Despite recent criticisms about the city’s handling of the high number of COVID-19-related deaths occurring at skilled nursing homes and assisted living facilities, a consultant’s report on the response to the pandemic praised the Pasadena Public Health Department’s efforts at stemming the high number of deaths occurring among elderly people.
“As a result of my review, I found the PPHD to have responded in a timely and thorough manner to provide orders and technical assistance to prevent, detect and/or mitigate the spread of COVID-19 in long-term care facilities,” wrote Brenda G. Klütz, managing partner of Sacramento-based B&R Klütz Consulting, LLC. “These efforts seem to be a continuation of the PPHD’s commitment to improve the health of vulnerable residents in long-term care facilities.”
More important than what is stated in the 12-page document, however, is what is not mentioned that bothers members of the City Council looking for answers to the growing number of deaths occurring in local skilled nursing facilities, or SNFs.
“This is third-hand,” Councilman Tyron Hampton told Pasadena Star-News reporter Bradley Bermont. Hampton also serves as vice mayor.
“Someone told this consultant what to write and they wrote it. There needs to be a thorough, independent investigation,” Hampton said.
Councilman Victor Gordo said he was looking for the opportunity for a “learning experience” from the report.
“We need to learn from our experience with this. We need to be out in front of it,” Gordo told the Pasadena Weekly. But, he said, “This chronology does not do that.”
“What would be helpful to me is a little more clarity in the form of a diagram or some exposition on how the regulatory authority is really divvied up between the state Department of Public Health, the county and the city,” said Mayor Terry Tornek.
“It’s overlapping and a little confusing,” Tornek said. “But apparently some of the council members don’t feel it was adequate and it didn’t answer all their questions, so we need to get them to articulate exactly what their questions are and we’ll do it again.”
According to the city, there are 16 skilled nursing facilities in Pasadena, with 886 beds per 100,000 residents, as compared to 383 facilities in Los Angeles County with 382 beds per 100,000 residents. This means there are 2.3 times more beds per 100,000 residents in Pasadena than LA County.
The Klütz report is largely a self-described “high-level snapshot” of events illustrating the Health Department’s performance in overseeing elder care in the city, as well as its response to the pandemic in actions taken from January through May.
According to the timeline, city Health Director Dr. Ying-Ying Goh declared a local public health emergency on March 4 at a joint press conference with LA County and Long Beach health officials, as Gov. Gavin Newsome declared a state of emergency in California. The next day, local health officials “began in-person visits to every state-licensed skilled-nursing facility in the jurisdiction. Nurses conducted on-site COVID-19 preparedness training with facilities staff,” the chronology states.
Also on that day, “SNFs were directed to follow the California Department of Public Health (CDPH) guidance for designation of specific staff with infection prevention and PPE training to care for patients with confirmed or suspected COVID-19, to instruct staff to monitor for symptoms and not work if sick, and to make contingency staffing plans should staff be sick. SNFs were directed to follow CDC guidance for ‘Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities’ that included posting signs to restrict sick visitors in order to prevent introduction of COVID-19 into facilities, and to report any possible cases of COVID-19 among residents or employees to the local public health department.”
In April, states the chronology, “PPHD staff continued on-site visits and daily communication with facilities. PPHD conducted daily communication and coordination with agencies with regulatory authority of long-term care facilities.”
On March 16, Goh issued written directives and guidance to facilities, including requirements to restrict visitors and non-essential personnel, instituting symptom screening for anyone entering a facility, and not allow anyone with symptoms to enter.
On March 17, the city Public Health Emergency Preparedness Program “offered all skilled nursing facility administrators, directors of nursing and infection control preventionists an allocation of N95 respirators.”
On March 18, the Health Department “notified assisted living facilities and adult/senior care facilities of a scheduled conference call on COVID-19,” which offered “guidance, outlined specific actions to take to protect clients, residents and staff and to slow the spread of the disease.”
On March 19, Goh issued a Safer at Home order, and revised it on March 22 to incorporate the State Health Officer’s Stay at Home order.
On March 27, Goh “issued orders requiring the self-isolation of persons diagnosed with or likely to have COVID-19 and self-quarantine of persons exposed to a person diagnosed with or likely to have COVID-19.”
March 30 was marked by the first report of a skilled nursing facility resident diagnosed with COVID-19. The report was submitted by the hospital when the patient was admitted, not by the SNF.
Starting April 1, health officials “continued on-site visits and daily communication with facilities and conducted daily COVID-19 clinical team case conferences to review cases and develop recommendations for each long-term care facility.” Goh then implemented COVID-19 testing strategies at these facilities, including outbreak investigation testing,” the timeline states.
On April 9, Chief Assistant City Prosecutor Michael Dowd sent letters to every skilled nursing and assisted living facility listing nine action items that they were required to implement in order to be in compliance with existing health orders. Over the following week, the city prosecutor’s office then contacted each of the SNF and assisted living facilities by phone or email, reminding them of their duties under the orders and to re-emphasize the action items required to be implemented, the timeline states.
In May, Health Department staff “continued on-site visits and daily communication with SNFs and assisted living facilities, and coordination with agencies with regulatory authority of long-term care facilities.” The department also conducted daily COVID-19 clinical team case conferences to review cases and develop recommendations for each long-term care facility. PPHD, the report states, “continued implementation of mass testing strategies in all facilities.”
Goh then ordered long-term care facilities to conduct COVID-19 diagnostic testing , required SNFs to implement a Facility Mitigation Plan, including testing and cohorting as directed by the local Health Department, and required SNFs to designate or hire an infection preventionist to ensure proper training on infection prevention, and for the SNF to have a plan for adequate PPE, including established contracts with vendors, states the timeline.
In the end, the consultant wrote, “The PPHD initiated restrictions on visitation of long-term care facility residents, and soon afterward enforced a ban on visitors. In addition, long-term care facilities were prohibited from admitting any new residents. The PPHD also worked closely with state licensing agencies, so that those agencies could impose more serious sanctions if warranted.”
On Tuesday, Pasadena recorded 82 deaths due to COVID-19, up by 11 deaths since last week, with 72 of those patients being tenants of elder care facilities. That number is up from 64 last week, according the Health Department’s COVID-19 dashboard on the city’s website.
“I think the Health Department is working very hard in a very tough environment, and I think the circumstance with the nursing homes is not unique to Pasadena. I think it’s a national, even international problem,” Tornek said.
Gordo said he was hoping for more detail that the council could study, “so we are in the best position to protect Pasadena residents going forward. I think we have an obligation to do that.”
“Despite major obstacles, the Health Department has and will continue to take the necessary actions to mitigate the spread of the virus, knowing this will be a sustained response,” wrote City Manager Steve Mermell.
“The city will continue to evaluate our progress and build upon lessons learned at a local level and from our county, state and federal partners,” Mermell wrote.