Nursing homes in Northwest Arkansas and across the state are seeing the impact of the omicron surge as the number of positive staff and patient cases increases.
Facilities in Benton, Washington, Crawford and Sebastian counties reported 32 active resident cases and 163 active cases among staff members Tuesday, up from 12 resident cases and 15 staff cases Dec. 13, according to numbers compiled from the Arkansas Department of Health's weekly nursing home reports.
Statewide, there were 649 active resident cases and 1,472 active staff cases Tuesday, the most recent report states -- up from 77 resident cases and 76 staff cases Dec. 13.
On Friday, 2.5% of the state's cases were in nursing homes, according to the department's website.
The omicron surge's biggest impact on nursing homes in the state has been the staffing shortages it's created, according to Rachel Bunch, executive director of the Arkansas Health Care Association, a trade association for long-term care facilities.
In addition to the industry's workforce crises and the general shortage of health care workers, many staff are testing positive for covid-19, she said. The return to work guidelines for health care workers are more stringent than for the general public, she said.
The good news is medical providers are reporting less severe illness among residents than earlier in the pandemic, she said.
"A bright spot to this, generally speaking, is while case counts are going up, we are not seeing the type of sickness or symptom severity we saw at the end of 2020 and 2021," Bunch said.
Medical providers are reporting few residents are having to be transported to hospitals or put on ventilators, Bunch said. It's also important to note that nursing homes test frequently for covid-19 and many people who are positive are asymptomatic, she said.
Better equipped
Compared to previous surges, nursing homes are better equipped to prevent the spread of covid-19, monoclonal antibody treatment is available at many facilities and a high number of patients are vaccinated and boosted, she said.
Most covid-related nursing home deaths took place earlier in the pandemic. Before July, there were 2,094 covid-related nursing home deaths in Arkansas, according to Department of Health data. Since then, there have been 223 covid-related nursing home deaths, for a total of 2,317, the data show.
The high vaccination rate among residents and staff members is a key difference, Bunch said.
In Arkansas, 84% of staff and 88% of residents are fully vaccinated, exceeding the 75% benchmark set by the American Health Care Association, Bunch said. The state has achieved the highest vaccination rate among staff and residents in the southern region, she said.
In addition, 60.5% of nursing home residents in Arkansas have received a booster shot, she said. Bunch did not have the percentage of staff members who have received a booster.
In comparison, 53.9% of the population in Arkansas was fully vaccinated as of Friday and 17.6% had received a booster shot, according to the Department of Health.
The U.S. Supreme Court recently upheld a decision that all Medicare and Medicaid accepting facilities must require staff members to get vaccinated. The deadline for employees of Arkansas facilities to receive their first vaccine is Feb. 14 and the second is March 15, Bunch said.
While most facilities have a small number of employees who are not vaccinated, some staff members are still vaccine-hesitant, Bunch said. Nursing homes are reviewing the language and rules they will have to comply with and exploring exemption options, she said.
Bunch's biggest concern with the requirements is they will exacerbate staffing shortages.
While families were kept away from nursing home residents for months at the start of the pandemic, the latest directive from the Centers for Medicare and Medicaid Services state that visitation must be available to all residents at all times, according to Bunch.
Lack of contact with family and friends was one of the most difficult aspects of the pandemic for residents, she said.
The Arkansas Health Care Association is working with facilities to make sure visitation is as safe as possible. Staff and visitors continue to wear masks, visitors are screened and spaces are sanitized before and after visitors arrive, Bunch said.
Family members are not required to be vaccinated, but if both the family member and the resident are vaccinated, they can visit without a mask, Bunch said.
Surge response
Butterfield Trail Village in Fayetteville is seeing the same impact from the omicron surge it has seen since the beginning of the pandemic, according to Jay Green, director of health care services.
"We have continued the same plan of action since the beginning of covid's appearance, which includes staff, resident and visitor education, vigilant hygiene protocols, and keeping our inventory of PPE fully stocked," he said.
On Tuesday, the nursing home had two active covid cases among staff members and zero cases among residents, according to the Department of Health report. Since then, the facility has had its first infection among residents in 14 months, Green said.
The facility has kept numbers low by following guidelines to the letter, setting high expectations for team members and being meticulous about sanitation, he said.
Approximately 98% of staff are fully vaccinated, and those who are not vaccinated and boosted must test weekly, Green said. In addition, all residents are vaccinated and around 98% have received a booster shot, he said. Those who didn't receive a booster were advised against it by their personal physicians, he said.
Vaccination is required for employment, but requests for medical or religious exemptions are reviewed by human resources, Green said. The facility has provided staff education, hosted multiple on-site vaccination clinics and offered employees time off work to be vaccinated elsewhere, he said.
Butterfield Trail Village has achieved the high vaccination rate among residents through continuing education and on-site clinics, he said.
Staffing problems
Staffing levels are the top indicator of quality care in nursing homes, according to Martha Deaver, president of Arkansas Advocates for Nursing Home Residents.
Nursing home employees were already overworked and underpaid before the pandemic hit and staff numbers have dwindled even more over the past two-and-a-half years, she said. Without enough employees, facilities can't feed and hydrate residents or turn them over to prevent bed sores, she said.
Deaver said she would like to see Arkansas call out the National Guard to help with staffing shortages in the state.
"The crisis is huge, they do not have enough direct care staff," she said.
Deaver is concerned that vaccination alone won't be enough to stop covid-19 from causing more serious illness and death among nursing home residents, pointing out they are the sickest and most vulnerable people in society.
The new guidelines that allow visitors are important because friends and family members provide oversight to resident care, Deaver said. In addition to the nursing home residents who died of covid-19 nationwide, many more suffered from a failure to thrive and depression from not being allowed contact with visitors, she said.
Family members who are concerned about the care their loved ones are receiving in nursing homes can contact the Arkansas Long-Term Care Ombudsman program, Deaver said. More information is available at arombudsman.com.
Arkansas nursing home cases
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NoneResident cases Staff cases Total cases
Dec. 13 77 76 153
Dec. 20 73 99 172
Dec. 28 45 53 98
Jan. 3 158 321 479
Jan. 11 329 940 1,269
Jan. 18 649 1,472 2,121
Source: Arkansas Department of Health