Nursing home infections surge

At least 255 nursing homes in the District of Columbia, Maryland and Virginia had novel-coronavirus cases as of last week, nearly double the number from April 11. According to data provided by officials, more than 2,000 residents and workers at these long-term care facilities have been infected.

Fifty-seven residents at the 92-bed Regency Care of Silver Spring, Maryland, have tested positive for the coronavirus, a spokeswoman for the Montgomery County Health Department said, and nine have died. Twenty-eight staff members have also contracted the virus.

In Fairfax County, Virginia, 29 nursing facilities have confirmed coronavirus cases, according to an email from the county health department obtained by The Washington Post. In Prince George's County, 308 residents and employees at 18 nursing homes have tested positive and 34 have died.

And in D.C., 13 nursing homes have reported 199 infections and 15 fatalities.

"We are beginning to see some of the cases cluster around our long-term care facilities and our immediate-care facilities," D.C. Health Director LaQuandra Nesbitt said.

Officials across the region have promised to ramp up testing at facilities and take every possible precaution. But in the meantime, many relatives of residents say they remain in the dark about cases and fatalities where their loved ones live.

D.C. last week began publishing information about infections at facilities. But Maryland and Virginia refuse to do so, citing patient privacy. They defer to local health departments and individual facilities, which may or may not tell relatives of patients - or the public - when outbreaks occur.

Patients' families say the lack of comprehensive information makes it difficult to decide how to care for loved ones and can compound their grief when relatives die. Advocates warn that a lack of transparency may allow outbreaks to go undetected and shield facilities that respond poorly to the crisis.

"It is frustrating. There's no other word to describe it," said Montgomery County, Maryland, Council member Evan Glass, a Democratic member of the Health and Human Services Committee and former CNN journalist.

"It's a delicate balancing act," he said, referring to privacy concerns. "We're in a health crisis and need to figure out how to share information in a timely way."

The federal government issued guidelines earlier this month requiring nursing homes to regularly update patients' families on coronavirus cases. But enforcement details have not been announced.

While Maryland and Virginia say they will not start publishing lists of nursing homes with coronavirus cases, a spokeswoman for the federal Centers for Medicare and Medicaid Services, which regulates care facilities, said the agency will soon release weekly data that includes the names of nursing homes with known outbreaks.

Herman Taylor, a former Maryland state delegate, said he was told April 15 that his sister, a resident at Regency Care of Silver Spring, had tested positive for the virus. As of Thursday, he had not received any updates on her condition.

All of Taylor's calls to the facility have gone unanswered, he said, and Regency employees refuse to tell him how many residents have been infected or whether any have died.

"It's the worst thing you can imagine," he said.

Regency did not respond to calls or emails seeking comment. The nursing home has an overall rating of two out of five stars from Medicare and a one-star rating based on recent health inspections. The report from its most recent health inspection included accounts of staff shortages, including instances in which there were just two or three nurses left in charge of nearly 60 patients.

"They've mistreated patients and their families for a long time, and the government's done nothing," Taylor said. "Now's their chance."

Raman Tuli, a geriatric doctor based in Montgomery, said at least 11 of her patients at Rockville Nursing Home have tested positive for the virus and three have died. Total numbers for the facility are higher, she added.

The facility's website said in a statement dated April 16 that seven residents had tested positive, but it did not mention fatalities. A receptionist at the nursing home told a reporter that no one was available to provide official numbers and hung up. The facility's medical director, Thomas Joseph, declined to comment.

"I just want a picture of things, to know what it was like for my brother," said Jan Hirschfeld. Her brother, Steve Joltin, moved into Rockville Nursing Home in November and died April 11, one day after testing positive for the coronavirus. She said staff members have refused to say how many others at the facility are sick or have died.

"It's just so difficult to understand," Hirschfeld said. "We want to know how many people were affected by this."

Employees at 10 other facilities in the region with known coronavirus cases either did not respond to calls seeking information on the cases or hung up when the virus was mentioned.

David Sherman learned Thursday that his 89-year-old mother, Marie Dowden, who lives at the Stoddard Baptist Nursing Home in D.C., had tested positive for the coronavirus and was running a fever. The next day, he called the facility eight times to try to see how she was doing. "It's been hell getting information," he said. "For all I know, she could be hospitalized or - God forbid - deceased."

A staff member called him back late Friday afternoon with an update, he said.

In its recent memo, the Centers for Medicare and Medicaid Services said facilities must report positive cases to the Centers for Disease Control and Prevention in addition to local and state health authorities. They must also inform residents and their representatives within 12 hours of an initial confirmation of the coronavirus and update them once a week or each time there is an additional confirmed case of the virus among residents and staff members.

Facilities that fail to do so will face penalties that the federal agency will release "in the coming days," a spokeswoman said.

Nesbitt, the D.C. health officer, said the city has told all facilities to comply with the updated federal requirements. Clinicians who violate regulations can have their licenses revoked, she added, and providers who do not comply may have their Medicare or Medicaid funding rescinded.

Maryland and Virginia require nursing homes to report cases to local and state authorities but do not demand that they release information to relatives of other residents or the general public.

Maryland recommends that facilities "coordinate" communication to the public with state and local authorities. Montgomery County Health Officer Travis Gayles said the county also has encouraged nursing homes to disclose cases to other residents of the facility and their representatives.

Gayles said that although a majority of long-term care facilities "have been very forthcoming," the county is asking its "action teams" of county nurses to help communicate with patients and their representatives, in addition to assisting facilities with medical response, contact tracing and other logistics.

"The hope is that through this process, we can improve care and service delivery, but also improve reporting," said Montgomery County Council member Gabe Albornoz, a Democrat who chairs the Health and Human Services Committee.

The Virginia health commissioner announced last week that long-term care facilities can share information on coronavirus patients with other providers, including the identities of patients. This shift in policy was intended to protect nursing home employees, who often work at multiple facilities, an agency spokeswoman said.

On Wednesday, the Fairfax County Health Department emailed the directors of the county's long-term care facilities a list of 29 sites that have confirmed coronavirus cases. Facility directors will receive an updated list three times a week, the email said.

Charlie Gischlar, spokesman for the Maryland Department of Health, said disclosing which long-term care facilities have infections "serves no public health purpose and could lead to the identification of specific persons who have tested positive for the disease."

Asked about the new federal reporting requirement, Gischlar said, "MDH follows Maryland law."

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The Washington Post's Fenit Nirappil, Antonio Olivo, Laura Vozzella and Rachel Chason contributed to this report.