Little is known about what’s going on inside Johnson County’s senior care facilities, which have been closed to the public—including families—for nearly two months.
Data released Tuesday by the county health department offered a glimpse.
Most of the county’s 18 senior care facilities failed to provide information detailing the impact of the coronavirus at their facilities until this week. Some, such as Otterbein Franklin SeniorLife Community and Hearth at Stones Crossing in Greenwood, were forthcoming with information, sharing with the public how many cases—and deaths—they had recorded.
Among them, dozens of seniors have died, according to the Johnson County Health Department. In fact, about two-thirds of the county’s coronavirus-related deaths were residents at six senior care facilities in Franklin and Greenwood.
Overall, there are more than 300 COVID-19 cases at the six facilities, according to the county health department and four facilities that provided their own data.
<strong>Setting the stage</strong>
Since the beginning, Otterbein Franklin has been transparent.
On March 25, seven Otterbein residents who had tested positive for COVID-19 were transported to three area hospitals. In the days that followed, some of those residents were returned to the facility and placed in isolation. That move thrust Otterbein into the spotlight and set the stage for a routine cycle of transparency.
Since its first report of cases and deaths, Otterbein officials have provided at least weekly updates with comprehensive data that includes how many residents and employees died, how many tested positive and how many are being tested, as well as insight about what Otterbein’s various levels of isolation look like and the types of residents that are in each.
To date, 47 residents and 28 employees have tested positive for COVID-19, and 14 residents have died, Otterbein Franklin executive director Rob Newcomer said Wednesday. Of the two recently reported deaths, both were females, one 80 and one 87, and both had significant pre-existing conditions, he said.
All residents and employees are being tested.
"With widespread testing as part of the Otterbein Offensive in full-force, additional positive cases were not unexpected. Otterbein will proceed with an over-abundance of caution. We must stay vigilant until the threat is behind us, and I believe a critical component to slowing the spread will be continued testing," Newcomer said in a statement Wednesday.
"I will continue to keep you updated as new phases of testing are introduced. Transparency is important as we engage this fight together."
Otterbein officials went as far as detailing how they think the virus made its way into the facility. In mid-March, a contracted therapist and Otterbein resident were admitted to the hospital where they tested positive for COVID-19.
The Hearth at Stones Crossing, which recorded seven COVID-19 cases and one death, has been mostly transparent, too. Hearth Management LLC, the Camillus, New York-based company that owns the Greenwood assisted living facility, also provided the public with information about precautions being taken at its facilities to protect residents.
Kevin Hunter, the company’s chief operating officer, has provided most information requested the same day, but has not said how many tests have been given to residents and employees.
Hearth publishes updates for families on a COVID-19 page on its website, and sends at least one update a week to families via email, Hunter said. With major updates, such as when the first case was discovered, staff members call families, he said.
<strong>Opening some doors</strong>
After the county health department released the data Tuesday, other senior care facilities came around.
The Greenwood Healthcare Center, which recorded the highest numbers of cases and deaths with 115 and 26, respectively, had only provided information about what its parent company, Cincinnati-based Communicare Health, was doing to slow the spread. Officials gave the following statement on April 23:
“It is our position that the media’s attention on those numbers stokes fear and uncertainty about the care being provided in our centers, which is counterproductive to the work we’re doing and the communication we’ve had with families. It also creates anxiety for our residents. With that in mind, we are not going to be releasing those numbers going forward,” said Frederick Stratmann, attorney for Communicare Health.
Although the facility was not disclosing numbers to the public, Communicare was providing some information to residents and their designee, even before the state required them to do so, Stratmann said.
“We have notified residents and family members when cases have been confirmed. Regulations do not require us to provide an exact number. We update in accordance with CDC guidance and state requirements,” he said.
Greenwood Healthcare Center officials say they’re unsure if the death count is accurate, because there is some debate over who should record a death, the facility or the hospital, Stratmann said.
Greenwood Healthcare has been accepting COVID-19 positive patients from other facilities and local hospitals. Of the 115 cases recorded, 35 are not residents, he said.
“(The Indiana State Department of Health) encouraged the creation of COVID-19 units so we wanted to do our part to accept those patients,” Stratmann said.
Another reason test numbers are high is because Greenwood Healthcare has tested all residents, and employees are tested when they’re symptomatic.
