Despite Efforts to Slow the Spread of the Virus in Long-Term Care Facilities, KFF Analysis Finds Many States Experienced the Worst COVID-19 Outbreaks and Highest Number of Deaths in December

For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. The novel coronavirus has had a disproportionate impact onMore

January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations

With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for 8 percent of cases but 40 percent of deaths fromMore

New National and State Estimates for Recommended COVID-19 Vaccination Priority Population

This month the Centers for Disease Control and Prevention (CDC) adopted a recommendation that health care workers and long-term care residents should be the first to receive the COVID-19 vaccine once it is authorized or approved by the FDA. A new KFF analysis estimates there are 15.5 million people working in health care settings whoMore

PointClickCare Acquires Collective Medical for $650M to Create to Largest Combined Acute and Post-Acute Care Network

PointClickCare Acquires Collective Medical for $650M to Create to Largest Combined Acute and Post-Acute Care Network

What
You Should Know:


PointClickCare announces its intent to acquire Collective Medical to create the
largest combined acute and post-acute care network in North America for $650M.


Collective Medical’s platform connects more than 1,300 hospitals, thousands of
ambulatory practices and long-term post-acute care (LTPAC) providers, as well
as accountable care organizations (ACOs) and every national health plan in the
country, across a 39-state network.

– With the acquisition of Collective Medical, PointClickCare will solidify its position as a high-growth, cloud-based SaaS leader, serving a large, diversified customer base across the acute, ambulatory, post-acute, and payer spectrum.


PointClickCare
Technologies
, a leader in senior care technology with a network of more
than 21,000 skilled nursing facilities, senior living communities, and home
health agencies, today announced its intent to acquire
Collective Medical, a Salt Lake
City, UT-based leading network-enabled platform for real-time cross-continuum
care coordination for $650M. Together, PointClickCare and Collective Medical
will provide diverse care teams across the continuum of acute, ambulatory, and
post-acute care with point-of-care access to deep, real-time patient insights
at any stage of a patient’s healthcare journey, enabling better decision making
and improved clinical outcomes at lower cost.

The acquisition follows a partnership, created between the
companies in August 2019, which streamlined the integration of Collective
Medical’s solution for care transitions with PointClickCare’s leading
cloud-based software platform. Hundreds of PointClickCare customers are already
leveraging this connection to the Collective platform to coordinate seamless
care transitions and influence decisions at the point of care.

COVID-19 Underscores Barriers to Care Coordination

Currently, hospitals, ACOs and health plans
lack the data and tools to effectively coordinate with LTPAC providers and
other disparate points of care – an issue spotlighted further by the COVID-19 pandemic.
And despite the healthcare system’s ongoing move to value-based payment
models
, barriers to care coordination
persist, especially for seniors and other complex patient populations. Through
this acquisition, the company will be uniquely positioned to address these
challenges.

PointClickCare supports a network of more than 21,000
skilled nursing facilities, senior living communities and home health agencies.
In the United States, 97 percent of all hospitals discharge patients to skilled
nursing facilities using PointClickCare. Founded in 2005, Collective Medical’s
platform connects more than 1,300 hospitals, thousands of ambulatory practices
and long-term post-acute care (LTPAC) providers, as well as accountable care
organizations (ACOs) and every national health plan in the country, across a
39-state network.

These providers come together via the Collective platform to
support patients suffering from a variety of complex conditions, including
substance use disorder, mental and behavioral health issues, and other care
needs requiring multiple interventions and transitions across disparate care
settings. The combination of PointClickCare and Collective Medical will enable
care to be more seamlessly delivered for the most complex (high-cost,
high-needs) patients, including the rapidly growing aging population.

The acquisition will connect care teams, post-acute
providers, hospitals and health plans with better data about their patients,
ultimately reducing administrative burdens and bringing down the high costs of
complex care. Providers and health plans will be empowered as they work to
solve the complexities around the senior patient population by leveraging
increased information across diagnoses groups and unprecedented access to drive
behavior change at the point of care.

Acquisition Establishes PointClickCare As Leader in Acute and Post-Acute
Care Network

With the acquisition of Collective Medical, PointClickCare
will solidify its position as a high growth, cloud-based SaaS leader, serving a
large, diversified customer base across the acute, ambulatory, post-acute, and
payer spectrum. As the shift to value-based care fuels growing market demand
for intelligence and collaboration tools, the company will be best positioned
to provide the most fully integrated set of real-time care coordination tools
across the entire continuum of care, powered by the largest network of its kind
in the U.S.

