San Diego's nursing homes taking steps to protect against flu
The spike in flu activity that is sweeping across the county at an alarming rate is forcing many of the region’s nursing homes, assisted living centers and residential rehab centers into lockdown mode as the best way to protect their medically vulnerable residents.
That was the case at Poway’s Villa Pomerado Convalescent Care Center from Dec. 27 through Friday after testing confirmed that four of the facility’s 92 residents tested positive for influenza.
The decision was made quickly to shut down the main places where residents congregate for meals, exercise and entertainment, forcing everyone to stay in their rooms until seven days after symptoms first appeared.
By Thursday, said Marilyn Bailey, the facility’s director of nursing, the stay-put routine had begun to wear thin.
“There was definitely a bit of cabin fever going on,” Bailey said. “One of the big things that our folks love is bingo, and we’ve had to cancel that, too. That has not been a popular move, but it’s what we’ve had to do to protect our people from the flu.”
Villa Pomerado is among the 55 congregate living facilities that had reported flu outbreaks to the county health department as of last week. Miles away from Villa Pomerado, Point Loma Rehabilitation Center in San Diego was in a similar lockdown mode.
Dr. Mike Wasserman, chief of Rockport Healthcare Services, the company that runs Point Loma Rehab, said that his workers began proactively testing residents after one patient was diagnosed, and discovered 10 more who, though they were not showing classic symptoms such as fever and cough, none-the-less tested positive for influenza infection.
Shutting things down, he said, is simply standard procedure.
“You have the most complex and the most frail people in our communities living in these facilities. They’re the most vulnerable to begin with, and we have to be hyper vigilant,” Wasserman said.
The flu has killed 45 people since July 1, according to the most recent weekly report from the county Health and Human Services Agency. The dominant strain in circulation this year is known to affect older people more severely, a fact that is showing up in the numbers. The average age of this year’s flu victim is 82, according to county records.
Because congregate living facilities feature shared spaces such as dining halls, recreation rooms, rehabilitation gyms and patios, the nation’s public health systems treat them much differently than single-family homes or apartments. County public health rules require group-living organizations to file a report any time they have two or more flu cases. One must be confirmed by a test but the second can be simply suspected due to the presence of flu symptoms.
While just two cases may seem like scant reason to curtail the movement of whole communities, Lynette Brammer, who heads up the Domestic Influenza Surveillance Team at the U.S. Centers for Disease Control and Prevention, said that there is plenty of evidence that waiting for more cases to appear can be devastating when the flu appears in an elderly population already coping with other illnesses.
The power of the human immune system wanes with age and other diseases commonly treated in residential facilities can make it even harder to fight off a virus that younger people, and those who are otherwise healthy, can vanquish with a week of bed rest why watching reruns on TV.
“You can have a lot of hospitalizations, and unfortunately a lot of deaths, if you don’t treat nursing home outbreaks seriously and very quickly,” Brammer said.
At both Villa Pomerado and Point Loma Rehabilitation Center, closing shared spaces meant that all therapy, including rehabilitation usually performed by walking hallways or visiting an on-site gym, had to be performed in patients’ rooms for seven days straight.
On Thursday, Marion Ruocco worked in her room, trying to get stronger after general weakness put her in Villa Pomerado about two weeks ago. Though she said that walking up and down beside her bed, rather than out in the hallway, was an adjustment, the Rancho Bernardo resident said she couldn’t complain.
“I can look outside and watch the birds. I can watch anything I want on TV. If I get really lonesome, I ring the bell and one of the girls comes by and says hi,” she said.
There was community, she said, even when things were locked down.
“One girl, she just works her heart out, she’s such a dear thing … she said ‘my mother isn’t here. I can’t hug her, but I’ll give you a hug,’” Ruocco said.
For Villa Pomerado’s 48 long-term residents, the week of curtailed movement seemed most painful.
Luis Kruglick, a retired family medicine doctor who has lived there for more than one year, said the lockdown meant no more trips to the gym. For a man suffering from debilitating nerve numbness in his legs which left him unable to walk for years, getting to the gym regularly is far from a luxury. Keeping moving is literally the key to maintaining his very ability to walk.
“It has taken me almost three years to be able to walk. Having my movement curtailed is really devastating. I’m losing my function right here as I sit. My muscles are dwindling,” he said.