story from the point of local government is how to ensure that they're able to enforce the new regulations that they're pushing at.

  • 12:10:26

    NNAMDIDana Parsons, have there been any Virginia state inspections of the nursing homes in your organization since the pandemic began.

  • 12:10:34

    PARSONSYes. There have been. They have been two types of inspections. We've had virtual inspections that have been conducted through CMS where they have conducted surveys by phone. We've also had in person surveys as well. And we have not heard any issues or concerns about that. Our state agency confirmed with me this morning, our survey agency, that they have enough PPE in place to conduct onsite surveys when necessary.

  • 12:11:10

    NNAMDIYou mentioned, CMS. What is CMS?

  • 12:11:13

    PARSONSThe Centers for Medicare and Medicaid. I apologize.

  • 12:11:17

    NNAMDIOkay. And how do the virtual inspections by phone work?

  • 12:11:22

    PARSONSIt's my understanding that the members, who have participated in those, they are contacted by CMS. There are certain things and information that they're asked for by phone. Those I understand have gone well. We continue to work with CMS to have guidance related to that. Our national association, LeadingAge, works with CMS to get information to provide to our members. But, you know, we haven't had many of those, but they seem to have gone well. Then the onsite follows if necessary.

  • 12:12:05

    NNAMDIOkay. Dana Parsons is the Vice President and Legislative Council for LeadingAge Virginia. Rebecca Tan is a Local Reporter for The Washington Post. We're going to take a short break. I'm Kojo Nnamdi.

  • 12:12:34

    NNAMDIWelcome back to our conversation about how the coronavirus pandemic is impacting local nursing homes. I'd like to go immediately to the phone where Rachel in Silver Spring awaits us. Rachel, you're on the air. Go ahead, please.

  • 12:12:47

    RACHELThank you for taking my call. My mother died of COVID-19 on May 15 in her nursing home. And she was first diagnosed with pneumonia on a Friday. And then they couldn't do COVID tests until Monday. And so she was being treated for pneumonia until Monday, when she tested positive, which happened to be my birthday. It's was not a good birthday present.

  • 12:13:19

    RACHELAnd she was in extremely good health. She had dementia, but her body was very strong. And, you know, how it got in there -- I know of at least one other person on her ward, who has it. But he's much younger and doing much better. But, you know, she was quarantined in her room since March. So the only people going in and out were the same staff members.

  • 12:13:52


  • 12:13:53

    RACHELAnd you would think -- I mean, I know, you know, it's very hard if people are asymptomatic. You can take their temperature all you want, but, you know, if it doesn't show up, it doesn't show up. But it's just terrifying to think to think of how many, you know, people are subject to this with no way really no way of knowing.

  • 12:14:20

    NNAMDIWell, Rachel, condolences on your mother's passing. And even though you got sad news on your birthday, I'm here to wish you belated birthday greetings anyway. But thank you very much for sharing your story with us. Rebecca Tan, some nursing homes in Maryland are struggling to maintain adequate staff and that could be a part of what may have happened with Rachel's mom. Have there been any efforts by the state to help staff these facilities because a number of people are working in several different facilities, aren't they?

  • 12:14:48

    TANThat's right. And, you know, this really has its roots in like years of underfunding basically of this industry. You know, what happened to Rachel, I'm so sorry for your loss. It's not an uncommon story. It's an incredibly common story, right? We've heard from so many nursing home employees who say that they have had to work in different facilities basically one shift -- a morning shift at one facility, evening shift at another facility. And generally speaking, right, that a lot of people have recognized that this is how the virus was able to spread from one facility to another because, like Rachel pointed out, a lot of these facilities have been in lockdown since early March, sorry.

  • 12:15:29

    TANAnd so really only the staff are moving in and out. And when they move from one facility to another they can become -- they became, you know, asymptomatic carriers of the virus. And now if they do test positive, what happens is that they fall out of shift for both these facilities or maybe multiple facilities. And the result of that is a severe understaffing.

  • 12:15:52

    TANThe state has provided, you know, quote on quote bridge teams, which are 200 state contract nurses that Hogan said were ready to deploy on April 29, right? But we, again, have heard from administrators and other nursing homes staff, who say they don't think 200 nurses is enough to cover the staffing shortages across the state. The state itself has 200 plus nursing homes and assisted living facilities and 200 nurses is just not enough. And then the second issue is, you know, how quickly have they been deployed? Again, a month after -- or coming up to a month after Hogan made the announcement we're still hearing many reports from nursing homes, who are struggling with understaffing and it's really affecting the quality of care for the residents.

