Coronavirus cases in Texas nursing homes more than doubled in July. Families say the state still isn't testing enough.

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COVID-19 infections have exploded in Texas nursing homes this month, with 8,291 confirmed cases through Monday — four times more than the number of cases recorded in all of June, according to the state’s health agency.

More than three quarters of Texas’ 1,215 nursing homes have reported at least one coronavirus case since the beginning of the pandemic, up from just over half at the end of June.

It’s the same story in the state’s assisted living facilities, which reported 924 cases to the Texas Department of State Health Services through Monday, compared with 267 in June.

Of Texas’ 5,489 deaths, more than one-third have been nursing home residents. Nationally, more than 40% of COVID-19 deaths are linked to senior-care centers, according to a New York Times analysis.

The dramatic increase in the number of new COVID-19 cases across Texas is what has led to the surge in nursing homes, said Chris Van Deusen, a spokesperson for the Texas Department of State Health Services.

On Monday, the Texas Health and Human Services Commission released its first list of COVID-19 cases and deaths with details about individual Texas nursing homes — after insisting for months that the information was not subject to public disclosure because of privacy laws. The state attorney general’s office recently ruled that the agency is required to release the information.

Texas initially required all nursing home residents and staff members to be tested, but it has since switched to less sweeping, targeted testing.

By June 11, Texas had completed an initial, monthlong round of mandatory testing in all Texas nursing facilities. On July 10, a new round of targeted testing was announced in partnership with a CVS Health company called Omnicare, with a goal of processing 100,000 tests in the first month. Health and Human Services Commission inspectors are identifying facilities with outbreaks that are in need of testing, said Kelli Weldon, press officer for HHSC. Individual facilities can also ask for testing.

So far in July, the state has tested residents and staff members at 148 facilities, with 93 more facilities scheduled through the end of the month, Weldon said. That’s about 7% of all Texas long-term care facilities, including nursing homes and assisted-living facilities.

Weldon said testing is conducted at facilities with at least one confirmed coronavirus case. This testing can be requested from the facilities or through the Quick Reaction Force testing teams operated in collaboration with the Texas Division of Emergency Management, which can complete a testing “mission” within two to four days of a request, TDEM spokesman Seth Christensen said.

New federal guidelines recommend weekly testing for all nursing home staff members in states that have seen COVID-19 surges, marked by 5% of coronavirus tests coming back positive — a threshold Texas has exceeded almost every day since June 1.

“I don’t have any evidence to say that currently, weekly testing of staff is being implemented,” said Alexa Schoeman, deputy state ombudsman in HHSC’s Office of the Long-Term Care Ombudsman. The state’s latest round of targeted testing in nursing homes is “better late than never,” she added; “however, I think [starting it] sooner would probably have been beneficial.”

Austin resident Cissy Sanders said her 70-year-old mother, who lives at Riverside Nursing and Rehabilitation Center in Austin, tested negative for the virus April 20 and has been tested once more since then. State data shows that 69 residents and 32 employees at the facility were infected between March and July 13, and 14 residents have died from COVID-19.

In an email, Regency Integrated Health Services, the company that manages Riverside Nursing and Rehabilitation Center, acknowledged that residents and staff tested positive for the virus “in the early days of the pandemic” but declined to comment further “due to privacy laws.” A spokesperson said the facility is following all federal guidelines, screening staff and medical professionals before they enter the buildings.

Sanders said two tests for her mother in three months isn’t nearly enough. “The only way that you’re going to win this race is test, test, test,” she said.

She has turned her frustration into action, writing to several elected officials and health authorities, including the head of the Centers for Medicare and Medicaid Services.

“You know those families telling their goodbyes to their loved one over the phone while their loved one dies in a hospital bed? I refuse to do that. I refuse,” she said. “I will not stand by and watch my mother contract the virus and die because of public health and elected officials’ incompetence.”

Genny Lutzel, whose mother is a nursing home resident in Dallas County, is adamant that testing at nursing homes and similar facilities needs to be more regular.

“I know my mom has been tested once, but that’s it. We need rapid testing and we need it now,” she said. The ability to reopen nursing homes — which have been closed to visitors since mid-March — depends on it, Lutzel said.

The state has been slow to put coronavirus protections in place at nursing homes and assisted living facilities, said Tina Tran, the state director of the AARP. She says the AARP has heard from families that still are not able to get information in a timely manner about active cases in Texas facilities.

Last week, the federal Centers for Medicare and Medicaid Services committed to sending testing devices to nursing homes. The agency has allocated 57 of those devices so far to Texas facilities that have reported at least three confirmed COVID-19 cases, one case among their staff or one death in the previous week.

But with more than 1,200 nursing homes and 2,000 assisted-living facilities in Texas, 57 devices are “not nearly enough,” Tran said.

Kevin Warren, president and CEO of the Texas Health Care Association, which represents providers, said he hopes that the combination of testing by the state and the devices from the federal government “will close that gap on the need for quick and rapid results.”

“We have to have some form of consistent and ongoing testing process for both staff and residents,” he said, adding that his organization has asked the state to provide money to nursing homes to buy more protective equipment, hire more staff and alleviate the financial burden of the pandemic.

In a survey by the American Health Care Association and National Center for Assisted Living, 64% of the surveyed providers said it was taking at least two to four days to get test results, and of those, 24% said it took five days or more.

“It is becoming a major concern for providers,” the groups said in a press release.

Warren said nursing homes “are doing everything they know to do to fight a virus we don’t see.”

Correction: On July 30, the state said an “automation error” caused approximately 225 deaths to be incorrectly added to the overall death count; a subsequent quality check by Department of State Health Services epidemiologists revealed COVID-19 was not the direct cause of death in these cases. We updated the cumulative numbers for July 27-29 to account for this error.

Disclosure: AARP, the Texas Health Care Association and The New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.