COVID deaths still loom over NH nursing homes as outbreaks continue

LEBANON — Norwich resident Susan White is mourning the loss of her husband, the Rev. Kenneth Cracknell, who died Oct. 26 at age 87 after testing positive for COVID-19 during an outbreak at Hanover Terrace Health and Rehabilitation Center.

That outbreak, which ended Nov. 1, included 39 residents and 10 employees, according to the New Hampshire Department of Human Services.

Cracknell, who had Parkinson’s disease and had lived at Hanover Terrace since 2019, was declining before contracting COVID-19, but White said she thinks he might still be alive if not for the virus.

Prior to COVID, Cracknell was “still present, active, talking,” White said in a phone interview. “We were doing the crossword puzzle and all that kind of stuff. And then he got very, very ill.”

White said it “sounded like he was drowning” and eventually his throat was so congested that he could no longer eat or drink.

“I’m always disturbed when people say, ‘Well, we’re kind of done with COVID, and it’s going to be a minor inconvenience,’ ” said White, who is immunocompromised herself and continues to wear masks indoors and out when around other people. “I think people have kind of let their guard down.”

Elsewhere in the Upper Valley, Lebanon Center Genesis and the Sullivan County nursing home in Unity have seen COVID-19 deaths in recent weeks amid outbreaks at the facilities. But nursing home officials say it is difficult to determine when residents have died of COVID or with COVID.

Though the virus is still causing illness and disruptions, vaccination and treatments are mitigating the severity of illness and the number of deaths facilities had seen earlier in the pandemic. Meanwhile, persistent staffing shortages are causing facilities to leave some beds empty and pay for costly traveling workers.

“I think the number of positive cases we’ve had over the last month or six weeks kind of caught us by surprise,” Sullivan County Manager Derek Ferland said of cases at the Sullivan County nursing home in Unity.

The outbreak included cases in 48 residents and 19 employees, according to Thursday’s weekly COVID-19 update from the New Hampshire Department of Health and Human Services. Two residents died.

The spike in cases at the nursing home seemed to coincide with a spike in the community at large, according to Ferland.

“The nursing home was really not exempt,” he said.

“This was our third big wave,” Ferland said, adding that he’s still uncertain “what the ‘new normal’ is.”

The outbreak at Lebanon Center Genesis has included 25 residents and 26 employees, according to DHHS’ Nov. 10 report. One person died. The Elm Wood Center in Claremont, which is also owned by Genesis, also has had an ongoing outbreak, which as of Thursday included nine residents and four employees.

But as of Wednesday just one resident was currently positive for COVID-19 at Elm Wood Center and one staff member was positive for COVID-19 at Lebanon Center, Lori Mayer, spokesperson for Lebanon and Elm Wood centers, said in an email.

“Our thoughts and prayers go out to the family of one resident who passed away while receiving end-of-life care at Lebanon Center,” Mayer said. “Others have generally had mild symptoms or were asymptomatic.”

Three years into the pandemic, health care providers have a better understanding of the virus and more tools to manage it, Dr. Gina Fernandez, interim director of geriatrics at Dartmouth Health, said in a Wednesday email.

“We can now offer vaccines and have more treatment options for our most vulnerable patients to prevent severe illness and death,” she said, noting that Vermont and New Hampshire both have among the highest rates of vaccination among nursing home residents in the country — more than 80% in each state have received both primary series and booster shots, according to a recent AARP survey. But fewer than 45% of nursing home residents in the Twin States are up to date on their shots and have gotten the latest booster, according to AARP.

Jake Leon, a spokesman for DHHS, pointed to vaccination rates as a reason the state is seeing fewer infections, hospitalizations and deaths associated with long-term care facility outbreaks than during the peak of the pandemic. Deaths recently hit a seven-day average of nearly three deaths a day, but that’s a far cry from the 12 a day average the state was seeing Dec. 25, 2021, according to DHHS’ COVID-19 data dashboard.

Though facilities cannot accept new admissions on affected units, Leon said, “the Department is not hearing from hospitals that transfers to residential care is currently more challenging due to COVID-19 cases and outbreaks than in previous months.”

Deaths and rates of serious illness may be down from the peak of the pandemic, but nursing homes continue to face challenges related to the COVID-19 pandemic, Fernandez said. For example, treatment options such as Nirmatrelvir-Ritonavir, or Paxlovid, may not benefit residents who are on multiple medications that have interactions with these medications or who have swallowing issues who can’t swallow pills that cannot be crushed. The alternative Remdesivir, while effective, is required to be given intravenously for three days, which presents a significant challenge amid ongoing hiring shortages.

In addition, testing kits and personal protective equipment required to protect residents and staff amid an outbreak are costly, she said, pointing to a study conducted by the American Health Care Association and National Center for Assisted Living, that found that nursing homes spent roughly $30 billion on personal protective equipment and additional staffing in 2020.

“Dealing with ongoing outbreaks like these requires a concerted team effort, creative systems-level interventions and state support,” Fernandez said.

Brendan Williams, president of the New Hampshire Health Care Association, which represents dozens of nursing homes in the state, said that people in the community who wish to do their part to help protect those most vulnerable to COVID-19 can get vaccinated and boosted, as he has.

“That would be helpful,” he said.

During Sullivan County nursing home’s recent outbreak, the facility has in some cases had to restrict visitation and require that visitors wear more personal protective equipment. It also has had to restrict admission to certain units at times.

“Depending on the extent of the outbreak, our admissions may be curtailed or stopped entirely,” Ferland said. If the cases are all on one unit, then the state might allow a facility to continue accepting new admissions on other units, he said.

If the Sullivan County facility “just had a moratorium, then our revenue (would) just get slaughtered,” he said.

At the same time, he said, the nursing home doesn’t want to accept new residents and put them at risk of contracting the virus.

“It’s very dynamic,” he said. “Everybody’s trying to do their best” to manage what can be “at times competing priorities.”

Hiring continues to be an issue for the facilities, which may have to take beds offline because they are unable to meet appropriate staffing levels. But Leon said those challenges are not related to COVID-19 outbreaks.

Nursing homes across the region continue to struggling with staffing. They often rely on expensive traveling workers to fill in gaps in the permanent full-time workforce. Even so, many are unable to staff up sufficiently to keep all their licensed beds open, which can cause backups in discharges from hospitals that can result in bed crunches there.

“We have so many agency nurses with us right now,” Ferland said. “That’s the only reason we’re able to stay afloat. It’s very costly.”

Williams, of the New Hampshire Health Care Association, said the staffing situation in New Hampshire nursing homes is “critical” right now, leading to a “Hunger Games” situation in which facilities are competing with traveling nurse agencies for the same workers.

“I just don’t know when we get back to normal,” he said. It’s a “race to the bottom when it comes to keeping staffing going.”

He pointed to some other states where nursing home closures have prompted policymakers to react by increasing reimbursement rates. While New Hampshire hasn’t seen closures, Williams said that all the beds that are offline due to staffing shortages “would be tantamount to closures of several facilities.”

Nursing homes are largely doing all they can to care for those who are currently in their care, Williams said.

“It’s really hard to accept new people right now,” he said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.