Here are key takeaways from KET’s May 8 program on the spread of coronavirus-19 disease, called COVID-19, in Kentucky. The show examined the high rates of infection at Kentucky’s long-term care facilities and spoke with administrators who are working to implement safety protocols to protect residents and staffs, and also delved into the health disparities that make African American communities more vulnerable to COVID-19.
Protecting Patients in Long-Term Care Facilities
In the commonwealth, patients and staff long-term care facilities have endured high COVID-19 infection rates – over 20 percent of total positive cases as of May 8 and over 50 percent of deaths.
According to Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, after the first cases of COVID-19 were detected in Kentucky, local public health officials directed the bulk of the national strategic stockpile of personal protective equipment (PPE) to hospitals in anticipation for a surge in critically ill patients. That surge did not occur, and now Johnson says that supplies are starting to be funneled to her member organizations.
Complicating matters, Johnson says many nursing homes had exhausted their normal supply of PPE during flu season, which ended around the same time COVID-19 arrived in the commonwealth.
Eric Friedlander, secretary of the state’s Cabinet for Health and Family Services, acknowledges the early problems but says that over the past two to three weeks the state has procured more PPE. Friedlander is a member of a special task force created by Gov. Andy Beshear designed to help long-term care facilities during the COVID-19 pandemic.
“We’ve received more assistance from the federal government, and we’ve been much more crafty and better at getting PPE here in the state,” he says. “Just this week, the federal government started shipping a 14-day supply of PPE to all of the nursing facilities here in Kentucky.”
As for COVID-19 testing, Johnson says there needs be comprehensive screening for residents and staff in every long-term care facility in the state, followed by a program to support these facilities if staff members that test positive are forced to self-quarantine and miss work.
“Think about that: you potentially could have half your staff test positive,” she says. “Well, under the CDC guidelines they would not be able to come to work for 14 days. How do you staff a skilled nursing facility when you have half of your staff quarantined?
Early on, Kentucky’s public health officials limited COVID-19 testing to persons who had symptoms, essential workers, and those at high risk of getting the virus. Sec. Friedlander says that enough tests have finally become available to open testing up to the entire population, prioritizing nursing homes.
“We’re going to test all facilities across the commonwealth,” he says,” and we’re rolling out the plan to do that. Formerly, there would have been no way to do that, but now, we think we have the capacity. And we stratify those according to most at risk… we put those folks into risk categories, and we try to test those places that we’re most concerned about.”
Aside from PPE and testing, Johnson says that her member organizations are currently dealing with an increased financial burden due to the pandemic. Nursing homes and long-term care facilities are dependent largely on Medicaid, which offers lower reimbursement rates compared with Medicare and private insurance. And many of them are paying higher costs than normal for scarce PPE and other supplies, as well as hazardous duty pay to staff.
“Every skilled nursing facility in the state, whether they have a COVID-19 positive individual in their building or not, they’re spending money like they do,” Johnson says.
In response to the added financial burden, Friedlander says that the state has made some adjustments designed to help long-term care facilities. “I know others may disagree, but I will tell you this: very early, we started our process to ask the federal government to allow us to make some changes – so we have,” he says.
Among those changes: a more streamlined process for determining whether a patient is eligible to live in a long-term care facility, says Friedlander. According to the secretary, what was once a three-month process to now lasts just a few days.
Addressing Health Disparities in the African American Community
While African Americans make up about 8.4 percent of Kentucky’s population, as of May 8 they account for 18 percent of total deaths from COVID-19. African Americans have higher rates of many chronic diseases that increase the risk of getting seriously ill from the coronavirus, including heart disease, diabetes, and respiratory disease.
According to Dr. V. Faye Jones, MD, the associate vice president for health affairs and diversity initiatives, medical leaders and government officials need to muster a coordinated response to address these health disparities.
“Our life expectancy is related to where we live, where we play, and where we work,” says Dr. Jones. “And a lot of times, persons of color live in places that have been low-resourced and are socioeconomically disadvantaged. And because of some of the structural inequalities that we see not just here, but across the nation, persons of color have more chronic illnesses which put you at increased risk for any type of infections like this.”
She adds that many low-income people, a disproportionate percentage of them African American, are essential workers such as medical staff, grocery workers, sanitation workers, transit workers, and so on, and have been unable to socially isolate during the onset of the COVID-19 pandemic.
Dr. Jones says that the Centers of Disease Control has a social vulnerability index that lists the various ways a community is affected by a stressful event, which the COVID-19 outbreak certainly qualifies as. She forecasts a lasting impact on African American communities caused by high COVID-19 infection and death rates.
“The fact that so many people are losing jobs, the food insecurity, the risk to just general well-being – it all plays a part in what we’re going to see in the next few weeks, the next months, the next years,” she says.
Going forward, Jones says that state and local government, along with the medical sector and business leaders, need to work together. The goal: building a focused, effective strategy to address health disparities within minority communities to achieve health equity and guard against future crises.
“We’ve said this for years – this is not a new thing,” Dr. Jones says. “Looking at our policies, we need to make sure there is an ‘equity lens’ placed on all of them. Making sure that our organizations are talking to each other – a lot of times, organizations are doing great things, but we’re doing it in silos. We can’t continue to do that.”
Dr. Jones says that health and government policy leaders in Louisville have in recent years worked together to create an interdisciplinary, innovative model addressing health disparities, releasing a comprehensive Health Equity Report in 2017.
“We need to do something similar for the whole state to see where the problems are,” she recommends, “and to see where we might need to make changes, or where we need to put more resources in.”