Florida Trend | Florida's Business Authority

How Florida's long-term care facilities are managing the COVID-19 virus

In mid-March, as Florida began to see an uptick in COVID-19 cases, Gov. Ron DeSantis issued a temporary ban on visitors to nursing homes and assisted living facilities, where roughly 155,000 Floridians live. At the time, the state had 77 COVID cases, but it was already becoming clear that the virus hit the elderly and infirm harder than younger, healthier people. Weeks earlier, the virus had ravaged a Seattle-area nursing home, killing dozens of residents. Florida officials worried the same would happen here if they didn’t take steps to protect its most vulnerable citizens.

During a news conference announcing the changes, Mary Mayhew, secretary of the state’s Agency for Health Care Administration (AHCA), noted the facilities weren’t equipped to deal with virulent respiratory pathogens in the same way that hospitals were, nor were they expected to. “They do not have negative pressure rooms. They do not have skilled staff ready to use N95 masks. That is above and beyond what is today expected of them for infection prevention,” Mayhew said — but she urged them to be vigilant. “We can’t let this infection into a facility for our elderly, into our longterm care residential programs.”

The state took other steps. It required daily temperature checks for staff and workers coming and going from facilities. Staff were instructed to wear personal protective equipment (PPE), and the Division of Emergency Management helped facilities shore up short supplies as best it could. When infections popped up, the state sent in medical “strike teams” backed by National Guard members to test staff and residents. The Veterans Administration dispatched 15 clinical support teams to assist with infection control at 67 facilities.

Florida officials also adopted a strategy of transferring COVID-positive residents out of facilities if they couldn’t be isolated — and prohibited hospitals from sending COVID-positive patients back, unless the facility has a COVIDonly isolation unit. The decision was in stark contrast to directives in several northern states, including New York, which until early May required nursing homes to take recovering COVID-19 patients. Many have blamed the policy for spreading COVID and contributing to 6,300 nursing home deaths in New York, though a New York State Department of Health analysis concluded that the fatalities were more likely “related to infected nursing home staff,” not transfers, based upon the timing of when the deaths occurred.

Whatever the case, the industry in Florida can claim some success in keeping COVID-19 at bay. Although 431 facilities had reported at least one COVID fatality as of July, more than 900 had reported zero deaths.

Avante, an Orlando-based company that manages 12 skilled nursing facilities and two assisted living facilities in Florida, reported nine COVID-related deaths — seven at its Boca Raton facility and one at its Lake Worth location and one at its Orlando facility. But as of late July, not a single resident in any of its other facilities had died from COVID.

Kimberly Biegasiewicz, vice president of clinical services for Avante, credits strong state leadership by Mayhew and DeSantis. She also says her company’s “prudent system” of planning and communication made a difference. “We had our facilities on a daily call since February, seven days a week, with our facility administrators and directors of nursing requiring updates on status as far as residents (symptoms), staff call outs and supplies — to the point that administrators were counting every piece of (PPE) supply in their facility,” Biegasiewicz says.

When facilities ran short, she says, the corporate office would send supplies over. The company also made sure it could separate residents who were sick from those who were well. Today, the company is helping to manage a COVIDonly isolation facility in Miami and created COVID-19 dedicated isolation units at its facilities in Boca Raton, Melbourne and Orlando.

But when facilities failed to keep the virus out, the toll often was horrendous. In June, Hialeah Nursing and Rehabilitation Center, a 276-bed facility just a few miles from Hialeah Hospital, reported a spike in cases — 169 residents and 72 staff tested positive for COVID. By July, 52 residents had died from COVID.

In Pinellas County, 28 residents at Seminole Pavilion Rehabilitation & Nursing Services died from the virus. Five miles away, at the Gulf Shore Care Center in Pinellas Park, 23 residents and one staff member died — and 10 miles to the east in St. Petersburg, Bon Secours Maria Manor Nursing Care Center reported 21 fatalities. The 72 deaths at thethree facilities made up 16% of the 460 total deaths in Pinellas County.