“The healthcare ecosystem is a mix of disconnected providers, systems, plans, processes and data. Healthcare costs and risk are on the rise, while patient care and provider-to-provider coordination are inconsistent. Our mission is to improve the lives of seniors, and we believe the best way to meaningfully advance this goal is by connecting disparate points of care,” says Mike Wessinger, founder and chief executive officer of PointClickCare Technologies. “Collective Medical offers the right fit of people and technology and together we will initiate a new era of data-enriched collaboration across the continuum that radically transforms how data and people are empowered to liberate health.”

The acquisition is subject to receiving regulatory
approvals, including from The Committee on Foreign Investment in the United
States (CFIUS), and other customary closing conditions, and is expected to be
completed by the end of December 2020.

Potential Health Policy Administrative Actions Under President Biden

This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.

Long-Term Care Workers, Grieving and Under Siege, Brace for COVID’s Next Round

In the middle of the night, Stefania Silvestri lies in bed remembering her elderly patients’ cries.

“Help me.”

“Please don’t leave me.”

“I need my family.”

Months of caring for older adults in a Rhode Island nursing home ravaged by COVID-19 have taken a steep toll on Silvestri, 37, a registered nurse.

She can’t sleep, as she replays memories of residents who became ill and died. She’s gained 45 pounds. “I have anxiety. Some days I don’t want to get out of bed,” she said.

Now, as the coronavirus surges around the country, Silvestri and hundreds of thousands of workers in nursing homes and assisted living centers are watching cases rise in long-term care facilities with a sense of dread.

Many of these workers struggle with grief over the suffering they’ve witnessed, both at work and in their communities. Some, like Silvestri, have been infected with the coronavirus and recovered physically — but not emotionally.

Since the start of the pandemic, more than 616,000 residents and employees at long-term care facilities have been struck by COVID-19, according to the latest data from KFF. Just over 91,000 have died as the coronavirus has invaded nearly 23,000 facilities. (KHN is an editorially independent program of KFF.)

At least 1,000 of those deaths represent certified nursing assistants, nurses and other people who work in institutions that care for older adults, according to a recent analysis of government data by Harold Pollack, a professor at the School of Social Service Administration at the University of Chicago. This is almost certainly an undercount, he said, because of incomplete data reporting.

How are long-term care workers affected by the losses they’re experiencing, including the deaths of colleagues and residents they’ve cared for, often for many years?

Edwina Gobewoe, a certified nursing assistant who has worked at Charlesgate Nursing Center in Providence, Rhode Island, for nearly 20 years, acknowledged “it’s been overwhelming for me, personally.”

At least 15 residents died of COVID-19 at Charlesgate from April to June, many of them suddenly. “One day, we hear our resident has breathing problems, needs oxygen, and then a few days later they pass,” she said. “Families couldn’t come in. We were the only people with them, holding their hands. It made me very, very sad.”

Every morning, Gobewoe would pray with a close friend at work. “We asked the Lord to give us strength so we could take care of these people who needed us so much.” When that colleague was struck by COVID-19 in the spring, Gobewoe prayed for her recovery and was glad when she returned to work several weeks later.

But sorrow followed in early September: Gobewoe’s friend collapsed and died at home while complaining of unusual chest pain. Gobewoe was told that her death was caused by blood clots, which can be a dangerous complication of COVID-19.

She would “do anything for any resident,” Gobewoe remembered, sobbing. “It’s too much, something you can’t even talk about,” describing her grief.

I first spoke to Kim Sangrey, 52, of Lancaster, Pennsylvania, in July. She was distraught over the deaths of 36 residents in March and April at the nursing home where she’s worked for several decades — most of them due to COVID-19 and related complications. Sangrey, a recreational therapist, asked me not to name the home, where she continues to be employed.

“You know residents like family — their likes and dislikes, the food they prefer, their families, their grandchildren,” she explained. “They depend on us for everything.”

When COVID-19 hit, “it was horrible,” she said. “You’d go into residents’ rooms and they couldn’t breathe. Their families wanted to see them, and we’d set up Zoom wearing full gear, head to toe. Tears are flowing under your mask as you watch this person that you loved dying — and the family mourning their death through a tablet.”

“It was completely devastating. It runs through your memory — you think about it all the time.”

