Enhancing COVID-19 Protections for Skilled Nursing Homes

Acting on a motion by Supervisor Mark Ridley-Thomas, the Board of Supervisors unanimously voted to call for comprehensive measures that would strengthen protections for residents and staff at skilled nursing homes, among other congregate settings, who tend to be particularly vulnerable to COVID-19.

The Los Angeles County Department of Public Health has found 312 institutional settings throughout the county with at least one confirmed case. As of April 27, 425 residents of institutional settings, such as skilled nursing homes, in LA County have died of COVID-19. They account for about 45 percent of LA County’s death toll from the pandemic.

“We cannot underestimate the risk that COVID-19 poses to skilled nursing home residents, given their age, physical condition and health status,” Supervisor Ridley-Thomas said. “We must also take comprehensive precautions to protect the heroic caregivers who work in these settings and then go home to their families. It is critical that we take comprehensive steps – in partnership with the State – to prevent the spread of infection and avoid a surge of patients that could easily overwhelm our healthcare system.”

“Nursing home residents are among our most vulnerable, and we must take every step to protect their health and safety, and the health of the dedicated providers who are caring for them during this pandemic,” LA County Department of Health Services director Christina Ghaly, MD, said.  “It’s critically important that we support these institutions and ensure they are staffed, resourced and equipped to prevent the spread of COVID-19 infection and able to conduct the necessary testing to protect those under their care.  Without such measures in place, the potential for outbreaks that can overwhelm the County health system remains high.  During this period marked by so much uncertainty, we are firm in our commitment to assist our health partners across the continuum of care as we all work together to confront and battle this terrible illness.”

“We share Supervisor Ridley-Thomas’ concern for this vulnerable population, which is being disproportionately impacted by COVID-19,” said LA County Department of Public Health director Barbara Ferrer, PhD, MPH, MEd. “We appreciate the Board’s efforts to put measures in place ensuring that essential staff at skilled nursing facilities are properly trained and equipped with the protective equipment they need to remain safe, and support residents who are in great need of continued care. Public Health is working with our agency partners at the state and federal levels to enhance COVID-19 responses within LA County’s skilled nursing facilities.”

“During this crisis, nursing home workers continue to risk their health, well-being and livelihood,” said April Verrett, president of SEIU Local 2015, which represents over 400,000 California long term care workers including 20,000 nursing home workers. “We want to assure that these vital workers have the necessary resources to perform their jobs, and continue the fight on the frontlines safely. This motion can provide the adequate protections that essential workers in our skilled nursing facilities deserve throughout this pandemic.”

Supervisor Ridley-Thomas’ motion called for working with Governor Gavin Newsom and the California Department of Public Health to consider several orders, guidelines and requirements to support the safe and sustained operation of skilled nursing facilities, including:

• Facilitating expeditious testing for all staff and residents as quickly as possible;
• Issuing standard protocols for skilled nursing homes to follow when they have a positive case of COVID-19;
• Requiring adequate staff-to-patient ratios, as well as a sufficient supply of personal protective equipment (PPE) and proper training on COVID-19;
• Banning retaliation against staff for working at multiple facilities, for advocating for PPEs as a condition of going to work, and for refusing to go to work;
• Expediting pending licenses for certified nursing assistants;
• Providing staff with additional pay, including overtime, until the COVID-19 crisis is over, as well as additional paid sick leave days so they can care for themselves or family members who may be infected;
• Paying facilities an enhanced rate if they care for residents who have tested positive for COVID-19; and
• Requiring skilled nursing homes to readmit patients once they are no longer sick, and keep them when they are mildly or moderately ill but do not require hospitalization to avoid overwhelming hospitals.

The LA County Department of Public Health also recognizes the risks in licensed congregate healthcare facilities such as skilled nursing homes and recently issued a Health Order that includes:

• Restricting access to such facilities;
• Requiring diagnostic testing, symptom screenings and temperature checks for staff and residents;
• Banning visitors and suspending communal dining and other activities;
• Requiring staff to wear masks and PPEs and follow infection control guidelines;
• Preventing staff from returning to the facilities if they have tested positive for COVID-19 or are symptomatic; and
• Offering additional shifts to their own employees and maintaining consistent staff to the extent possible.