Idaho Falls health care facility had to call COVID-positive staff to work. Is that OK?

IDAHO FALLS — One day in late August, a resident at an Idaho Falls long-term care facility came down with a cough.

The administration at Tambree Meadows Assisted Living was not testing residents or staff members for COVID-19 on a regular basis — only if someone had symptoms or a known exposure to the coronavirus. Now that a resident had a cough, it was time to test everyone.

The results came back: 26 cases. Then, over the next two weeks: 12 more cases, and one death.

The coronavirus had silently permeated the Tambree Meadows memory care unit, which housed 21 people with Alzheimer’s and dementia. All but two of those patients had the virus as of mid-September, said Troy Bell, president and CEO of TanaBell Health Services, owner of Tambree Meadows.

The facility’s assisted living unit, which housed 15 people, also had cases of COVID-19, Bell said.

There were still residents who didn’t have COVID-19. But soon, Tambree Meadows faced a question: Who would take care of those residents? So many staff members had the virus that Tambree Meadows struggled to find enough uninfected employees to come to work, Bell said.

“We only had eight employees that were eligible (to work) that didn’t have signs or symptoms and weren’t positive,” he said.

Bell said managers who hadn’t been infected took over caring for the two uninfected residents in the memory care unit. TanaBell also sent employees from facilities in Idaho Falls, Pocatello and Rexburg to help with the uninfected assisted-living residents, he said.

Tambree Meadows management soon took a step that few others have: calling infected employees in to work.

WHAT HAPPENS WHEN ALMOST EVERYONE HAS THE CORONAVIRUS?

Staffing has always been a challenge for long-term care facilities. The jobs offer relatively low wages for work that can take a physical and emotional toll.

But the COVID-19 pandemic made it worse. Nurses, aides and other employees have fallen ill from the virus, been forced to quarantine due to exposure, or left the profession altogether.

Because of this, the Idaho Health Care Association launched a campaign at Idaho.CareForTheAging.org to recruit new people to work in nursing homes, assisted living facilities and group homes.

“Many Idaho facilities are facing a situation similar to that faced by hospitals in New York City,” the website says. “Like New York, we need compassionate heroes to fill staffing needs immediately.”

The facilities want licensed and trained medical workers, service members or residents’ family members, the website says. But they will take “anyone with a strong back and a soft heart!” the website says. “Positions are open to anyone who can lift at least 50 pounds, provide compassionate care and pass a criminal background check.”

Without those new employees and volunteers, facilities that have a COVID-19 outbreak can quickly end up in a crisis situation.

What happens when almost all the staff in a facility are infected, and there’s no one to take their place?

Faced with the grim reality of that scenario playing out across the country, the Centers for Disease Control and Prevention drafted guidance that does allow people infected with the coronavirus to return to work in facilities that house people most vulnerable to severe illness or death from COVID-19.

At least one nursing home in Illinois brought employees back to work in August shortly after they tested positive for COVID-19, according to a news report from Fox2Now in Madison County, Illinois. The same thing reportedly happened in May at a nursing home in Mobile, Alabama, according to the news station WPMI.

There may be other options, though. The Pennsylvania National Guard had been deployed 14 times by mid-August to help relieve staffing crises in long-term care facilities in that state, according to The Daily Item.

CDC: INFECTED STAFF CAN WORK IN WORST-CASE SCENARIOS

Bell told the Statesman that Tambree Meadows got approval from public health officials to have infected employees return to work. April Busby, the facility’s administrator, told the Statesman they had “special permission from the health department to do that.”

Eastern Idaho Public Health Director Geri Rackow clarified that the regional health district doesn’t give special permission, nor does it approve or deny plans.

“Tambree Meadows, in consultation with Eastern Idaho Public Health and the Idaho Bureau of Facility Standards, implemented crisis capacity strategies to address their critical staffing shortages,” Rackow said in an email to the Statesman.

“We did not give them any special permission,” Rackow said in an interview. “Having staff that are positive for COVID, and having those staff work, is allowable according to the CDC under their strategies for handling crisis capacity for staffing shortages, so we asked them what they planned to do (and) told them we felt like that was in alignment with the CDC guidelines.”

The CDC says in its “Strategies to Mitigate Healthcare Personnel Staffing Shortages” guidance:

• If not already done, allow HCP (health care providers) with suspected or confirmed COVID-19 to perform job duties where they do not interact with others … such as in telemedicine services.
• Allow HCP with confirmed COVID-19 to provide direct care only for patients with confirmed COVID-19, preferably in a cohort setting.
• Allow HCP with confirmed COVID-19 to provide direct care for patients with suspected COVID-19.
• As a last resort, allow HCP with confirmed COVID-19 to provide direct care for patients without suspected or confirmed COVID-19.

Bell said Tambree Meadows “tried to keep all positive staff with positive residents” and “tried to isolate (residents) the best we could.”

He said the facility “had full (personal protective equipment for the staff) per CDC guidance, and shields and masks and everything.”

