Lytton Gardens Assisted Living in Palo Alto has reported at least two cases of COVID-19 among its patients this month, parent company Covia Communities has confirmed.
One case involves a patient who was visiting family members at an outside apartment on Sept. 6 and tested positive four days later. That person remains quarantined in the family's apartment, according to a Sept. 15 letter to residents and families from Lytton Gardens, which was obtained by this news organization.
The other case was linked to an outside caregiver who came to the downtown facility to attend to a patient, Covia spokeswoman Laura Darling said. The caregiver, who was contracted through a Santa Clara County and state program, exposed a resident in the assisted living section to the coronavirus prior to Sept. 6, Darling said.
A third resident has also tested positive recently, but no details about the origin of that case are available, a spokesperson from the county's Emergency Operations Center told this news organization.
This second case brought to light a possible gap in testing involving external or contracted caregivers who come face to face with high-risk elderly patients when they are not in skilled nursing or nursing home settings, Darling said during a phone interview this week. As a result, Covia's administrators met on Sept. 21 to discuss a new monthly COVID-19 testing protocol for outside caregivers, which will begin on Oct. 1.
Using the nasal swab method (the polymerase chain reaction (PCR) antigen tests), Lytton regularly tests its own staff for the coronavirus on a rotating basis, with 20% tested each week. But the facility has not tested outside contractors who are hired through the state's and the county's In-Home Supportive Services program. Instead, Lytton relied on testing of those caregivers through the Public Health Department, she said.
Lytton screens everyone who comes through the door, including the contracted caregivers, through temperature checks and symptom screening. But health authorities estimate 40% of COVID-19 patients are asymptomatic, Darling noted.
In-Home Supportive Services is a federal, state and locally funded program that pays caregivers to help low- and extremely low-income disabled, blind and elderly residents to stay in their homes and avoid nursing home care. Lytton residents who live in assisted-living apartments would be eligible for such care. The program is administered through the county's Social Services Agency.
"We're very concerned about how we can adequately screen (contracted) caregivers," Darling said.
A spokesman for the Santa Clara County Emergency Operations Center, which addresses the county's COVID-19-related questions, said in an email that the Public Health Department requires that "any employee coming into the facility who has face-to-face contact, whether an employee or contractor, should be tested once a week until there is a two-week time period without a positive test for all residents and workers at the facility."
But that guideline only appears to apply to employees and contractors at facilities with active incidents of COVID-19. He did not provide an answer about how contractors coming to facilities without COVID-19 cases were being tested.
In a follow-up email on Friday, the county spokesman said paid caregivers arranged through IHSS are employees of the person receiving the care; they are not employees of the county.
"As essential workers, caregivers are able to access testing both through their healthcare provider or through the county's testing sites," which implies they may not have direct oversight by either Lytton or the county.
A state Department of Public Health guideline, which identifies protocols for skilled-nursing facilities — a higher care level for often frailer patients — requires baseline testing of patients and health care staff and surveillance testing of 25% of staff weekly to ensure that all staff members are tested once a month. An email request for information to the department regarding testing of contracted caregivers was not answered as of Wednesday night.
The Centers for Medicare and Medicaid Services, however, recommends that operators of assisted-living facilities consider using the same guidelines as for nursing homes. A memorandum recommends "all nursing home staff (including volunteers and vendors who are in the facility on a weekly basis) to receive a single baseline COVID-19 test, with re-testing of all staff continuing every week," according to the Quality, Safety and Oversight Group at the agency's Center for Clinical Standards and Quality.
State and local leaders may adjust the requirement for weekly testing of staff based on data about the circulation of the virus in their community, with areas of higher prevalence having the weekly tests and those with lower prevalence having less frequent testing, according to the memorandum.
Lytton currently tests its own skilled-nursing staff once each week.
Local senior-care facilities Vi at Palo Alto and Channing House did not respond to requests regarding how they monitor outside contractors. A spokesperson for Palo Alto Commons declined to be interviewed on the record.
On Tuesday, an Emergency Operations Center spokesman said the county Public Health Department has tested Lytton staff and residents in response to the current cases and will continue to test them weekly until there is a two-week time period with no positive tests. He didn't say if testing for contracted workers is included.
He added that Lytton had three residents who recently tested positive for the coronavirus, but no staff members were found to be infected.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.