Communicare distributed 3,000 test kits to its facilities in high-risk areas, including Greenwood. As many as 50% of residents at each facility have tested positive, with up to two-thirds being asymptomatic, Stratmann said.
“The reason we are showing high numbers is that we took the proactive step of testing the whole house. When you do that you get more positive results. We are seeing that a lot of these numbers are asymptomatic,” he said.
Although the facility has been under a COVID-19 prevention action plan since March 3, and has been closed to the public since March 10, the virus had already taken hold, Stratmann said.
“Our company has been very proactive in trying to prevent COVID-19 from coming into the facility. But we can’t prevent our employees from bringing it in and our residents may have already been exposed,” he said.
Greenwood Meadows, which recorded 103 cases and 14 deaths, was also initially reluctant to disclose information about COVID-19 cases at its facility. Its parent company, Indianapolis-based American Senior Communities, provided a blanket statement April 23 about virus prevention and patient assessments.
The company provided an updated statement Wednesday after the public release of the numbers of cases and deaths at its facility.
Sherri Davies, spokesperson for the company, said at some point early on in the pandemic, Greenwood Meadows tested all of its residents who were displaying COVID-19 symptoms. The facility then broadened testing to all residents to reduce the risk of early exposure if some residents were asymptomatic, isolating all residents who tested positive, she said.
Greenwood Meadows has a staff member assigned to each resident, so families can contact that person with any questions, Davies said. That staff member is kept in the loop about the number of cases and deaths at the facility each day, and is responsible for relaying that information to the family of the resident they are assigned to, she said.
“We are saddened by the impact COVID-19 has had on the long-term care community. The residents and families we serve are very important to us and we will continue to move forward with compassion, and an over-abundance of caution and quality care,” Davies wrote in the statement.
The company did not answer questions regarding the total number of residents and employees at Greenwood Meadows, or about how many employees, if any, have the virus.
At Compass Park in Franklin, one of three residents who tested positive for COVID-19 died. That resident was already gravely ill before contracting the virus, said Mike Spencer, CEO of Compass Park. The other two residents have recovered, he said.
Compass Park is home to 375 residents and has about 320 employees, three of whom also tested positive for COVID-19. Those employees started feeling ill when they were not at work and have all since recovered. Two of the three employees are back at work, and the third set to return next week, he said.
Compass Park staff is taking several precautions to prevent further spread of the virus, Spencer said Tuesday.
“If a resident goes to the doctor, when they come back, they are quarantined in their room for 14 days,” he said. “Anybody who developed signs or symptoms is quarantined until there is testing and results. (We also protect ourselves) through the proper use of PPE. We have shoe covers, head covers, masks, gowns, gloves. We’re prepared for it and educate staff on the proper use of PPE.”
Morning Pointe in Franklin, which recorded three positive COVID-19 cases and two deaths, remains tight-lipped.
Morning Pointe is following guidelines from the Johnson County Health Department and Centers for Disease Control and Prevention on how to prevent the spread of infection, spokesperson Will Brewer said in an email.
Brewer would not answer questions about the numbers of deaths, cases and tests, or the total number of residents and employees at the nursing home, and said it was private information.
<strong>Holes in guidance</strong>
Nursing homes are not obligated to report cases to the public, as most are private entities, said Luke Britt, Indiana’s public access counselor.
“Since nursing homes are private entities, there wouldn’t be a public access requirement,” Britt said. “I think the state government could make a law to require disclosure, but that would be up to lawmakers.”
But that doesn’t mean they shouldn’t be more transparent.
Unless the state requires long-term care facilities to disclose more information, it is unlikely they will, said Steve Key, executive director and legal counsel for the Hoosier State Press Association, which the Daily Journal is a member of.
“One problem you have is that the majority of long-term facilities are private entities. They are not subject to the Open Door Law or Access to Public Records Act. This means there is no obligation for them to answer your questions or provide you with records or data.”
One reason why facilities may be reluctant to disclose data is because they fear bad publicity, Key said. An argument could be made that the state should require facilities to disclose more data, he said.
Some facilities may be reluctant to disclose more information due to the Health Insurance Portability and Accountability Act, or HIPAA, a federal law that protects sensitive patient health information. However, HIPAA refers exclusively to information about an individual patient’s health care, Key said. Since a number of cases at a facility would not reveal any individual’s personal information, disclosing facility-level data would not be a HIPAA concern, he said.
