Sick Report

In January, the staff at Providence ElderPlace Glendoveer, a residential care facility in Northeast Portland, responded with speed when patients at the 84-bed center started showing signs of norovirus infection.

They had seen this virulent bug before: The facility had been hit with norovirus once a year for the previous three years—77 cases in all, according to newly released state records.

Providence officials say this year's illness (although listed as norovirus in a state records) turned out be another kind of bug. But the alarm it set off indicates the threat norovirus poses to facilities that care for the elderly.

"We take this very seriously," says Providence spokesman Gary Walker. "We have protocols to respond right away, and we report it immediately."

Norovirus is highly contagious and triggers severe diarrhea and vomiting. It can be spread anywhere—schools, workplaces, restaurants. The virus is usually passed through fecal matter that contaminates food, surfaces and unwashed hands, and even lurks in the air around people who are sick.

It's not unusual for a nursing home or other long-term care center to get hit with norovirus. It's suspected in sickening more than 23,000 residents in 365 Oregon long-term care facilities in the past decade, according to a state report to be released this week and obtained by WW.

But the records also show 48 facilities have seen more than one norovirus outbreak in the past decade, and 22 have reported repeated outbreaks since 2011.

State health officials say the number of outbreaks at a particular facility doesn't mean there's a problem there. They say many factors—including the type of facility, its size, and the simple fact that norovirus is difficult to keep out—can play a role.

"The reporting largely indicates that [long-term care facilities] are taking it seriously and that they did something about [the outbreak]," says Dr. Paul Cieslak, manager of the Oregon Public Health Division's communicable diseases section.

Norovirus has become more prevalent in recent years, and so have warnings about how to avoid it.

In the past, state officials have disclosed names of other public places—such as restaurants—tied to norovirus outbreaks. But they have resisted naming nursing homes, assisted-living centers and other long-term care facilities. They have claimed the facilities names were not subject to release under the Oregon Public Records Law, and that disclosing the names would discourage long-term care centers from reporting outbreaks.

But this week, the Oregon Health Authority, following a series of requests by WW, will publish details of more than 1,000 communicable disease outbreaks in the past decade and name the care facilities that reported them. Seven out of 10 outbreaks were caused by norovirus.

"Our concern in public health practice was that if we could not get accurate information about outbreaks, we'd be less able to protect the public," says Tom Eversole, administrator of the Center for Public Health Practice at the state health authority.

"But the question really prompted us to look at that. We decided to go ahead and see if we could do this and also maintain good sources."

But some public health officials say disclosing detailed outbreak information could distract or mislead people who are trying to weigh the quality of long-term care facilities.

"It's important when you seek supportive housing for aging family members that you get information on staffing, bedsores and hospitalization rates—all far more important than reported disease outbreaks," says Dr. Paul Lewis, deputy tri-county health officer.

Facility administrators concede norovirus is almost impossible to keep out of long-term care centers, with visitors and residents coming and going every day.

"It is a constant battle to keep it out of the facility," says Deborah Nedelcove, vice president of risk management and chief compliance officer at Avamere Health Services, which operates nearly 40 care and residential centers in the Pacific Northwest. 

Two Avamere facilities have seen a series of recent outbreaks: Avamere Crestview in Southwest Portland, which saw outbreaks in January and April, and Avamere Rehabilitation of Beaverton, with an outbreak in 2011 and another this year.

The Avamere Crestview outbreaks were contained to fewer than 10 residents each—a relatively low number, compared to outbreaks at other facilities. "We've had to become very skilled at dealing with it," Nedelcove says.

Eversole says the state health authority plans to update public reports of outbreaks on a semi-regular basis.

Joe Greenman, legal counsel for the Oregon Health Care Association, a trade group for nursing homes and other care centers, says consumers could learn a lot about a facility if they knew more about its track record.

"An outbreak isn't the sole fault of the [long-term care facililty]," Greenman says. "If you're a consumer, you'd be more interested in knowing how they responded to an outbreak than whether they had one or not."

Advocates for the elderly say such information should be readily available on a regular basis.

"With norovirus, you can find out about restaurants. You ought to be able to find out about nursing homes,” says Mary Jaeger, Oregon’s long-term care ombudswoman. 

"People making decisions about where they might put a loved one should have this information, " she adds. "It's just one piece of information, but someone could find it an important one.” 

WWeek 2015