WESTERLY — Two of four nursing homes in the town are struggling after dozens of their residents tested positive for COVID-19 in recent weeks. The other two facilities have dealt with the virus but so far at a lower volume.

The trend at both the Apple Rehab Clipper facility on Post Road and Apple Rehab Watch Hill on Watch Hill Road mirrors the experience of nursing homes throughout the state, where case numbers are rivaling those from an earlier wave of the pandemic in the spring. The state Department of Health reported at least 475 new cases in nursing homes in the last two weeks, according to statistics that were last updated Wednesday.

Apple Rehab Clipper Administrator Cheryl Picard confirmed on Thursday that 37 of the facility's current 39 residents tested positive for the virus recently. Apple Rehab Watch Hill, according to DOH statistics, had 20 to 24 new resident cases in the last two weeks. The two facilities are owned by Apple Rehab Corporate, a Connecticut-based corporation that operates the two facilities in Rhode Island and 21 nursing homes in Connecticut.

The cases at Apple Rehab Clipper have all been traced to a resident who came to the facility from Rhode Island Hospital during the last week of November. Picard said the resident tested negative twice before leaving the hospital but was tested soon after arriving to the Westerly facility, and the results, two days later, showed the patient was positive for the virus.

"We were all taken aback by this. We had been COVID free and worked very diligently to remain so," Picard said. "Most of us go home after work and never leave."

All new residents, including the one who first tested positive at the facility in late November are treated "as if they are COVID positive" and isolated from other residents when they first arrive regardless of testing status, Picard said.

Five days after the first patient tested positive other residents started getting sick and testing positive, Picard said. In general, Picard said, most of the residents who contracted the virus have had flu-like symptoms, fever and body aches. But at least one of the residents had to be hospitalized and was being treated on a ventilator at Westerly Hospital as of Thursday, according to the resident's son.

The facility's experience has brought the reality of the pandemic into clearer focus, Picard said.

"We have the most vulnerable population... We've all seen it on the news and now we know firsthand how quickly it can spread," Picard said.

Nursing homes are under pressure, Picard said, to accept new residents because hospitals are filling up with COVID patients. She said it might be necessary for DOH to revise its testing guidelines for patients moving from hospitals to long-term facilities.

Joseph Wendelken, a DOH spokesman, said the department's guidance changed from a test-based approach to a symptom-based approach. Under the test-based approach, DOH recommended two negative tests 24 hours apart for a COVID-positive person to discontinue isolation and go to a long-term care facility. Under the symptom-based approach, DOH recommends at least 10 days must pass since symptoms appeared or 20 days for immunocompromised patients or those who are severely ill, at least 24 hours have passed without a fever without use of medications, and symptoms have improved.

The reason for the change was that COVID-19-positive people can persistently test positive for months, which is due to shedding of dead virus. Viable or live virus has not been demonstrated after 10 days or after 20 days in people with compromised immune systems, he said.

For people who were not known to have COVID-19, DOH previously recommended a test right before discharge. For people not known to have COVID, this would be a second test, since hospitals were testing upon admission. The DOH recommended moving away from a second test requirement before discharging back to a long-term care facility and focusing more on symptom monitoring. The DOH guidance is for people to quarantine for 14 days after entering a long-term care facility from a hospital, no matter how many times they have been tested.

"Quarantining new residents has always been the most effective way to prevent the introduction of COVID-19 into facilities by new residents," Wendelken said. "We know that a person can have a negative test before being discharged but test positive at any point over the next 14 days."

Unlike other nursing homes, Picard said, her facility has not experienced large numbers of workers leaving their jobs because of safety concerns related to the pandemic.

"This is the best group of people I have ever worked with. ... The people who work here care deeply about the people who live here. We call them residents because they live here. We treat them like they are part of our family. It's difficult. When one of them gets sick, it's like our own grandmother is going through this," Picard said.

There is a discrepancy between the number of positive cases reported by Picard and those reported on the DOH website. Wendelken, the DOH spokesman, said the department reports weekly.

"Depending on the date of diagnosis, those cases may get counted with the next week’s data," he said.

Both the Apple Rehab Clipper facility and Apple Rehab of Watch Hill appear to have had the majority of COVID-19 cases appear within the past few weeks, according to the DOH website.

Nicki Cicogna, the administrator at Apple Rehab Watch Hill, declined to comment for this article and referred questions to the corporation's Connecticut office. Karen Donorfio, the corporation's vice president of operations, did not return a message seeking comment for this article.

The daughter of an elderly resident at Apple Rehab Watch Hill said her parent recently contracted COVID-19 after another resident of the facility came down with the virus shortly after Thanksgiving. The woman was granted anonymity because she is concerned about her relative's treatment. She said her relative entered the facility about two months ago.

Prior to her relative testing positive, the woman said care for her relative at the facility had been good.

"The care has been phenomenal, but things clearly got out of hand," the woman said.

The woman said the most recent information her family received was that at least nine residents of the facility had tested positive for the virus but the DOH statistics show a higher number.

Two other nursing homes in the town — Westerly Health Center and Royal of Westerly Nursing Center — have been more fortunate, with fewer residents testing positive for the virus since March 1.

Westerly Health Center has largely avoided the virus. Since March 1, the facility has had no more than four residents test positive and fewer than four within DOH's most recent two-week reporting period. Jennifer Campbell, the center's administrator, attributed the center's positive outcomes to location.

"I think a lot of it is geography. Our community, so far, has not been as bad as the urban centers, and our staff tend to live locally," Campbell said.

Westerly Hospital and South Country Hospital, the two primary sources of the center's residents, have both worked closely with the center and prioritized testing to prevent introduction of the virus by new residents into the center, Campbell said.

"They've been really great about ensuring very current testing," Campbell said.

Campbell also spoke highly of support DOH has provided in the form of personal protective equipment for staff and input from a congregate care support team.

The center, Campbell said, is following both DOH guidelines and guidelines set out by the federal Centers for Disease Control. New residents are quarantined in private rooms for 14 days upon arrival, and staff, who are dedicated exclusively to new residents, use a higher level of precaution, she said.

If new residents do not show signs of the virus during the first 14 days, they are moved to a regular unit where vital signs and overall well being are monitored throughout the day.

"If something seems off we then take full precautions, isolate the resident and test them," Campbell said.

A message seeking comment for this article from staff at Royal of Westerly Nursing Center was not returned. According to the DOH website, Royal has had no more than 14 residents test positive for the virus since March 1 and none within the last 14-day reporting period.

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