“There are situations where entities are using HIPAA to avoid disclosing information,” Key said. “[But] if you have several nursing homes in a community, from a marketing perspective, do you want to be the one where this ran wild?”
A hole in the state’s guidance is not disclosing data about staff cases to the public, Key said. Residents with COVID-19 are not a threat to public health because they can’t leave the facility, but staff could be, he said.
“Beyond family members, where is the obligation to the community?” Key said. “(People want to know) do we have a hot spot developing where there are 10 or 15 staff members who are infected and have been circulating among their family and going to the grocery store?”
Facilities are required to report much more to the state. But the state is only reporting aggregate numbers of facilities that have at least one case and at least one death to the public.
All tests given must be reported to the state health department within 24 hours of receiving test results, according to an order from Dr. Kristina Box, state health commissioner. All deaths must be reported within the same time frame, the order says.
The state requires long-term care facilities to provide family members of residents with the following data:
<ul>
<li>How the facility is handling issues with care and staff shortages;</li>
<li>General information about COVID-19;</li>
<li>The number of residents and staff who have tested positive and the number of “new” positive cases (in the last 14 days);</li>
<li>The number of residents who have died due to the virus;</li>
<li>Facility mitigation actions implemented to reduce the risk of COVID-19 transmission, including if normal operations of the facility have to be altered.</li>
</ul>
Effective Monday, data on the outbreak is to be provided to families by a designee at the facility, according to state guidance.
This individual is required to provide “daily group emails, automated voicemails or automated electronic communications to residents and their designated representatives, informing them of the total number of COVID-19 cases, number of new cases in the last 24 hours and if there are three or more new cases of respiratory illness that have occurred in the last 72 hours in residents and/or staff within the facility,” the state guidance says.
<strong>Why now?</strong>
The county health department decided to release the numbers Tuesday because they were advised they would not be violating any HIPAA laws and it was in the community’s best interest to know, said Betsy Swearingen, director of the Johnson County Health Department.
"We believed we were protecting these victims’ identities," Swearingen said of the health department’s decision not to release any information until now.
The data the county health department provided came from the state health department, she said.
Staff members at the county health department have been in contact with all 18 of the senior care facilities in the county, and are doing what they can to help monitor the situation and put plans in place to contain it, Swearingen said.
"The thing is, these nursing homes, they’re dealing with literally our most vulnerable population. So many of these people were already sick with pre-existing conditions," Swearingen said. "They are doing the best job they can do … they are doing everything in their power to overcome deficiencies."
How bad an outbreak is doesn’t necessarily have anything to do with the facility’s management of the situation, she said. Other factors, such as number of beds and employees, also come into play.
"A lot of it does have to do with the population they serve, absolutely. Some of them specialize in more ill patients who are in the final days or months or years of their lives," Swearingen said.
"I don’t believe these long-term care facilities are being malicious in their intent," she said. "They are trying to protect their patients’ confidentiality, and their families’ confidentiality."
<em>Daily Journal reporters Andy Bell-Baltaci, Leeann Doerflein and Emily Ketterer, and editor James Vaughn contributed to this report.</em>
[sc:pullout-title pullout-title="By the numbers" ][sc:pullout-text-begin]
Here is a look at the COVID-19 impact on senior care facilities in Johnson County that have recorded cases and deaths:
<strong>Greenwood Healthcare</strong>
Resident deaths: 26
Total cases: 115
Resident cases: 80
Employee cases: 10
Residents: 164
Employees: 200
Source: Greenwood Healthcare
<strong>Greenwood Meadows</strong>
Resident deaths: 14
Resident cases: 103
Source: Johnson County Health Department
<strong>Otterbein Franklin</strong>
Resident deaths: 14
Total cases: 75
Resident cases: 47
Employee cases: 28
Residents: 500
Employees: 300
Source: Otterbein Franklin
<strong>Morning Pointe</strong>
Resident deaths: 2
Resident cases: 3
Source: Johnson County Health Department
<strong>The Hearth at Stones Crossing</strong>
Resident deaths: 1
Resident cases: 7
Employee cases: 0
Source: The Hearth at Stones Crossing
<strong>Compass Park</strong>
Resident deaths: 1
Total cases: 6
Resident cases: 3
Employee cases: 3
Residents: 375
Employees: 320
Source: Compass Park
[sc:pullout-text-end]
