JULY 17, 2020 by Kristof Stremikis, director COVID-19 TRACKING POLL SERIES CHCF Market Analysis and Insight Most Frontline Staff at California Nursing Homes See Infections at Work S eventy-six percent of certified nurse assistants and they work in facilities with a large proportion of Black other frontline employees at California skilled nurs- and Latino residents report known or suspected cases ing facilities say they have had known or suspected among staff. COVID-19 cases among staff at their facility, according to a statewide survey from CHCF and Truth on Call (see Sixty percent of respondents statewide say their facility Figure 1, page 2). These numbers are higher in facilities has had known or suspected COVID-19 cases among located in Los Angeles County and in those with a major- residents. Among those working in Los Angeles County, ity of residents who are Black or Latino. 76% report infections among their facility’s residents com- pared to 50% of those who work elsewhere in California. Again, this is consistent with the CDPH data. Seventy-six percent of certified nurse assistants and other frontline Sixty-six percent of those who work in facilities with half or employees at California skilled nursing more Black or Latino residents report cases among resi- dents compared to 50% of respondents where less than facilities say they have had known or half of residents are Black or Latino. These poll findings suspected COVID-19 cases among are in line with other data showing that the disease is hav- ing a disproportionate impact on people who are Black staff at their facility. or Latino. These higher rates of COVID-19 are occurring despite the fact that Black and Latino Californians report The survey, conducted June 5 – July 12, 2020, among 353 compliance with prevention measures — like wearing employees at California skilled nursing facilities, included 285 certified nurse assistants, who typically perform the most patient care tasks in nursing homes. Other survey COVID-19 Tracking Poll Series participants included people in food service, janitorial To help Californians and state policymakers under- staff, housekeeping, and laundry. Questions were asked stand evolving demands on the state’s health care either in English or Spanish. SEIU Local 2015, which rep- system during the COVID-19 pandemic, CHCF is resents long-term care workers, sent the poll to its 20,000 working with survey firms on two fronts. CHCF and members employed by skilled nursing facilities on behalf global survey firm Ipsos are assessing residents’ desire of CHCF and Truth on Call. for COVID-19 testing and their access to health care services. CHCF and Truth on Call, a physician market- research firm, are surveying different types of health Eighty-nine percent of respondents in Los Angeles care providers about availability of testing, personal County report known or suspected cases among staff. protective equipment, and their experience in Califor- Sixty-nine percent of people who work at a California nia’s health care delivery system. nursing home outside Los Angeles County report staff Download the charts and data for your own presen- cases of COVID-19. These findings are consistent with tations and analyses. Get all the results from CHCF’s data reported by the California Department of Public surveys of California’s health care providers and the Health (CDPH). In addition, 81% of those who say general public in this collection. Figure 1. COVID-19 Cases Observed by Certified Nurse Assistants and Frontline Staff at Skilled Nursing Facilities in California Source: CHCF / Truth on Call survey of certified nurse assistants and frontline staff at skilled nursing facilities in California, June 5 – July 12, 2020. California Health Care Foundation www.chcf.org 2 masks, handwashing, and social distancing — at above- More than 9 in 10 respondents are worried about con- average rates. tracting the disease while working, with 51% “extremely concerned,”28% “very concerned,” and 14% “some- Nearly half — 47% — of those surveyed say they think what concerned.” The rate of concern is similar whether that COVID-19 is spreading among residents and staff respondents worked in Los Angeles County or elsewhere at their facility (see Figure 2). The rate is slightly higher in the state. Fifty-five percent of respondents in facilities for those who work in Los Angeles County, where 54% where half or more residents are Black or Latino report believe COVID-19 is spreading at their facility compared being extremely concerned about contracting the virus to 42% of those who work at a nursing home elsewhere while working, compared to 45% of those in facilities in California. where less than half the residents are Black or Latino. Figure 2. Concerns About COVID-19, Certified Nurse Assistants and Frontline Staff at Skilled Nursing Facilities in California Source: CHCF / Truth on Call survey of certified nurse assistants and frontline staff at skilled nursing facilities in California, June 5 – July 12, 2020. Most Frontline Staff at California Nursing Homes See Infections at Work www.chcf.org 3 More than 8 in 10 respondents say both patients and A key strategy to containing a COVID-19 outbreak in a staff are being tested for COVID-19 when needed at nursing home is to quarantine residents who may have least “most of the time” (see Figure 3). Eighty-two per- been exposed and to “cohort,” or group together, those cent of respondents reported residents were generally who have the illness. When asked if their facility could tested as needed compared to 85% who said staff were quarantine or cohort residents, 88% say their facility has generally tested as needed. that capability. While 77% report adequate personal protective equip- Nearly three in four respondents (74%) say they are “very ment (PPE) at their facility, 23% say PPE is not adequate confident” or “somewhat confident” in their employer’s (see Figure 4, page 5). There are not substantial dif- ability to respond to current or future COVID-19 infec- ferences in PPE availability by geography or facility tions among residents or staff, while one in four say they demographics. are not confident. Figure 3. COVID-19 Testing, Certified Nurse Assistants and Frontline Staff at Skilled Nursing Facilities in California Source: CHCF / Truth on Call survey of certified nurse assistants and frontline staff at skilled nursing facilities in California, June 5 – July 12, 2020. California Health Care Foundation www.chcf.org 4 Figure 4. COVID-19 Observations by Certified Nurse Assistants and Frontline Staff at Skilled Nursing Facilities in California Source: CHCF / Truth on Call survey of certified nurse assistants and frontline staff at skilled nursing facilities in California, June 5 – July 12, 2020. Most Frontline Staff at California Nursing Homes See Infections at Work www.chcf.org 5 Methodology About the Foundation This survey was conducted online with Truth on Call, a The California Health Care Foundation is dedicated to health care market research firm. The study consisted advancing meaningful, measurable improvements in the of 353 employees at California skilled nursing facilities. way the health care delivery system provides care to the Truth on Call is a division of Slingshot Insights. Responses people of California, particularly those with low incomes were collected June 5 – July 12, 2020. SEIU Local 2015 and those whose needs are not well served by the status assisted in this survey by soliciting responses over email quo. We work to ensure that people have access to the from its membership who work in skilled nursing facilities care they need, when they need it, at a price they can in California. afford. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemak- ers to create a more responsive, patient-centered health care system. For more information, visit www.chcf.org. California Health Care Foundation www.chcf.org 6