  • 12:16:42

    NNAMDIIndeed. Deborah emailed us to say, "I recently had two family members residing in two different nursing homes in Maryland. Although they received adequate care, it was very scary knowing that nurses and employees came back and forth from other facilities at great risk to patients. They need added protection in these facilities." Dana Parsons, how have the facilities in your organization, LeadingAge Virginia, been reporting coronavirus infections?

  • 12:17:08

    PARSONSCoronavirus infections are reported through the VHHA system that I mentioned earlier on a volunteer basis. We understand that there are organizations that share staff. So we believe that it's very important that this information be communicated to nursing homes so that they understand where staff are being shared. And so they are working through their local health departments to obtain information about communities that have positive outbreaks in the events that there's staff that they share.

  • 12:17:46

    NNAMDIHere is Manny in North Carolina. Hi, Manny, you're on the air.

  • 12:17:50

    MANNYYes. Thank you. Actually I have Northern Virginia --

  • 12:17:55

    NNAMDIOoh, Manny just dropped off the line. But Dana Parsons, what Manny was going to say as he said he apparently has Northern Virginia connections is that he has been working in nursing homes over the years. And the situation that we're seeing now has been going on for a long time. He said it's a sad situation. Is there anything you can add to that?

  • 12:18:15

    PARSONSCould you clarify a sad situation related to?

  • 12:18:19

    NNAMDIWell, he's not on the line anymore and we're hoping that he calls back. So if indeed Manny calls back I'll bring the issue up again. In the meantime, Rebecca Tan, earlier this month the Centers for Medicare and Medicaid Services, which regulates nursing homes across the country announced that they had released data on the number of positive coronavirus cases and death among nursing home residents and staff for every facility they oversee regardless of whether the state or local health department was making that information public or not. Is that happening yet?

  • 12:18:49

    TANNo. So that was sort of the big issue maybe like just about a month ago I think, was that a lot of family members were being kept in the dark, right? Of whether there were any cases at that facility, how many people at that facility had died? We were hearing a lot of the same story, which is folks saying like, you know, we didn't even know that coronavirus was in the building until I got the call that my grandmother or my mother had passed away from it.

  • 12:19:19

    TANSo that was a sort of a big drama, you know, not just locally but across the country. And so in response what CMS, and again this is Centers for Medicare and Medicaid, they said that they were going to release a national list, A list nationwide basically of all the facilities. They haven't done so yet. But Maryland publishes its own list of all the skilled nursing and assisted living facilities in the state and how many numbers that they -- how many cases and deaths that they have.

  • 12:19:49

    TAND.C. as well publishes that information. And Virginia really is the outlier in the region in terms of not publishing names or identifying the facilities where there have been cases and death.

  • 12:20:02

    NNAMDIRebecca, who are nursing homes required to report confirmed cases of COVID-19 to and what is that process like?

  • 12:20:10

    TANRight. So after sort of this period of, you know, no one knowing who to report to there's now a bunch of people and a bunch of agencies that facilities have to report to. And we've heard from, you know, administrators to be fair to them that there's some duplication in the reporting process. Right now a facility in Maryland, for example, has to report daily the number of cases and deaths to CMS, to CDC, the Center for Disease and Control Prevention, to the state health department, as well as, their local health department.

  • 12:20:43

    TANAnd, you know, from what we understand, from what they're telling us this process is not unified. They are doing the reporting independently for each of these agencies. And again I think that's just sort of another reflection of how sort of rapidly local government and state government and federal government agencies had to respond to all of this at once. And, you know, in a matter of weeks a facility went from not having, you know, to tell many people to tell a bunch of different agencies how many cases and -- how many infections and deaths they were having.

  • 12:21:14

    NNAMDIHere is Abby in Silver Spring or in Rockville, Maryland. Abby, you're on the air. Go ahead, please.

  • 12:21:19

    ABBYHi. My mom's in a long term care place for dementia in Baltimore County. But I have a lot to say. But my main question is how frequently are staff and residents going to be tested? They have been tested. But they have like a unit where they sequester the people who are positive.

  • 12:21:42

    NNAMDIOkay. Don't have a lot of time left. But, Rebecca Tan, does that vary from facility to facility?

  • 12:21:45

    TANIt's unclear at the moment. So the state's goals right now are just to test every staff and resident once. I don't think they've gone about testing people twice. But that is the goal.

  • 12:21:56

    NNAMDIHow about in Virginia, Dana Parsons. We only have about 30 seconds left.

  • 12:22:01

    PARSONSYeah, so we have protocols in place for testing of staff. You know, depending on the outbreaks in the community each community is going to implement their own policy. But testing is a priority.

  • 12:22:18

    NNAMDIIt varies. Dana Parsons, Rebecca Tan thank you both for joining us. We're going to take a short break. When we come back what your workplace is likely to look like when you return to it. I'm Kojo Nnamdi.

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