92% of Iowa nursing homes had at least one resident test positive for COVID-19, Register review of federal data shows
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Originally published June 29, 2021.
Since the coronavirus came to Iowa, COVID-19 struck nearly every nursing home in the state and thousands of elderly residents, a review of federal data shows.
Fewer than 10% of nursing homes, 33 of Iowa’s 431 such facilities, have reported no confirmed cases of COVID-19 among their residents, and only three reported zero confirmed cases among either residents and staff.
Where the disease did strike, it often devastated the fragile population.
At 57-bed Dunlap Specialty Care in Harrison County, the disease killed 36 residents. At Great River Care Center, a 39-bed facility in McGregor, COVID-19 killed 32 residents. It killed a dozen or more residents at each of another 55 facilities, an illustration of the toll the coronavirus took on Iowa’s most vulnerable population as it spread across the state.
The nursing home data is self-reported by facility officials and published by the U.S. Centers for Medicare and Medicaid Services. It offers a more granular look at how the coronavirus tore through group living facilities for many of Iowa’s oldest residents.
'Like having a house next to a forest fire'
Community spread of the virus allowed it to seep through the impromptu protective barriers at the slightest openings. For most of the pandemic, public health experts labeled Iowa’s viral activity as at the community spread level or greater, meaning people were getting infected without being able to narrow the origin.
In all, there have been more than 400,000 positive tests for the COVID-causing coronavirus, or enough for one out of every eight Iowans.
“(Managing COVID) was like having a house next to a forest fire and trying to keep smoke out,” said Lori Ristau, a senior vice president with the Iowa Health Care Association, a nursing home trade group. “Really it was kind of a luck of the draw for those homes, if they had zero cases or got some cases of it.”
COVID-19 killed more than 2,300 nursing home residents before the vaccines slowed the pandemic in Iowa and nearly wiped it out from those facilities.
More than 11,200 nursing homes residents tested positive for the virus, according to the nursing home reports. Despite making up less than 1% of Iowa’s population, nursing home residents accounted for more than a third of the more than 6,100 Iowans killed by the disease.
But that loss of life happened in relatively slow motion, spread out over almost a year before vaccines became available to the residents.
Brent Willett, president of the Iowa Health Care Association, described those pre-vaccine days as “fighting a battle without a weapon.” Guidelines at the start of the pandemic changed often, state and federal regulators sent mixed messages about policies, enforcement was inconsistent, and COVID tests and personal protective equipment were in short supply, Willett said.
"Everybody wanted to test, everyone wanted to comply with those testing regulations,” Willett said. “But those tests just weren't physically available, anywhere."
However, the long-term health care system is more resilient after the harrowing year, with stronger support networks in place, and stronger understanding of infection controls and the resources needed to care nursing home residents, he said. Comparing early pandemic and late pandemic responses is like comparing apples and oranges, Willett said.
"The system bent, but it didn't break,” Willett said. “We bent pretty far, but we didn't break, as a long-term health care system in this county and in this state. The only way to dishonor that is not to learn from it, and every bit of evidence that I've seen, from our regulatory agencies to our facilities on the ground, (leaders) are taking these lessons and turning them into preparation."
How one facility dodged COVID
Sara Casey, administrator of the 80-bed nursing home Shady Oaks in Lake City, can’t say for sure how her facility dodged COVID and entered the summer of 2021 as one of the 33 homes with zero confirmed cases among residents. But she credits the hard work and diligence of the staff, community support and a little bit of luck.
“Each situation is a little bit different,” Casey said. “But we always did a little bit more than was required. If we were required to test once a week, we tested twice a week. We did everything that we could to make sure there was no exposure within the building, and it worked quite well. Our team members did everything they could to stay safe as well, but, as we know when we’re out in public and we’re spiking with COVID cases, there’s not anything we could do.”
Shady Oaks was also in perhaps a stronger position to defend against it, Casey said.
She described the rural Lake City community as tight knit and the families of the residents understanding the dangers and the federal requirements under the pandemic.
Calhoun County, where Shady Oaks is located, has a population of about 9,700. The number of positive coronavirus tests among its residents never topped 50 in a week, until the November wave that crashed over the state. The seven-day total of positive tests capped at 360 on Nov. 10, according to the Iowa Department of Public Health. In all, there have been 1,443 positive tests from Calhoun County residents.
Casey estimates there were about 450 changes in infection control policies passed down over a 300-day period, as people learned more about the disease and how to stop its spread. The staff worked daily to ensure up-to-date best practices, she said. They also followed their instincts, she said, and would test for COVID at the slightest possibility of exposure.
She also remembers the joy of Jan. 18 — the day of the first vaccination clinic at the facility. Ultimately, about 80% of the staff and 96% of residents have been vaccinated, and information about the vaccines and their availability are shared with all new staff members and residents. The vaccinations allowed a return to normalcy for many of the residents, with federal guidelines allowing for close contact without masks or other protective gear if all participants are vaccinated.
"I don't think the danger has passed. I think there's always going to be dangers that we have to overcome,” she said. “… But there was pure joy when we were able to host our first vaccination clinic. We had team members and residents crying."
But it wasn’t a smooth road to get there, even if the facility didn’t experience the tragedies seen in other nursing homes. She recalls hitting her own breaking point — wanting to throw out the personal protective equipment, freely welcome visitors, and let residents with dementia see uncovered faces again — before leaning on her own support network to put the pandemic, and the loss being felt across the state, in perspective.
She called the employees at facilities who worked through outbreaks "heroes."
"I feel for those facilities that have had outbreaks and lost loved ones," she said. "Their sacrifices have been undeniably heroic."