Long-term care facilities have started sharing COVID-19 information with families to comply with government guidance, but an increasing number of deaths and confirmed cases at some locations have been an ongoing cause for concern.
The situation inside the facilities also has been trying for residents, who have faced the death of friends, loss of contact with other residents, sudden relocation, reduced mobility and anxiety associated with a lockdown that began nearly two months ago, family members said.
Nicole Ramirez's 77-year-old mother found out on Mother's Day that her former next-door neighbor died after leaving Dyer Nursing and Rehabilitation for surgery.
The neighbor's sight wasn't so good, so Ramirez's mother often read letters the woman received from family aloud to her. Ramirez's mother felt as if she had become part of her neighbor's family, she said.
"She was distraught the whole day," Ramirez said of her mother. "They would read, have coffee, laugh."
At the beginning of the coronavirus pandemic, facilities often cited federal health information privacy laws when declining to disclose case information with families. The Indiana State Department of Health issued a mandate April 27 requiring long-term care facilities to provide daily updates on the number of COVID-19 infections and deaths to residents and their designated representatives.
Administrators at several Region facilities said Tuesday they're facing an unprecedented challenge as they work to comply with changing local, state and federal guidelines.
Ron Nunziato, CEO of Extended Care Consulting LLC, said long-term care facilities plan for emergency situations, but even the best planning couldn't match coronavirus or its impacts on nursing homes. Extended Care consults with Dyer Nursing and Rehabilitation and Sheffield Manor.
"Everyone is doing the best we can to ensure our residents are cared for the best way we can," Nunziato said. "We recognize that not being able to see and visit with loved ones is creating anxiety. We understand."
Deaths, cases increasing
Residents of long-term care facilities are among those at the highest risk for contracting the virus, because of their age, underlying health conditions and congregate living conditions.
The total number of COVID-19 deaths at long-term care facilities in Lake County rose by 13 from Thursday to Monday, to a total of 59, according to information released Tuesday by the Lake County Health Department.
The number of positive cases among long-term care facility residents rose to 434, while the number of infections among staff members increased to 123.
Statewide, 197 facilities reported at least one positive case Monday, while 121 reported at least one death, according to the Indiana State Department of Health. A total of 584 deaths and 3,033 positive cases were reported at long-term care facilities throughout the state.
All data was provisional and subject to change as more information is reported to local and state officials.
The Indiana State Department of Health lists 61 nursing homes operating in Lake, Porter and LaPorte counties.
The Lake County Health Department has not released facility-specific information. Symphony Care Network shared its information with The Times.
Family members shared emails and voicemails regarding COVID-19 cases at Dyer Nursing and Rehabilitation and Sheffield Manor and Majestic Care St. Anthony Nursing and Rehabilitation in Crown Point.
Dyer Nursing and Rehab
Dyer Nursing and Rehabilitation and Sheffield Manor, which are both at 601 Sheffield Ave. in Dyer, accounted for approximately 28% of all nursing home deaths in Lake County, records showed.
The company informed patient representatives Monday of 16 deaths in the rehab facility and one death at Sheffield Manor, the facility's assisted living side.
On Tuesday, the facility listed 92 positive cases, including 77 residents and 12 staff members in the rehab center and two residents and one staff member at Sheffield Manor. That was down from Monday totals of 80 residents and 13 staff at the rehab center and two residents and one staff member at Sheffield Manor.
Nunziato said 18 residents will be moved out of isolation Wednesday, which means they have had no symptoms after a 14-day incubation period.
Extended Care isn't planning to investigate how the virus entered the facility, he said.
"There would be no way to isolate how the coronavirus entered and spread to any facility," he said. "There are so many variables, timelines and people."
Jen Jocic, whose 87-year-old grandmother is a patient at Dyer Nursing and Rehab, said the daily updates Extended Care provides are good information.
"But it's also scary, because you can't communicate to your loved ones," she said. "You just see it on a piece of paper."
