The Indiana State Department of Health has released a preliminary dataset documenting the spread of COVID-19 in nursing homes and assisted living facilities, belatedly joining the growing majority of states releasing data.

“We’re pushing for 100% of facilities to submit their data before the release of the public dashboard,” Dan Rusyniak, the chief medical officer of the Family and Social Services Administration, said. “This is a mandate and, as such, (facilities) are required to (submit) or will face potential penalties.”

An ISDH spokesperson clarified that penalties could include licensure action or state funding cuts. No facilities have been cited for not reporting, though 130 facilities didn’t meet the July 14 deadline.

Rusyniak said that data gathering had revealed an additional 128 deaths at long-term care facilities, bringing the total number of deaths to 1,390 – or 53% of Indiana’s COVID-19 deaths. Though long-term care facilities, such as nursing homes and assisted living facilities, account for a relatively small number of cases, the vulnerability of residents makes the virus far more deadly.

Long-term care facilities accounted for 11% of the state’s cases, Rusyniak said, attributing the rise to improved reporting. Cases don’t always indicate outbreaks, he said, because facilities may have accepted COVID-positive patients.

“Many facilities admit patients from a hospital, who were there because they had COVID, and now require a nursing home,” Rusyniak said. “While these cases would count as a positive resident case for that facility, they would not be from spread within that facility.”

Rusyniak said that nursing homes had the discretion to admit COVID-positive patients. Some facilities may not have realized they had discretion to admit COVID-positive patients, since an April newsletter to facilities from the health department said that facilities “are expected to” accept these residents if they had the capacity.

COVID-positive patients

Six facilities reported 100 or more cases of COVID-19 among their residents: Greenwood Healthcare Center, of Greenwood, with 192 cases; Wildwood Healthcare Center, of Indianapolis, with 173 cases; Greenwood Meadows, of Greenwood, with 113 cases; Dyer Nursing and Rehabilitation Center, of Dyer, with 112 cases; Diversicare of Providence, of New Albany, with 104 cases; and Cardinal Nursing and Rehabilitation Center, of South Bend, with 100 cases.

Two of the facilities, Greenwood Healthcare and Wildwood, accepted COVID-positive patients, according to Fred Stratmann, spokesperson and general counsel for CommuniCare, which operates the facilities.

“Greenwood, Wildwood and a number of other CommuniCare centers in Indiana did accept COVID-positive residents from the community. Those known to be positive were immediately placed in our isolation units with other COVID-positive residents,” Stratmann said via email. “Our isolation procedures followed CDC guidelines: double plastic walls, sealed with tape, isolated HVAC systems and full decontamination procedures. We segregated supplies, equipment and staff to prevent cross-contamination.”

Stratmann pointed to the high amount of community spread in Marion County, which some research suggests is the most significant factor for introducing COVID-19 in nursing homes. Those with underlying health conditions, such as those treated at Greenwood Healthcare’s special ventilator unit, are at increased risk, he said.

Greenwood Healthcare’s 31 resident deaths tied for the fifth-highest reported deaths with Diversicare of Providence, in New Albany. They are preceded by Harrison Terrace, of Indianapolis, with 38 deaths; Greenwood Meadows, of Greenwood, with 35 deaths; North Woods Village, of Kokomo, with 33 deaths; and Bethany Pointe Health Campus, of Anderson, with 33 deaths. All of the facilities are nursing homes.

Among assisted living facilities or continuing care communities, Kesslerwood Place in Indianapolis reported 14 resident deaths while The Village at Hamilton Pointe in Newburgh had 11.

The numbers

The facilities reporting large numbers of cases or deaths are in the minority, with a majority of facilities reporting zero resident cases since the pandemic began.

Of the 626 facilities that submitted information to the Department of Health, 361, or nearly 58%, reported no resident cases. Forty-two homes, or 7%, reported 50 or more resident cases, with just six homes, less than 1 percent, reporting 100 or more. About 21% reported fewer than 10 cases.

In terms of deaths, 447 facilities, or 71%, reported zero resident deaths. Another 123 facilities, or 20%, reporter 10 or fewer deaths.

The Health & Hospital Corporation of Marion County (HHC) owns at least 89 facilities operated by American Senior Communities, making the government entity the largest nursing home owner in the state. Their facilities account for at least 1,489 resident cases, at least 329 resident deaths and at least 372 staff infections.

Data omitted for privacy, not reported

The state will also share staff cases and deaths for the first time. Staff infections, if facilities don’t take proper infection control measures, can introduce the virus to vulnerable residents and spread quickly in the congregate setting.

Only 12 staffers reportedly died from COVID-19. Because of the low numbers, and the possibility that employees worked at multiple facilities, the state won’t report staff deaths by facility.

Of the homes that submitted reports to the health department, a majority of facilities, 378, reported staff infections, while 248 reported no staff infections. Of the 378 reporting staff infections, 238 reported fewer than five staffers infected with the virus.

Rusyniak said that 130 facilities hadn’t submitted their data, emphasizing that these facilities may have previously reported some cases but didn’t include cases dating back to the beginning of the pandemic.

One of the largest operators failing to submit data appears to be Golden Living Centers. Of the 23 Golden Living Centers in the state, 21 didn’t submit – with the Fountainview and Mishawaka facilities being the exception.

It’s unclear if the 130 facilities that didn’t submit are included in the state’s totals for cases or deaths. To protect resident privacy, the state didn’t report specific numbers for facilities with fewer than five cases or deaths.

Clearest picture of COVID-19 in Indiana nursing homes

The new data offers the first opportunity for Hoosiers to analyze the full scope of COVID-19 in Indiana’s nursing homes.

Previously, the Centers for Medicare and Medicaid released data for the nation’s 15,500-plus nursing homes from May forward but nursing homes reported numerous errors and difficulty correcting mistakes.

Contrary to the national database, Indiana will release cases and deaths from the start of the pandemic for nursing homes and assisted living facilities. As of May 27, the state had 534 nursing homes, 202 freestanding assisted living facilities and 155 residential facilities within nursing homes.

Residential facilities within a nursing home may be located in another wing or separate unit within the nursing home. The state said the 155 facilities were counted with their attached nursing home.

Data, organization still lacking

The dataset doesn’t include information on facility type or facility addresses. The CMS database includes 57 columns of data detailing testing availability, personal protective equipment supplies and bed occupancy.

AARP Indiana, along with several media outlets, pushed the state to release the data in early May. The state ultimately announced it would release the data on July 1.

“The difference in the new numbers from what had previously been reported highlights how important it is to make this information publicly available,” Sarah Waddle, AARP Indiana’s state director, said via email. “This new data is giving us a better opportunity to provide families with the information they need to make the best decision for their loved ones, learn if outbreaks in facilities mirror what is happening in communities, and better deploy resources like PPE and testing for residents and staff.”

Rusyniak said the interactive dashboard would be available within three weeks and future releases could include demographic data, recovery data and visualizations of outbreaks at specific facilities. Data will be updated on Mondays.
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