Updated: 9/19/2020, 3:06 p.m. There was very little evidence of proactive preparation or planning for COVID-19 at the Yukio Okutsu State Veterans Home, according to a report released late Friday. The 16-page report was compiled by a team of infectious disease experts from the Department of Veterans Affairs after an onsite assessment last week.
The report comes as four more deaths were reported today at the Hilo veterans home, bringing the death toll from COVID-19 to 22 at the nursing facility, the Hilo Medical Center reported.
The VA assessment concluded that many of the observed veteran home's practices seemed as if they were a result of recent changes. "Even though these are improvements, these are things that should have been in place from the pandemic onset and a major contributing factor towards the rapid spread. A basic understanding of segregation and workflow seemed to be lacking even approximately three weeks after first positive case."
The VA team recommended making some structural changes such as installing physical barriers (non-flammable plastic with zipper entries) in the COVID unit at each entrance to the hallways. This includes an ante chamber for nurses to don and doff gowns prior to entry and exit. The team also recommended assigning a dedicated staff member to assist with employee exposure risk assessments, audits of PPE and training.
Smaller recommendations were also included, such as placing additional hand sanitizers throughout the building, removing cloth chairs and paper signage from areas that need to be regularly cleaned, and issuing scrubs that are only used in the building.
In a written response attached to the VA report, Utah-based Avalon Health Care Group said it has been following the health guidance of the U.S. Centers for Disease Control and Prevention, Centers for Medicaid and Medicare Services and state health department.
Avalon said on receiving the VA assessment team's briefing on Sept. 13, it began to prioritize and implement the recommendations, even though it said many are "above and beyond CDC, CMS and State COVID-19 rules and guidance and are not common practice in long term care facilities, even during a COVID-19 outbreak."
Avalon also said some of the recommendations are hospital level (and above) interventions that a "very, very small number of nursing homes nationwide would have implemented or had the capability to implement."
The company said the veterans home already had more than 60 percent of the recommendations in place at the time of a Sept. 11 visit from the Department of Veterans Affairs.
Avalon appeared to take issue with the VA team not reviewing the nursing home's pandemic plan or training records. "Thus, while the VA may not have seen evidence of their noted observations, many of them had already been operationalized."
The company concluded by saying it is committed to "working side-by-side with the Department of Veterans Affairs in this fight against COVID-19."
Avalon Health Care Group also operates the Hale Nani Rehabilitation & Nursing Center in Makiki, where 5 residents have died of COVID, and the Avalon Care Center in Kalihi, where 3 residents have died.
Besides the Department of Veterans Affairs, Hawaii Emergency Management Agency and state Department of Health are also investigating the deaths and outbreak at the veterans home.
VA Report On State Veterans Home and Avalon Health Care Response