Rackow said the health district talked with the facility’s management about their plan on Sept. 4. That was a week after a Tambree Meadows manager sent a message to employees, telling them to come into work even if they were ill.

“As you all know we have had many positive tests, both employees and residents,” read the message from the last week of August. “If you are positive and have COVID symptoms, but they are not preventing you from working, you are still expected to come to work. If you are positive and are currently unable to come in, please update me on your symptoms and when you think you will be able to come back. The next couple weeks will be rough, please be a team player during this time. We’ve got this!”

That message was prefaced by the words “COVID-19 POLICY.” Bell and the administrator of Tambree Meadows, Busby, told the Statesman that it wasn’t actually a “policy.” Busby said employees were allowed to decline the request.

The Statesman and EastIdahoNews.com received tips from multiple people regarding the situation.

“We would never force people (to work),” Busby said. “We had several people that chose not to work. (They) said, ‘Nope, I don’t want to work,’ so we honored that.”

The Statesman also received a copy of a message Busby sent to staff after the Statesman contacted her, reading: “Hey heads up everyone! The Idaho Statesman is trying to get a statement from our employees about how we have forced you to work while you’re sick. Anyway, if anyone calls you from the Idaho (Statesman) you cannot, please please please, don’t talk to them. Refer them to Troy Bell and ask them if they need the number.”

When asked about that message, Busby said that Bell, the CEO, “asked us not to talk to you anymore. So, I’m so sorry. Thanks anyway,” and hung up the phone.

Bell told the Statesman that it’s company policy for employees to refer media calls to him.

“Our company policy (is) if they are contacted by the media any time, ever, that they are not to speak to the media. … They are not authorized to speak to the media and represent the facility,” he said. “I mainly do it to protect the employees. I don’t want to put them in a bad situation.”

He also said, “If they want to talk to the media, they are able to.”

WHY DIDN’T TAMBREE MEADOWS TEST FOR COVID-19?

Tambree Meadows had a critical staffing shortage because the coronavirus had infected so many of its employees. The outbreak also included many of its residents and killed one person.

“When COVID enters into any facility, it spreads quickly and rapidly,” Bell said. “We did everything we could to stop the spread as soon as we were aware of it.”

But without regular testing, Tambree Meadows didn’t become aware of the outbreak until it was at a crisis point.

That is one reason the federal government now requires nursing homes to test routinely.

The Centers for Medicare and Medicaid Services have ordered nursing homes in hot spots to test staff for COVID-19 once or twice a week, depending on the rate of positive coronavirus tests in their county. Fourteen counties in Idaho were in the highest-rate “red” category in late August, requiring their nursing homes to test twice a week. Bonneville County, where Tambree Meadows is located, was among the “red” counties.

But that testing rule applies to nursing homes, which are federally regulated. It does not apply to assisted living facilities like Tambree Meadows, which the state regulates.

There is no state or federal requirement for assisted living facilities to test staff on a regular basis.

The state does recommend that facilities test staff “at some regular interval (e.g., every 7-14 days),” according to the Idaho Department of Health and Welfare’s long-term care testing strategy issued in June. “If testing capacity is limited, focus testing on those (health care providers) who reside or work in counties with known community spread of (the coronavirus) or who work in other health care facilities with cases of COVID-19.”

Bell said there are a few reasons Tambree Meadows wasn’t testing on a regular basis.

“We didn’t have the resources to do it, nor the tests to do it. And second of all, in assisted living, there’s never been a mandate to do daily or weekly testing,” he said in a phone interview Wednesday. “There just has not been resources for test kits and things, except for in the last three to four weeks.”

Bell’s company, TanaBell, owns eight facilities in the state. Most of them are not required to test regularly, and haven’t been given the resources to do so, he said.

One of TanaBell’s facilities is The Canyons Retirement Community, a facility in Twin Falls that had a severe COVID-19 outbreak in the spring — killing 11 people and infecting at least 36, according to state records.

“In most circumstances, similar to what we had in Twin Falls, we didn’t have test kits readily available,” Bell said. “Once we had an outbreak, (the public health agency) steps in and helps with test kits. … Now it’s becoming more readily available, but mainly nursing homes have the kits.”

But cost is a major factor, Bell said. Each test costs $100 to $150, he said.

“Especially for smaller assisted livings, the resources to conduct regular tests aren’t there,” he said. “If employees or residents don’t have insurance, it’s a difficult thing to provide.”

Bell said that funding for the coronavirus pandemic has been focused on hospitals and nursing homes. Meanwhile, assisted living facilities in Idaho have had more than 1,000 cases and more than 100 deaths.

“Assisted livings have been affected as bad or worse as (nursing homes),” he said. “And it’s too bad that the assisted livings haven’t received any support or funding, or things like that, until recently.”

The Trump administration on Sept. 1 announced that assisted living facilities are now eligible for grants from the CARES Act Provider Relief Fund.

TanaBell has since received nearly $1.5 million from the fund, according to CDC records.