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There may be no more vulnerable place to be during this pandemic than inside a residential senior home. As of last month, residents and workers at nursing homes and other long-term care facilities accounted for more than a third of all COVID-19 deaths nationwide, and more than half of the deaths in California.

Here in Humboldt, all four of our COVID-19 fatalities to date were the result of an outbreak at Alder Bay Assisted Living. And while the state and county now require plans for regular testing of both patients and staff at skilled nursing homes, there is no such requirement for assisted living facilities such as Alder Bay.

Unlike skilled nursing facilities, which provide care in a medical setting, assisted living homes are for seniors who just need help with daily activities such as eating, bathing, dressing and managing their medications. But because they live on-site during the shelter-in-place order, the elderly residents are especially vulnerable to COVID-19.

Despite advice from public health officials, several assisted living facilities reached by phone last week told the Outpost that they’re not testing employees or residents for the novel coronavirus. Some of these care providers said they didn’t think testing was necessary because employees have limited interactions with the public. Others said they weren’t worried because employees hadn’t yet displayed any symptoms. 

Humboldt County Health Officer Dr. Teresa Frankovich says county officials have been encouraging such facilities to get employees tested regularly at the OptumServe testing site at Redwood Acres. But in the absence of federal coordination, a state mandate or public funding, the onus for testing falls on individual businesses, and locally, their owners have differing attitudes about the importance of such screening. 

At this week’s Board of Supervisors meeting, Frankovich said staff at the county’s Emergency Operations Center has been “incredibly active” in engaging assisted living facilities countywide. They’re conducting a weekly survey to ask facility managers about their status in preparing for the virus, including safety equipment supplies and levels of training.

She offered similar assurances in a recent email to a local community member who had reached out to voice concern about the lack of testing at Timber Ridge, which operates senior homes in McKinleyville and Eureka. 

In the June 5 email, Frankovich explained that the county’s authority is limited because it doesn’t own, operate or license assisted living facilities. Unlike skilled nursing facilities, which are licensed and regulated by the California Department of Public Health, assisted living homes are regulated through the Department of Social Services, which doesn’t require testing of staff or residents. 

That’s despite the fact that, as the L.A. Times recently reported, assisted living facilities often house patients for longer than skilled nursing homes, and in California alone there have been more than 2,000 positive COVID-19 cases and 305 deaths among staff and residents.

Frankovich added that despite the county’s lack of regulatory authority, “our Congregate Living Task Force in the EOC [Emergency Operations Center] has been going out to assisted living facilities, like Timber Ridge, offering planning assistance, doing walk-throughs with infection control checklists and making suggestions, advising on PPE [personal protective equipment] and offering trainings for staff and yes, encouraging them to have staff tested regularly through Optum.”

Julie Eagle, marketing director at Timber Ridge, confirmed to the Outpost last week that management is not requiring staff to be tested regularly, though they did provide employees with antibody testing last month. The results all came back negative. 

“Testing isn’t necessarily the first thing we’d do, though we want to implement that for new hires,” Eagle said. “We will have that as an option for them.”

Asked if management is concerned about employees accidentally bringing the virus into the facility, Eagle said, “I think we’re aware that that’s our biggest risk.” But rather than requiring regular surveillance testing, she said, “more of our emphasis is for education and support for our staff when they’re out in public.” In other words, they’re advising workers to follow public health protocols such as masking and social distancing while not on the job.

[UPDATE, 4:19 p.m.: Shortly after this post was published, Eagle emailed the Outpost to say, “[W]ith help from our Humboldt County Emergency Operations Center, we have set up onsite testing for Timber Ridge Eureka and McKinleyville beginning next week and will continue to test monthly. This is alongside strict protocols and new-hire testing.”]

Lenore Phillips, a caregiver at Cleo’s Home Care Facility in Eureka, said they’re not testing staff or residents either. “No, our residents haven’t left the facility since two weeks before [the shelter-in-place order]. And us as caregivers, we literally just go from work to home.” She said employees order food and have it delivered by DoorDash, though they do go out for groceries. “None of us have had symptoms,” Phillips said.

Health experts say it takes anywhere from two to 14 days for symptoms to manifest after exposure to COVID-19.

Ken Lende and his wife own and operate Cutten Care Home, a 15-bed residential care home just south of Eureka. He said they’re taking precautions such as not allowing visitors or delivery people, but they’re not getting themselves or residents tested for COVID-19. Asked if he’s considered it, Lende said, “Not yet. I haven’t had any symptoms. We really don’t go out.”

After thinking about it for a second he acknowledged that they do go out to get supplies, shop and buy gas. “We see a lot of people with masks,” Lende said, “[but] I’ve been seeing less and less of that.”

Other assisted living facility owners have chosen to test their staff. “We all did it last week,” said Amanda Mitchell, an administrator at Especially You Assisted Living in Eureka. Asked what motivated that decision she replied, “Because of what happened at Alder Bay.”

Susan Powell manages a staff of 13 employees at Humboldt House Lodge, another assisted living facility in Eureka. She had them all sign up and get tested at the Optum site last month and plans to have them get tested again on a monthly basis. “I’m a nurse and I don’t want any of my residents to be sick,” she said.

Several other local assisted living facilities did not return calls seeking comment.

Critics of California’s approach to testing at senior homes say the state has effectively shifted responsibility onto counties and the homes themselves. The likely result, according to the L.A. Times: “scores of individual, uncoordinated plans with no clear rules for how programs will work, what is required and who will pay.”

Earlier this week, Oregon officials finalized a plan to test all staff and residents at long-term care facilities in the state by October. Other states are also providing such universal testing.

We wrote to the California Department of Public Health to ask for more clarity on exactly how much authority county health officers like Dr. Frankovich have in this situation. Could she, in fact, mandate testing at the county’s assisted living facilities?

A spokesperson for the agency noted that California Health & Safety Code 120175 provides that when there’s a communicable disease outbreak within her jurisdiction, the health officer “shall take measures as may be necessary to prevent the spread of the disease or occurrence of additional cases.”

Does that include mandated testing? The spokesperson said no: “Local health officers have the ability to recommend testing at certain facilities, but … any resident or staff member has the right to decline.”

Frankovich closed her June 5 email to a concerned community member by reiterating that the county lacks any enforcement authority over assisted living facilities. “Our role is to offer assistance and guidance and help to make testing available to them,” she said. “Nearly all have been receptive to our help. This is a high risk, vulnerable population and one of our highest priorities.”