In late April, when memory-care residents of the Walker Methodist Health Center in East Harriet started testing positive for COVID-19, the Minnesota Health Department (MDH) advised staff to leave all 30 of the secure unit’s residents in their private rooms instead of isolating positive patients in a separate wing of the facility.
Given how many residents tested positive within a short time span, MDH determined that the unit’s more than 20 asymptomatic residents had all been exposed, Walker Methodist spokesperson Sarah Benbow said.
By May 11, 29 of the 30 residents of the memory-care unit had tested positive for the virus, and 10 of those residents had died. (The 30th resident was awaiting their test result as of press time.)
Both the vulnerability of residents in terms of age and pre-existing conditions and the close quarters in which they live make COVID-19 apt to ravage long-term care facilities. While less than 1% of Minnesotans live in long-term care facilities, they have seen 16% of Minneapolis’ confirmed cases of the virus and 85% of its confirmed virus-related deaths.
Once the virus enters a facility, it can be difficult to contain.
“The team implemented strict isolation procedures, but the virus is pervasive and even our best efforts weren’t able to stop it from spreading through the unit,” Benbow said. “Our team’s vigilance has kept it contained in the unit at this time.”
The Centers for Disease Control asks facilities to consider “potential risks and benefits” before moving residents with confirmed COVID-19 out of a memory-care unit, noting that moving residents “may cause disorientation, anger, and agitation as well as increase risks for other safety concerns such as falls or wandering.”
If residents elsewhere at Walker Methodist contract the virus, staff are planning to isolate them in a newly cleared COVID-19 wing that is waiting empty.
The coronavirus outbreak has also worsened at the Jones-Harrison Residence. A total of 20 residents have tested positive in the Cedar-Isles-Dean facility’s nursing home as of May 11, including nine who have died. And the virus has now spread to the assisted living portion of the home, where four residents have tested positive, including one who has died. In all, 19 staff members of the facility have tested positive. President Annette Greely said the virus is not confined to a single unit but has been “ping-ponging” through the facility.
At Mount Olivet in Windom, there have been six COVID-19 related deaths and one other resident hospitalized as of May 12, all in the long-term care facility. Mount Olivet has at least 14 confirmed cases; none have been in the independent living home.
Issues in memory-care units, like the outbreak at Walker Methodist, are not surprising to experts.
“There’s a whole host of instructions that are simply not realistic when you talk about people in advanced stages of dementia — social distancing, washing hands, and help with daily living, like bathing, toileting, feeding and medications,” said Eilon Caspi, a gerontologist and adjunct faculty member at the University of Minnesota’s School of Nursing.
Nationwide, Caspi said, most nursing home residents and about half of assisted living residents have some form of cognitive impairment. It’s not uncommon for residents with dementia to wander into other residents’ bedrooms at all times of the day, he said.
At Walker Methodist, staff have been monitoring the hallway of the memory-care unit 24/7 and trying to keep residents separated, but the nature of their needs and capabilities makes it a challenge to keep them safe.
“Residents don’t understand why they have to stay in their rooms and why they can’t walk the halls,” Benbow said. “So our staff is very often reminding residents, ‘You have to go back to your room now, you have to go back to your room now.’”
Greely said Jones-Harrison’s memory-care residents continually take their masks off and like to touch things throughout the building.
“They’re tactile,” she said. “That’s why we’re constantly spraying with disinfectant and wiping stuff down.”
On April 7, Gov. Tim Walz’ office promised facility-wide testing at care sites with multiple cases. But so far that promise has gone unfulfilled, even as testing capacity has grown statewide.
The difficulty in obtaining testing for asymptomatic staff and residents can negate containment strategies.
“It’s like fighting a wildfire blindfolded,” Caspi said. “You don’t really know who’s positive and who’s not.”
At the Jones-Harrison Residence, where 19 staff members have tested positive, Greely said some staff are volunteering to work with COVID patients but others are hesitant to do so.
“We’re making it, but we don’t have any cushion,” she said. “It’s all hands on deck.”
Kristine Sundberg, executive director of Elder Voice Family Advocates, said staffing was a challenge in senior living facilities before the pandemic. Now with staff getting sick, there are serious shortages throughout the state. Much of that is due to systemic problems with the business model of high-demand, lower-pay work, Sundberg believes.
“The only outcome is poorer care for residents,” she said.
MinnPost contributed reporting to this story.
If you have a loved one at Walker Methodist or Jones-Harrison who has been affected by the COVID-19 pandemic and are willing to speak about the experience, please email email@example.com.