As of Aug. 4, at least 3,155 residents of Florida long-term care facilities had died from the virus — accounting for about 45% of the state’s deaths so far, according to data posted by the Florida Department of Health. As of the same date, 11,682 (3.5%) residents and staff tested positive for the virus, up 130% from one month earlier.

FLORIDA TREND’S examination of available data indicates little linkage between how well a facility had performed on state and federal inspections and the likelihood that it would experience an outbreak of COVID-19. Of the 30 facilities with the greatest number of fatalities, 15 are on the state’s Nursing Home Watch List, and 15 are not. The state's watch list tracks facilities that are operating under bankruptcy protection or have been on a “conditional” licensing status during the past 30 months based on inspection results.

There’s even less of a link when looking at federal ratings data: Of the 30 hardest hit facilities, only 10 scored “below average” or “much below average” on CMS’ quality rating system, which rates facilities in terms of health inspections, staffing and other quality measures. The Hialeah Nursing and Rehabilitation Center — which tops the list of elder care facilities with deadly outbreaks — had earned a three-star “average” rating on health inspections and an overall “above average,” four-star rating from CMS.

In other words, some high-performing nursing homes did well at keeping their residents safe; others did poorly. Some homes with a record of deficiencies did well, others poorly. The size of the facility didn’t seem to have much bearing either. Facilities with more residents had more cases and deaths. But an examination of 100 Florida nursing homes with the highest rate of deaths per 1,000 residents showed significant variation in facility size: They ranged from 27 beds to 276 beds and averaged about 130 beds. Zero-death facilities also ran the gamut from 18 beds to 391 beds and averaged about 114 beds, an analysis of CMS data showed.

Overall, outbreaks in nursing homes largely followed the same path as spikes of COVID-19 in the general population, with the largest number of deaths in South Florida. For the most part, outbreaks occurred in facilities where community spread is high.

Success at keeping the virus from spreading through a nursing home seems largely to come down to local management decisions and practices. Fair Havens Center, a Miami Springs nursing home with 51 COVID-19 fatalities, had a poor record even before COVID-19 hit. A February inspection by the Department of Health and Human Services detailed multiple health violations — about double the number of a typical inspection — and the home was one of 197 facilities as of late July on the state's watch list.

Following a complaint in early May, state inspectors found that the Fair Havens staff were not isolating residents who had COVID-19, failing to use PPE and not tracking infections within the facility. Mayhew issued an emergency order on May 8 halting admissions to the facility.

The Issues

The pandemic has complicated a number of longstanding issues in the industry.

Low Wages and Staffing Shortages: Registered nurses earn about $33 an hour, and licensed practical nurses earn about $22 an hour in Florida. Certified nursing assistants (CNAs) — the workhorses in nursing homes and assisted living facilities — earn about $11.80 an hour on average in Florida, according to the U.S. Bureau of Labor Statistics. CNAs say starting salaries can be even lower — $9.65 to $10.40 an hour, depending on the company.

To make ends meet, many aides work double or triple shifts. As demand for their services has increased during the pandemic, some have quit their jobs for better-paying gigs with staffing agencies, which pay anywhere from $16 to $21 an hour. Ironically, the staffing agencies have assigned some of those aides to the same facilities they left. Aides may also pick up shifts at other facilities on an asneeded basis, referred to as PRNs.

The churn worries caregivers such as Amy Runkle, who works full time at a nursing home in Venice. ‘We’re not getting a lot of full-time people now. We’re just getting the PRNs that work multiple jobs. They work here and down the street and down a little further because there are so many nursing homes,” Runkle says. She’s concerned about them potentially spreading the virus among facilities ("On the Front Lines," page 97).

Kristen Knapp, a spokesperson for the Florida Health Care Association, a trade group that represents Florida’s nursing homes and long-term care facilities, says the industry has been dealing with a staffing shortage for a while. Turnover is high. The last time it conducted a survey in 2016, the now-defunct Florida Center for Nursing at the University of Central Florida reported a 100% rate of turnover for direct care nurses (RNs and LPNs) at skilled nursing centers. The same survey estimated that half of CNAs in long-term care facilities quit each year — and Knapp says it’s hard to compete with other business sectors, such as retail, which pay better.