Jocic's grandmother has a difficult time talking on the phone, and communicating through a window also has been challenging, she said.
Jocic's grandmother was relocated several times, and her belongings were placed in bags and left them on the floor, she said.
Both Jocic and Ramirez said their family members, who each have limited mobility, were not receiving regular baths. Ramirez said her mother was moved to a new room late at night and once commented, "The astronauts are here," when workers wearing personal protective equipment entered her room.
Nunziato said staffing shortages have delayed showering and bathing at times, but residents were receiving the services as requested.
Residents have been relocated to different rooms as staff implement infection-control protocols and standards, he said.
"We always try and reduce room moves as they are disruptive to residents and staff alike," he said. "However, based on timing of testing of COVID and timing of receiving results we have had to move some residents to try and isolate the virus."
All long-term care facilities have been dealing with frequently changing guidance from state, federal and some local health officials, Nunziato said.
"It is extremely challenging, especially since much of the guidance is not coordinated between agencies," he said. "So you have one agency saying do this 'this' way and you have another saying doing this 'that' way. None are wrong in their guidance, just different in requirements, so the operational side is left with trying to implement guidance to meet these differences. It is very time-consuming, and can be very challenging."
Majestic Care St. Anthony
Representatives for two patients at Majestic Care St. Anthony Nursing and Rehabilitation, both of whom asked not to be identified for fear of retaliation, told The Times more than 50 people at the facility were COVID positive as of Tuesday.
According to a voicemail, a total of 54 residents in the nursing care facility and one in assisted living were positive, along with two team members. Every resident was tested, but some results remained pending.
Caryn Coppotelli, director of business development for Majestic Care, declined to confirm case totals but said the company has been calling patient representatives with detailed updates about COVID-19 in its communities.
"Our residents’ and care team members’ health and safety are of the utmost importance to St. Anthony Nursing and Rehabilitation," she said.
Like other long-term care facilities, St. Anthony temporarily closed its facility to visitors, began checking residents' and employees' temperatures and screening for symptoms, and implemented other infection-control protocols. The facility will continue to follow all government guidance in its response to the pandemic, Coppotelli said.
Symphony Care Network
Symphony of Dyer has 43 COVID-positive patients and 20 positive employees, said Natalie Bauer Luce, spokeswoman for Symphony Care Network.
Symphony of Crown Point had four COVID-positive patients and five positive employees. Symphony of Chesterton, which has seen one death, had no positive patients or employees as of Tuesday, she said.
Symphony has been advocating for universal testing, which includes tests for those without symptoms, particularly since an asymptomatic employee at its Joliet facility unknowingly spread the virus while distributing tables for in-room food service. As a result, 26 patients and two staff members at the facility died.
The Indiana State Department of Health was sending supplies to Symphony of Dyer to test everyone to determine if the company's isolation method is effective, Bauer Luce said.
"Testing is important, because the more you test the more you can control transmission rates by isolating COVID-negative patients from known positives," she said.
Symphony also purchased its own testing supplies through private labs and created a COVID-19 task force, which is led by infectious disease expert Dr. Alexander Stemer. The task force is working to introduce advanced clinical treatments for positive patients and implement disease-control strategies, she said.
The Indiana Health Care Association said long-term care facilities are doing all they can to contain COVID-19 and protect residents.
"They are taking extraordinary measures and are putting residents before themselves and their families," the association said in a statement.
Facilities adjusted to the state's requirement that they provide daily updates to families, the association said. If a family is not receiving information about COVID-19 from their nursing facility, they should report it to email@example.com.
Jacqueline B. Hill, of Northwest Indiana Community Action Corp., which works with the state's long-term care ombudsman's office, said facilities are required to inform families on a weekly basis.
"We are hearing that it is not being done on a consistent basis," she said. "Early on, facilities were operating according to guidelines from their corporate offices. My experience is, accurate numbers from facilities are hard to come by."
Families can email Indiana's long-term care ombudsman at firstname.lastname@example.org.
Times correspondent Bill Dolan contributed to this report.