Mostly, Sangrey said, she felt empty and exhausted. “You feel like this is never going to end — you feel defeated. But you have to continue moving forward,” she told me.

Three months later, when we spoke again, COVID-19 cases were rising in Pennsylvania but Sangrey sounded resolute. She’d had six sessions with a grief counselor and said it had become clear that “my purpose at this point is to take every ounce of strength I have and move through this second wave of COVID.”

“As human beings, it is our duty to be there for each other,” she continued. “You say to yourself, OK, I got through this last time, I can get through it again.”

That doesn’t mean that fear is absent. “All of us know COVID-19 is coming. Every day we say, ‘Is today the day it will come back? Is today the day I’ll find out I have it?’ It never leaves you.”

To this day, Silvestri feels horrified when she thinks about the end of March and early April at Greenville Center in Rhode Island, where up to 79 residents became ill with COVID-19 and at least 20 have died.

The coronavirus moved through the facility like wildfire. “You’re putting one patient on oxygen and the patient in the next room is on the floor but you can’t go to them yet,” Silvestri remembered. “And the patient down the hall has a fever of 103 and they’re screaming, ‘Help me, help me.’ But you can’t go to him either.”

“I left work every day crying. It was heartbreaking — and I felt I couldn’t do enough to save them.”

Then, there were the body bags. “You put this person who feels like family in a plastic body bag and wheel them out on a frame with wheels through the facility, by other residents’ rooms,” said Silvestri, who can’t smell certain kinds of plastic without reliving these memories. “Thinking back on it makes me feel physically ill.”

Silvestri, who has three children, developed a relatively mild case of COVID-19 in late April and returned to work several weeks later. Her husband, Michael, also became ill and lost his job as a truck driver. After several months of being unemployed, he’s now working at a construction site.

Since July 1, the family has gone without health insurance, “so I’m not able to get counseling to deal with the emotional side of what’s happened,” Silvestri said.

Although her nursing home set up a hotline number that employees could call, that doesn’t appeal to her. “Being on the phone with someone you don’t know, that doesn’t do it for me,” she said. “We definitely need more emotional support for health care workers.”

What does help is family. “I’ve leaned on my husband a lot and he’s been there for me,” Silvestri said. “And the children are OK. I’m grateful for what I have — but I’m really worried about what lies ahead.”

The Navigating Aging column last week focused on how nursing homes respond to grief sweeping through their facilities.

Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation here and submit questions in advance here.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Prayers and Grief Counseling After COVID: Trying to Aid Healing in Long-Term Care

A tidal wave of grief and loss has rolled through long-term care facilities as the coronavirus pandemic has killed more than 91,000 residents and staffers — nearly 40% of recorded COVID-19 deaths in the U.S.

And it’s not over: Facilities are bracing for further shocks as coronavirus cases rise across the country.

Workers are already emotionally drained and exhausted after staffing the front lines — and putting themselves at significant risk — since March, when the pandemic took hold. And residents are suffering deeply from losing people they once saw daily, the disruption of routines and being cut off from friends and family.

In response, nursing homes and assisted living centers are holding memorials for people who’ve died, having chaplains and social workers help residents and staff, and bringing in hospice providers to offer grief counseling, among other strategies. More than 2 million vulnerable older adults live in these facilities.

“Everyone is aware that this is a stressful, traumatic time, with no end in sight, and there needs to be some sort of intervention,” said Barbara Speedling, a long-term care consultant working on these issues with the American Health Care Association and National Center for Assisted Living, an industry organization.

Connie Graham, 65, is corporate chaplain at Community Health Services of Georgia, which operates 56 nursing homes. For months, he’s been holding socially distant prayer services in the homes’ parking lots for residents and staff members.

“People want prayers for friends in the facilities who’ve passed away, for relatives and friends who’ve passed away, for the safety of their families, for the loss of visitation, for healing, for the strength and perseverance to hold on,” Graham said.

Central Baptist Village, a Norridge, Illinois, nursing home, held a socially distanced garden ceremony to honor a beloved nurse who had died of COVID-19. “Our social service director made a wonderful collage of photos and left Post-its so everyone could write a memory” before delivering it to the nurse’s wife, said Dawn Mondschein, the nursing home’s chief executive officer.

“There’s a steady level of anxiety, with spikes of frustration and depression,” Mondschein said of staff members and residents.

