Nearly all nursing homes in Arkansas battled a covid-19 outbreak that lasted five or more weeks, a federal watchdog's report said this month, placing the state among those most affected by sustained hot spots at long-term care centers.
The 20-page Government Accountability Office analysis found that Arkansas was among five states -- joining Alabama, North Dakota, South Carolina and Tennessee -- where at least 95% of local nursing homes saw "long-duration" outbreaks.
That's a larger segment of homes than in the majority of states, where 75% or more of the care centers had outbreaks they couldn't snuff out in less than five weeks.
Alaska, Hawaii, Maine, Massachusetts, New Hampshire, Oregon, Vermont and Washington were the exceptions, with less than three-quarters of nursing homes experiencing longer outbreaks.
The findings further quantify the workings of covid-19 in long-term care facilities, showing that the disease spread for more than a month within almost every nursing home in Arkansas. During those times, residents and staff members were more likely to pass illness from person to person.
For every 1,000 nursing home residents in Arkansas, 805 have tested positive for covid-19 since spring 2020, data from the federal Centers for Medicare and Medicaid Services shows. The same data shows that 2,227 nursing home residents, or about 15% of the state's total, died.
The head of the trade and lobbying group representing nursing homes in Arkansas said she isn't sure why a larger group of facilities was affected by long outbreaks compared with other states. Nursing homes have dealt with many challenges through the crisis, including unfamiliar protective gear requirements and high levels of staff turnover, she said.
"We know so much more now than we did a year ago -- but there's still so many questions and things that we don't know," said Rachel Bunch, executive director of the Arkansas Health Care Association.
Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, pinned the high rates on infection-control failures that she said are commonplace, on limited accountability for nursing home owners, and on listless enforcement of federal health guidelines. Those guidelines are long-established and "not rocket science," she said.
People living in nursing homes are "the sickest and most frail and vulnerable citizens," Deaver said. "If you care about the residents, you make sure you follow the basic health requirements to protect them from infections."
In the government report, analysts reviewed data that nursing homes submit each week about covid-19 tests, cases, access to personal protective equipment and more. The review is part of monitoring compelled by the Coronavirus Aid, Relief and Economic Security Act; reports are delivered to a few members of Congress.
Researchers also found that more than a third of the nation's nursing homes, or 36%, had multiple outbreaks lasting more than five weeks. The most common long-outbreak duration was seven weeks, and some homes -- 413 of 13,316 reviewed -- saw an outbreak lasting 20 or more weeks.
SLOW TEST RESULTS
Kelley Garner, an epidemiology supervisor and program coordinator with the Arkansas Department of Health, wrote in an email that the agency needs more time to understand the federal report's findings, but that its scientists appreciate it as an opportunity to learn from other states.
She said Arkansas was "conservative" in its nursing home response efforts and began facilitywide testing in March 2020, six months before federal regulators required it for the care centers, but the state's efforts were sometimes hindered by slow turnaround times for covid-19 test results.
Nationally, most longer outbreaks in nursing homes took place between October and December, according to the report. That's when community spread of the virus was high, and it led up to the point when vaccinations began in long-term care facilities, around mid-December.
Health experts say the shots caused infections and deaths to plunge in nursing homes.
Researchers found no connection between a nursing home's business model -- whether nonprofit, for-profit or government-run -- and the length of its outbreaks. They also couldn't match lengthy outbreaks to a site's history of infection-control deficiencies.
A 2020 report from the same watchdog found that infection-control problems were "widespread and persistent" in nursing homes before covid-19, with 82% of the nation's facilities receiving citations from regulators for such problems during a five-year period, and about half of those receiving sanctions in consecutive years.
That included Arkansas, where 153 of 243 nursing homes surveyed had infection-control issues recorded in multiple years of the period studied.
SPREAD FROM STAFFS
The federal analysis also found that about 66% of nursing home outbreaks of any length began with a positive test for a staff member.
The data point supports an argument that public health experts have made for months: that workers -- often those with asymptomatic infections -- have unwittingly driven the infection clusters that took hold in "congregate care" settings, especially as nursing homes were closed to family visitors.
The facilities are better prepared now with equipment and experience to help mitigate infections spread by caretakers, but "the vaccines are key" in heading off the issue, said Bunch, the nursing home industry representative.
By June 14, the federal government will begin posting public data that shows vaccination rates for nursing home staffs at the facility level, as well as the same rates among residents. About half of Arkansas' facilities already began reporting that data, according to the Health Department.
Bunch called the data a good step for transparency and said it will shed more light on where vaccination numbers have lagged. Some nursing homes in the state have reached out to her group for resources to answer staff members' questions about the shots.
Garner, the epidemiology supervisor, said that looking ahead, core concepts such as hand hygiene, social distancing and personal protective equipment will continue to "provide a foundation" as the state helps facilities and their staffs respond to infectious-disease outbreaks.
The Health Department also plans to roll out a new federal Centers for Disease Control and Prevention initiative dubbed "Project Firstline" that will offer infection-control training to any health care worker in the state.
Standardizing that knowledge will be "a huge move forward" at the front lines, she said.