Originally published on the Philadelphia Inquirer on April 14, 2020

Montgomery County officials said Tuesday that one of its long-term care facilities has more than 50 cases of COVID-19, a disclosure that highlights the risk of outbreaks in buildings filled with frail seniors. A total of 67 residents in senior facilities have died, comprising 61% of the county’s fatalities from the virus.

In all, 364 residents and 223 staff members of long-term care facilities in the county have tested positive, officials said, though County Commissioner Valerie Arkoosh has stressed that the “vast majority” of the 75 state-licensed facilities in Montgomery County have “just one or two cases.”

In a bid to prevent more outbreaks in the county’s 59 nursing homes, Arkoosh announced this week that the county will start using the services of Real Time Medical Systems, which taps into nursing homes’ existing electronic medical records to find warning signs of infectious diseases and other problems.

“By identifying a problem within a facility early, we can focus limited resources and equipment and we hope save lives of patients and staff,” Arkoosh said.

Montgomery County has been forthcoming about problems in nursing homes, but it’s not clear whether the problems there are worse than in other counties in Southeastern Pennsylvania.

Bucks and Delaware Counties are not providing numbers for nursing home infections, though Bucks said Sunday that 30 “congregate living facilities” in the county had COVID-19 cases. Philadelphia is providing the number of deaths in nursing homes, but not the number of infections or information on their specific locations. Chester County is also providing very little information, though its website says nine residents and one staff member at the county-owned Pocopson Home have tested positive for COVID-19.

Philadelphia, as of Tuesday, has reported 103 deaths in nursing homes, which amounts to one for every 63 nursing home residents in March. That figure for Montgomery County is one in 94, and possibly higher because the county may not be distinguishing between nursing homes and other long-term care facilities, such as assisted living or personal care. Resident counts for those facilities are not readily available.

The current reporting regimen makes it hard to catch problems early in a nursing home. Pennsylvania regulations require that nursing homes report positive test results for COVID-19 to state and local health departments, but there’s no requirement or official mechanism for nursing homes to report worrying collections of symptoms to public health officials. Meanwhile, it still takes three to five days for the virus test results to come back.

That means health departments are inevitably late to act. “By five days, you went from two cases in a nursing home to everybody,” said Scott Rifkin, founder and executive chairman of Real Time, which is based in Linthicum Heights, Md.

Real Time works by monitoring patient data that nursing home staff already collect — such measures as temperature, breathing rate, pulse, and oxygen saturation of the blood. The system then combines the indicators to flag facilities where trouble might be brewing.

In a sample surveillance report, Rifkin pointed to an unidentified facility that had nine residents with a fever and a low oxygen level. “You have at least nine patients that I’d want to know what was going on with,” Rifkin said.

“The problem in the nursing homes is putting A and B and C together. You might have eight units and have one patient with a fever on unit 3 and two patients on unit 5 and they’re not necessarily putting all that data together. This does that,” said Rifkin, whose company already provides services to 55 Pennsylvania nursing homes, including four in Montgomery County.

Rifkin is known in Montgomery County because his former company acquired the county nursing home, Parkhouse in 2014. He sold that facility and other Pennsylvania holdings in 2017.

Real Time is not charging Montgomery County for three months, Rifkin said. “After three months, if they want to continue it, we’ll figure something out,” he said. It will take about 10 days to get all of the county’s nursing homes on the Real Time platform, he said.

Arkoosh said that representatives from the county’s health department are in daily contact with administrators at the hardest-hit facilities, and that the facilities have been receiving regular supplies of personal protective equipment from the county.

Two of those facilities particularly burdened by the coronavirus are in Upper Gwynedd Township and Springfield Township, according to Arkoosh. On Friday, she said that six senior citizens living at those facilities had died from the virus. She declined to identify the facilities.

Last week, as the number of cases rose in the county, a local firm was tapped to join a statewide effort to mitigate the virus’ effects.

The ECRI Institute, a Plymouth Meeting-based watchdog that evaluates the effectiveness of medical devices, is contracting with the state Department of Health to test PPE being used at long-term care facilities, as well as develop best practices to help staffs at these facilities keep their residents safe.

Karen Schoelles, ECRI’s vice president of clinical excellence and safety, said the institute’s engineers and researchers have experience working with long-term care facilities. They can research and quickly answer questions on a variety of pressing concerns, from which equipment to prioritize purchasing to how best to dispense a staff stretched thin.

“It’s messy right now in that a lot of the questions from these facilities come from people getting one set of directions from their management, and then they hear different things from other sources,” Schoelles said. “They just need somebody to talk them through their particular circumstance.”

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