“From the beginning of this pandemic, it has been one of my top priorities to protect the residents and staff of long-term care facilities,” said Governor Brown. “We took early and swift action to enact some of the strictest visitation policies in the country in the first days of Oregon’s outbreak. I know it has been incredibly hard for residents and their families to not be able to see their loved ones. But even with those protocols in place, the residents of long-term care facilities are particularly at high risk for serious illness and death due to this disease.
“I have directed the Oregon Health Authority and the Department of Human Services to implement a plan to test all residents and staff of long-term care facilities, starting with the facilities at highest-risk. Expanding testing is an essential first step that will allow us to examine how visitation policies can be safely and incrementally eased.”
Full details of the plan will be released by the Oregon Health Authority and the Department of Human Services later this week. Public health officials will also be working with long-term care facilities to implement recommended best practices for ongoing monitoring, including:
• Conducting active daily screenings for fever and COVID-like symptoms for all residents and staff, providing testing for any residents or staff with even mild symptoms. Residents who test positive should be isolated.
• Providing testing for all staff every month on a staggered weekly basis, with the goal of having 25% of all staff tested each week over the course of the month.
• Providing testing for all residents and staff if there is a single new confirmed or suspected resident case or a confirmed staff case, and retesting weekly until at least 14 days pass without a new positive result. Residents who test positive and are symptomatic should be isolated.
• Testing all new residents prior to admission or readmission, including transfers from hospitals or other health care facilities. Even new residents who test negative should be quarantined for 14 days.
Data have shown that the greatest risk of an outbreak is driven by the type of facility and its location. Among facility types regulated by the Oregon Department of Human Services Office of Aging and People with Disabilities (APD) at high risk are nursing facilities that serve medically fragile people, including those in need of memory care. Nursing facilities can face additional challenges to infection prevention and control due to residents’ care needs, behavioral health conditions, and capacity to adhere to infection control guidelines.
Oregon’s long-term care facilities house about 31,000 residents and employ about 29,000 staff—about 60,000 people in all. As of June 9, 16 of Oregon’s 688 large long-term care facilities had current confirmed COVID-19 cases, down from a recent peak of 27 facilities. At no point during the pandemic have more than 4 percent of Oregon’s long-term care facilities reported having an active confirmed case of COVID-19 among residents or staff.
APD has been tracking licensed long-term care facilities with COVID-19-positive residents and staff since early March, requiring that these facilities adopt stricter infection control practices. According to the testing plan, nursing facilities account for about 50% of the outbreaks at licensed long-term care facilities in Oregon despite representing less than 20% of the total number of facilities.
Long-term care facilities in Multnomah, Washington, Clackamas, Yamhill, Marion and Polk counties account for the vast majority of outbreaks, indicating that facilities in these counties are currently at the highest risk of experiencing outbreaks.
The state’s ability to quickly test all long-term care facility residents and staff is partially dependent on the federal government’s supply of necessary testing materials to Oregon. Governor Brown released a letter today pressing federal officials for more testing swabs and transport media for testing samples. According to federally-reported figures, Oregon has received far less assistance in terms of testing supplies than many other states, hampering the state’s ability to expand testing capacity.
“I am deeply frustrated that Oregon is not receiving equal treatment from the federal government when it comes to supplying testing materials,” said Governor Brown. “Actions speak louder than words, and it’s far past time for the federal government to step up and send Oregon the testing supplies we need.”
By testing residents and staff, DHS, OHA, and local public health officials can more effectively work with long-term care facilities on strategies to prevent new infections of the virus and ensure infection control measures are in place and working. Such strategies can include isolating those who test positive for the virus or had close contact with confirmed cases.
The agencies need to complete several crucial steps before the plan can launch. Among them are initiating a communication strategy for informing facility operators, health care providers and laboratories about the new plan, and updating testing guidelines. Considerations also need to be made for ensuring compliance with relevant federal and state employment laws, providing equitable leave options and coverage for staff who test positive or need to be quarantined due to close contact, along with identifying options for temporary housing for staff who have to be isolated or quarantined and can’t do this at their homes.