As Pennsylvania’s public health chief warns of a second wave of covid-19 community spread, nursing homes are bracing for a potential correlative wave of nursing home outbreaks and deaths.

Nursing home operators and staff are looking for more protective gear, help with testing and other aid to ensure the next outbreaks at long-term living facilities aren’t as deadly and rampant as they were in the spring and early summer.

About a quarter of Pennsylvania’s nearly 700 nursing homes reported not having enough personal protective equipment during September, according to an analysis of federal data released last week by senior advocacy group AARP. Staffing is a concern for 18% of facilities statewide.

Last week, Allegheny and Westmoreland counties logged their highest numbers of new covid-19 cases since July. Pennsylvania’s health secretary, Dr. Rachel Levine, said statewide data signal a “fall resurgence” and experts can’t predict when it will peak.

“We are definitely keeping an eye on our long-term care facilities and our nursing homes,” said Dr. Debra Bogen, health director of Allegheny County. “As we’ve seen in the past, the cases in nursing homes tend to trail behind the cases we see in communities. So if we see a rise in community cases, a couple weeks later, we’ll see a rise in nursing home cases.”

‘No guarantees’ in thwarting covid

With about 66 deaths per 1,000 residents, Pennsylvania’s nursing home death rate ranks eighth in the nation.

That’s a lower rate than in Massachusetts, New Jersey and Mississippi, but it is higher than in Texas, Arizona and Alabama, according to data published by the Centers for Medicare & Medicaid Services.

Facilities that held off widespread outbreaks in the spring remain vulnerable to the virus, as evidenced by several developing outbreaks in Western Pennsylvania.

Among them is one at Westmoreland Manor, where more than a third of residents — at least 117 — have tested positive for covid-19 and three residents have died since late September. Thirty-four employees became infected. Officials called in the Pennsylvania National Guard in late September to assist the Westmoreland County-run facility with ongoing testing of residents and staff. Guard members, after a two-week stay, left the Manor last weekend.

After months of reporting zero cases, an outbreak at Allegheny County’s Kane Community Living Center in Scott has climbed to 150 cases among residents and staff and 13 resident deaths. Kane Center Director Dennis Biondo said the 71 actively infected individuals as of Friday have been isolated or quarantined. None of the county’s other three Kane centers has any active resident cases since the Glen Hazel site overcame an outbreak that killed 16 residents by mid-May.

At places where most residents havecontracted and recovered from covid-19, risks remain for staff and new admissions, and asymptomatic carriers who work at nursing homes can pose a risk to their families and other people outside their workplaces.

Presbyterian SeniorCare Network — which runs facilities in 10 counties, including long-term care facilities in Oakmont and Washington — has reported 33 covid-19 cases out of nearly 600 residents, according to state data. Lisa Fischetti, the network’s senior director of communications, said nursing home operators are “cautiously optimistic” about navigating the next round of the disease’s spread.

“We know that there’s no guarantees,” she said. “Despite all the precautions you can take, it’s a highly contagious virus.”

Across the United States, more than 28,000 nursing home residents tested positive for covid-19 and 5,200 died between late August and September, “showing the virus is still raging in nursing homes,” says the report produced by AARP with the Scripps Center at Miami University in Ohio.

Bill Sweeney, AARP’s senior vice president of government affairs, called the findings related to persistent staffing and supply shortages “profoundly disappointing.”

“This is a nationwide crisis, and no state is doing a good job,” Sweeney said. “While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time.

“These are places where people are vulnerable to infection, whether it’s covid or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Group helps facilities obtain PPE

Bogen said the creation of a state task force charged with monitoring nursing homes has helped the facilities become better prepared than they were in the spring.

Among state-funded efforts underway is the Regional Response Health Collaboration Program. The state doled out $175 million to several groups to assist long-term care facilities in various parts of the state by procuring supplies, assessing infection control programs and offering in-person and virtual consultations and a 24/7 hotline for nursing home operators seeking guidance.

In southwestern and parts of northwestern Pennsylvania, the work is being carried out by UPMC Community Provider Services, which submitted the group’s application on behalf of UPMC, Allegheny Health Network, the Jewish Healthcare Foundation and the Healthcare Council of Western Pennsylvania. The group received $38.9 million from the state.

Program member Emily Jaffe, a geriatrician and Allegheny Health Network’s medical director of post-acute care and HM Home and Community Services, described the regional team as “the best health care collaboration that I’ve seen in my career.”

“We’re seeing collaboration between the Department of Health, Department of Human Services and PEMA. They are running a twice-daily command center that each of these regional collaborative is participating in,” Jaffe said. “When the state came forward with this, we recognized that we were stronger together and that these are the most vulnerable patients or citizens.”

Members of the regional group began working together on education and outreach at the start of April. It distributed the first sets of protective gear and other supplies in early August.

“The nursing home industry is taking a pretty hard hit right now. While this (pandemic) is going on, they still have to get everybody up, get everybody dressed, feed everybody,” Jaffe said. “We look at the environment, we look at what kind of PPE is available, how do they use it, what kind of cleaning supplies, how do they use their shared spaces.”