Elderly care facilities under pressure amid COVID surge

The Yomiuri Shimbun
The Health, Labor and Welfare Ministry

The number of infection clusters at elderly care facilities has hit all-time highs amid the seventh wave of the novel coronavirus pandemic.

In Okinawa Prefecture, where the occupancy rate of COVID-19 hospital beds has surpassed 90%, residents of care homes have died because they could not be hospitalized, including some whose symptoms were moderate.

After the sixth wave of the pandemic, the government established a system under which specialist teams are meant to be dispatched to elderly care facilities to provide medical support but the teams have not been able to keep up with the workload.

At a nursing home in Okinawa Prefecture in late July, 24 coronavirus patients were receiving treatment in a multipurpose space at the facility. All of the home’s 16 oxygen concentrators were hooked up to patients. “It was like a field hospital,” a 33-year-old nurse said.

Of the 84 residents at the nursing home and an affiliated facility, 59 were infected with the coronavirus at the time. Of the 24 patients with moderate symptoms who were receiving treatment in the multipurpose space, only three were subsequently admitted to hospitals.

Nursing home employees provided basic medical care based on the advice of the prefecture’s support team, which visited the facility four days after the first COVID-19 case had been detected.

Among the care home’s 55 staff, 22 tested positive for coronavirus. Infected employees were made to look after the facility’s COVID patients.

Six of the COVID patients with moderate symptoms died.

“The quality of medical care is inevitably lower at care facilities,” the nurse said. “It’s heartbreaking because hospitalization could have saved lives.”

Following an outbreak of the highly contagious omicron coronavirus variant in April, the Health, Labor and Welfare Ministry asked local governments to establish a system under which medical assistance teams are sent to facilities with infection clusters within 24 hours of detection.

However, a record 587 clusters were detected at nursing homes nationwide in the week ending Aug. 7 amid the seventh wave of the pandemic.

“The support system has collapsed,” said Takashi Nakamura, an acute care physician who leads a medical support team in Okinawa Prefecture.

The health ministry had also called for the use of a system that enables elderly care facilities to receive visits by doctors, and 94% of such facilities had utilized the system as of May, according to a ministry survey.

However, workers on the ground have said the system is inadequate.

A facility in Tokyo’s Tama district was visited several times by a doctor from a nearby clinic in late July when seven care home residents were infected with coronavirus, but the facility’s director said there was reluctance to contact the clinic every time there was a change in the patient’s condition. “It caused a great deal of anxiety,” the director said.

Since May, the Tokyo metropolitan government has prepared 289 hospital beds at three temporary medical facilities in Tokyo to provide treatment for elderly care-home residents who have been infected with the virus.

Each facility is staffed by doctors, nurses and rehabilitation staff, but as of Monday, only 41% of the beds were occupied with 119 patients receiving treatment.

“Patients with underlying medical conditions tend to prefer being treated at a hospital rather than a temporary medical facility,” a metropolitan government official said. “But hospitals are under pressure, so more patients have to be treated at temporary facilities,”

Hiroyuki Hirakawa, vice chairman of the Tokyo Medical Association, said: “Some elderly care facilities were unaware of the existence of temporary medical facilities in Tokyo. I want the metropolitan government to make sure the public knows about them and increase the number of such facilities.”