Vitas Healthcare, a hospice provider in 14 states and the District of Columbia, has created occasional “virtual blessing services” on Zoom for staffers at nursing homes and assisted living centers. “We thank them for their service and a chaplain gives words of encouragement,” said Robin Fiorelli, Vitas’ senior director of bereavement and volunteers.

Vitas has also been holding virtual memorials via Zoom to recognize residents who’ve died of COVID-19. “A big part of that service is giving other residents an opportunity to share their memories and honor those they’ve lost,” Fiorelli said.

On Dec. 6, Hospice Savannah is going one step further and planning an online broadcast of its annual national “Tree of Light” memorial, with grief counselors who will offer healing strategies. During the service, candles will be lit and a moment of silence observed in remembrance of people who’ve died.

“Grief has become an urgent mental health issue, and we hope this will help begin the healing process for people who haven’t been able to participate in rituals or receive the comfort and support they’d normally have gotten prior to COVID-19,” said Kathleen Benton, Hospice Savannah’s president and chief executive officer.

But these and other attempts are hardly equal to the extent of anguish, which has only grown as the pandemic stretches on, fueling a mental health crisis in long-term care.

“There is a desperate need for psychological services,” said Toni Miles, a professor at the University of Georgia’s College of Public Health and an expert on grief and bereavement in long-term care settings. She’s created two guides to help grieving staffers and residents and is distributing them digitally to more than 400 nursing homes and 1,000 assisted living centers in the state.

A recent survey by Altarum, a nonprofit research and consulting firm, highlights the hopelessness of many nursing home residents. The survey asked 365 people living in nursing homes about their experiences in July and August.

“I am completely isolated. I might as well be buried already,” one resident wrote. “There is no hope,” another said. “I feel like giving up. … No emotional support nor mental health support is available to me,” another complained.

Inadequate mental health services in nursing homes have been a problem for years. Instead of counseling, residents are typically given medications to ease symptoms of distress, said David Grabowski, a professor of health care policy at Harvard Medical School who has published several studies on this topic.

The situation has worsened during the pandemic as psychologists and social workers have been unable to enter facilities that limited outsiders to minimize the risk of viral transmission.

“Several facilities didn’t consider mental health professionals ‘essential’ health care providers, and many of us weren’t able to get in,” said Lisa Lind, president of Psychologists in Long-Term Care. Although some facilities switched to tele-mental health services, staff shortages have made those hard to arrange, she noted.

Fewer than half of nursing home staffers have health insurance, and those who do typically don’t have “minimal” access to mental health services, Grabowski said. That’s a problem because “there’s a real fragility right now on the part of the workforce.”

Colleen Frankenfield, president and chief executive officer of Lutheran Social Ministries of New Jersey, said what staffers need most of all is “the ability to vent and to have someone comfort them.” She recalls a horrible day in April, when four residents died in less than 24 hours at her organization’s continuing care retirement community in northern New Jersey, which includes an assisted living facility and a nursing home.

“The phone rang at 1 a.m. and all I heard on the other end was an administrator, sobbing,” she remembered. “She said she felt she was emotionally falling apart. She felt like she was responsible for the residents who had died, like she had let them down. She just had to talk about what she was experiencing and cry it out.”

Although Lutheran Social Ministries has been free of COVID-19 since the end of April, “our employees are tired — always on edge, always worried,” Frankenfield said. “I think people are afraid and they need time to heal. At the end of the day, all we can really do is stand with them, listen to them and support them in whatever way we can.”

Coming Monday: The Navigating Aging column will look at the grief faced by long-term care workers as COVID-19 cases and deaths mount.

Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation here and submit questions in advance here.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

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Hotspot States See More COVID Cases in Nursing Homes

In his Axios column, Drew Altman discusses new data on the surge of new infections in long-term care facilities in COVID-19 hotspots. The dominant narrative about the Sunbelt surge in new cases is that the infected population is younger, but he says that’s not the whole story. There is also a spike in cases in long-term care facilities, especially in Florida and Texas.

Rising Cases in Long-term Care Facilities Are Cause for Concern

LTC cases in hotspot states are increasing at 4x the rate as LTC cases in non-hotspot states. Media has largely focused on the share of cases attributed to a younger population. However, increased cases in long-term care facilities are cause for concern, given that nearly half of all COVID-19 deaths have been in long-term care facilities. This piece provides state-level data, including data that shows that long-term care cases in Texas and Florida have increased by over 50% in 2 weeks.