Problems with identifying asymptomatic carriers and having difficulty with memory-care patients have contributed to the spread of COVID-19 in nursing homes. But resident advocates say issues in the homes preceding coronavirus also have an impact.

A population that is highly susceptible to COVID-19, a lack of availability of personal protective equipment, a slow response to provide testing and the presence of asymptomatic carriers are all primary factors in why nursing homes have been ravaged by the deadly virus.

But some patient advocates and others critical of the nursing home industrys response to the pandemic say the level of staffing, problems with infection control and the buildings themselves all preceded the coronavirus devastating effect on residents and the industry.

This is an unprecedented challenge for us across society in every single facet of our lives, including those for nursing home residents and operators, said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group for residents. However, we have known that infection control and prevention standards are too often flouted by nursing homes."

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A total of 1,247 deaths in Ohio were in nursing homes, assisted-living and intermediate care facilities collectively referred to as long-term-care facilities out of the statewide death toll of 1,781 as of Wednesday, the most-recent nursing home data available. There have been 4,666 residents and 2,124 employees test positive in the facilities since April 15, when the health departments long-term-care facility database was created.

In the latest update, 38 facilities have had at least 50 cases and 78 have had at least 30. Seven facilities, including Scioto Community in Franklin County, have had at least 100.

Ohios more than 950 nursing homes have 73,826 residents, according to the most-recent data via the Kaiser Family Foundation. Another 30,000 people, at least, reside in Ohios 760 assisted-living facilities, according to the Ohio Assisted Living Association.

In nursing homes specifically, a 2019 report from the inspector general of the U.S. Department of Health and Human Services stated that the second-most-common deficiency from 2013 through 2017 was infection control. The Centers for Disease Control and Prevention states there are between 1 million and 3 million serious infections each year in long-term-care facilities and about 380,000 deaths.

Though some of that is attributed to lack of compliance with basic hygiene protocols, such as hand-washing, Mollot said the biggest contributor to issues in nursing homes is the lack of investment in staffing.

In Ohio, 536 facilities are below average in staffing, according to Nursing Home Compare, a federal Medicare website that has detailed information about every Medicare-certified nursing home in the country.

"It's really sad its taking this pandemic to bring out the issues of nursing homes, said Paula Mueller, founder and president of Elderly Advocates, based in the Cleveland suburb of Parma. But I think it is really seen that they had poor infection control before this started.

The virus hasnt just hit one- or two-star-rated facilities. ONeill Healthcare in Lorain County and Crandall Nursing Home in Mahoning County are each five-star facilities with more than 100 total cases.

The design of the facilities is another contributor to the spread of coronavirus. Most are set up similar to hospitals, with multiple resident rooms along a single hallway, which can make it difficult to separate sick residents from healthy ones.

Charles Camosy, a professor at Fordham University who has researched nursing homes, said in a New York Times opinion piece that a throwaway culture is the crux of the problem. Of all the problems the coronavirus has exposed, Camosy said the care of seniors needs to be examined.

"At least part of the story, seems to me, has to be we just didn't care about these people, he said in an interview. Both the workers and residents of these homes we considered expendable.

Others say the spread of the virus would have been difficult to prevent.

Dr. Amy Acton, director of the Ohio Department of Health, has said repeatedly that nursing homes arent to blame for the spread of the virus, acknowledging that medically compromised seniors will die in congregant settings.

Kristine Provan, regional director of operations at Laurel Health Care, who oversees several facilities in central Ohio, agreed, saying the virus was impossible to defend against.

I can tell you with 22 years in long-term care, this is not the flu, Provan said. This spreads like nothing I've ever seen before.

Back in April, facilities pushed for universal testing to identify asymptomatic carriers, but some facilities are still searching for tests and personal protective equipment.

Provan said residents suffering from dementia are difficult to protect from the virus because they tend not to remember to regularly wash their hands or understand theyre living in a pandemic.

Pete Van Runkle, executive director of the Ohio Health Care Association, which represents more than 1,000 facilities, said the only way to properly prevent spread of the virus is to have personal protective equipment for everyone and to test employees at the start of every shift, every day.

The state only recently has been conducting more than 9,000 tests per day.

Even if you do testing, they still may be not showing, Van Runkle said. It takes a day or two to show on a test and ,of course, a test is not 100% accurate any way.

Mollot said the overwhelming majority of health-care workers in nursing homes are going extra lengths to protect residents. Provan agrees. That, however, hasnt made reality easier to accept.

"It's just like a petri dish for infection spread, Provan said of the long-term-care facilities. This has been I know for me the greatest challenge of my entire career."

jmyers@dispatch.com

@_jcmyers

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Coronavirus in Ohio nursing homes: Who is to blame? - The Columbus Dispatch