Iowa is one of several states, mostly in the Midwest, where coronavirus cases in nursing homes are rising faster than in nursing homes nationally.
While national cases in nursing home residents and staff rose by 8% between September and October, the numbers in Iowa more than doubled in that time, according to the AARP.
Hospitalizations are also climbing. Iowa is one of a handful of states with the highest number of people hospitalized per million residents.
Dr. Glenn Hurst, who is the medical director at seven nursing homes in and around Council Bluffs in western Iowa, says nursing homes and hospitals both play a part.
Hospitalized patients typically need to do rehabilitation at a nursing home after they leave the hospital, he says. Sometimes they're there for weeks.
"If your hospitals are bottlenecked and you open up that bottleneck with more beds or field hospitals or however you do that, but you don't open the bottleneck at the nursing home, and we're just going to fill up all those beds in the hospital and everybody will be stuck," he tells Rachel Martin on Morning Edition.
In an effort to control the virus in Iowa nursing homes, visitors have been strictly limited for months.
Here are excerpts of the interview:
So what needs to happen?
We have to be thinking about the patients who don't have COVID and protecting them. And that's what I have been doing with nursing homes in our county. This is a frail population. Forty-eight percent of all deaths in Iowa from COVID are people from nursing homes. ...
We've got to prevent the condition from coming in to the facility and infecting those people. But at the same time, we've got to be able to provide rehabilitation care for those patients who did have COVID and were hospitalized and ventilated and need some rehab time.
Back in March, we looked at trying to open a nursing home that had been closed in the community as a COVID space. It would save us staffing issues. It would provide beds and appropriate care. But we didn't get the support from the government to do that.
This is largely a financial issue?
Money could solve a lot of this problem in terms of space to take care of patients. Here in western Iowa we're also dealing with a staffing problem. There just aren't enough nurses and [certified nursing assistants] who are able and willing to do this work. We've got to train people up quickly.
How are you managing the expectations of residents who, especially around the holidays, will expect or hope to be able to connect with family?
Residents, family, staff, everybody is on an emotional roller coaster through this crisis. We take care of these people on a daily basis. We know their likes, their senses of humor, their kindness towards one another and the relationships with one another. And we value that in the same way that we value the relationships with their families and the same way we value relationships with one another.
And the isolation absolutely has a negative effect on that family relationship. But I had a facility that had an outbreak and six patients died. And I assure you that the pain that those patients suffered, losing their friends that they see on a daily basis, and trying to recover through that whole outbreak process was far greater trauma than the separations that we're seeing with family that we do mitigate with window visits and with assisting them using the computer and online technology to have some face-to-face time. The holidays will be difficult.
Taylor Haney and Catherine Whelan produced and edited the audio interview.