Sherwood Oaks is a local, privately owned nursing home in Ft. Bragg. As the only skilled nursing facility here on the Mendocino Coast, it is licensed for 79 beds and currently has 45 residents. It experienced an outbreak of COVID during July and August of last year. Unfortunately, it is experiencing another outbreak now. Beginning about two weeks ago, there were 3 staff and 4 residents affected. They all did well and are now off isolation, however, that introduced the virus into the nursing home population again. The facility immediately began taking the necessary steps to limit the spread. As of this writing, there are 15 new active cases amongst residents and two new cases in staff members, bringing the total for this outbreak to 24 residents and staff thus far. Last year, the outbreak ended at a total of 32 with 24 residents and 8 staff being infected. There were 8 deaths as a result of last year’s outbreak.
There are some significant differences now when compared with last year. On the upside, all but five of the 45 residents (89%) and 85% of the staff are now fully vaccinated. Recall that vaccination does not keep a person from becoming infected and thus turning positive, but it does help tremendously in reducing the chance that a person will progress to serious illness. So, it is expected that we may not see folks getting as sick this time around. So far, none of the infected persons appear to be getting seriously ill.
The high vaccination rate at Sherwood Oaks compares quite favorably to national statistics and is a credit to the leadership at Sherwood Oaks. According to the Center for Medicare and Medicaid Services (CMS), the average rate of vaccination in US skilled nursing facilities is 84% of residents and 64% of staff.
On the downside, staffing challenges at the nursing home are worse than before. This is critical because each of these new COVID cases must be isolated and that increases the need for staffing that the facility simply does not have at this time. Last year the hospital was able to step in to help by accepting the COVID positive residents from Sherwood Oaks, thus relieving the staffing stress and helping limit further exposures in the facility. Now, however, all three hospitals in our county are at capacity due to the county’s surge in COVID cases and are experiencing staff shortages of their own.
To address this problem, there has been good collaboration between Sherwood Oaks administration, hospital leadership, the county health officer, and officials from the California Emergency Medical Services Authority (EMSA). Our frequent meetings have included Dr. Dave Duncan, the medical director of EMSA. As a result, EMSA has sent 6 nurses (RNs and LVNs) and 4 nurse aides (CNAs) to Sherwood Oaks for the next 4 to 6 weeks to help the staffing crisis. This support has allowed Sherwood Oaks to avoid the undesirable alternative, which would have been to start transferring residents to other nursing homes. Since most nursing homes in northern California are themselves critically understaffed and full, this would have meant sending residents to central and southern California.
EMSA also sent a mobile team that has been traveling to COVID hot spots around the state to assist with administration of the monoclonal antibody, Regen-COV, which has been shown to reduce the risk of progression to hospitalization (see the Miller Report of September 6th for more information on that treatment). At this writing, 12 of the residents have received it.
It appears that a crisis like we saw last year may be avoided due to the support staff provided by the state and the high rate of vaccination amongst the residents. Much appreciation is given to the state’s EMSA team for their assistance. However, this underscores several critical challenges that we face locally for both our healthcare system and nursing homes. The biggest of these is lack of staffing.
Even before COVID, there was a national shortage in healthcare workers. This shortage is in all areas from nurses, to highly trained staff such as laboratory and radiology technicians, to support staff such as housekeepers and all the way up to primary care physicians and specialists. Rural communities are particularly affected by these shortages. We will examine this national and local dilemma in more detail in next week’s Miller Report, along with specific information about local job openings in healthcare and how to apply for them.
United States nursing homes have been struggling for almost two decades with what can be described as a perfect storm. As baby boomers are aging and as a result needing more healthcare services including long term care in nursing homes. Payment to nursing homes by Medicare, MediCal and private insurance has been steadily going down while at the same time the cost of doing business has been rising. This has led to a reduction of available nursing home beds at the very moment we need more to accommodate growing numbers of elderly. The design of nearly all SNF's in the United States tends to promote overcrowding. The Miller Report for the week of October 5th will examine these nation-wide nursing home problems in more detail and bring it home to how this is affecting the future of local facilities like Sherwood Oaks.
Lastly, this will be an interesting test of the effectiveness of the vaccines in reducing progression to serious illness since such a large number of the cases here were fully vaccinated.
Miller Report for the Week of September 20, 2021; by William Miller, MD; Chief of Staff at Adventist Health – Mendocino Coast Hospital
The views shared in this weekly column are those of the author, Dr. William Miller, and do not necessarily represent those of the publisher or of Adventist Health.
You can access previous Miller Reports by visiting www.WMillerMD.com.