"We already had a workforce crisis before this pandemic began. There was a shortage of workers — nurses are retiring, and we were competing against the Targets and Amazon warehouses of the world who could frankly pay a more competitive wage,” Knapp says.

Once the pandemic hit, it got worse. Staff who became sick couldn’t come in, and some never returned. School closures and a lack of day care added to the problem, and the industry’s pipeline of new employees was cut off when testing sites for CNA exams were closed amid the shutdown. The test sites recently reopened, but there’s still a backlog of test takers.

In early July, 68 Florida nursing homes reported a shortage of aides to the Centers for Disease Control’s National Healthcare Safety Network system, and 57 facilities said they were short on nurses; 29 facilities reported a shortage of three of more categories of workers, including aides, nurses, other clinical staff and other employees, such as housekeepers.

In the meantime, the Agency for Health Care Administration is allowing skilled nursing facilities to hire a new category of direct care employees known as personal care attendants, or PCAs, to perform some of the duties usually done by CNAs. They can change bed linens, check temperatures and feed residents, for instance, but can’t help them with toileting.

Andi Clark, chief nursing officer for Maitland-based Consulate Health Care, which operates 82 facilities in Florida, told Skilled Nursing News in an April interview that the chain was making a push to try to hire nurses and caregivers laid off from hospitals and clinics during lockdowns. Clark also said the chain was having all its staff — including administrators — go through patient care assistant training. “Activity directors, social workers, HR folks, business office — just that little extra help on days when we can use a little bit of extra help, especially around some of the things that take up a CNA’s time,” she told the industry news site.

Some facilities are also offering “hero” or “hazard” pay and overtime to try to attract and retain employees. But Knapp doesn’t think the industry can pay its way out of the staffing shortage. “We’re 60% funded by Medicaid, so we don’t have the ability (to bump pay) — our rates are set by the state, and Medicaid already underfunds the cost of care,” she says.

While DeSantis approved a $105 million Medicaid increase for nursing center care in the $92.2-billion budget he recently signed, it’s not clear how much will trickle down to individual employees’ pocketbooks. “We were seeing reimbursements at 2016 rates, so this funding increase is really our inflationary cost to get us up to today’s payment level,” Knapp says.

Infection Control: As with pay and staffing, infection control was a challenge pre-COVID. More than 600 of 699 nursing homes surveyed between 2013 and 2017 in Florida were found to have infection prevention and control deficiencies, according to a May 2020 report from the U.S. Government Accountability Office. Many were repeat offenders: 144 were cited in multiple non-consecutive years and 283 were cited in multiple consecutive years. Problems range from a failure to wash hands to not isolating sick residents or wearing proper protective equipment.

But shortages of equipment, testing delays and confusion over how the new virus spreads — up to 40% of cases are asymptomatic — have created a nightmarish scenario for facilities that were never intended to operate like hospitals in the first place. Emergency orders and inspections conducted by AHCA during the pandemic reveal some facilities in disarray — failing to follow social distancing guidelines or protect their residences and staff from infection.

Thus far, the state has halted admissions to five long-term care facilities — including the Fair Havens Center in Miami and Lakeland’s Grace Manor at Lake Morton — and suspended the licenses of three South Florida assisted living facilities after inspections indicated improper operations during the COVID outbreak.

Salmos 23V, which operates a 67-bed facility in Hialeah, was one of the facilities that had its license suspended. AHCA inspected the facility in late May after 47 residents were hospitalized with suspected COVID-19 infections. The agency found a staff member who’d tested positive for the virus at the entrance of the facility taking temperatures and screening staff. That employee wasn’t wearing a mask, nor were other staff or residents, according to the emergency order. The facility had reported two resident deaths to the state as of July.

Heritage Park Rehabilitation and Healthcare, a 120-bed provider in Fort Myers, has had trouble with PPE shortages. In May, the 1199 SEIU United Healthcare Workers East union, which represents workers at 75 nursing homes in Florida, filed complaints with the Occupational Safety and Health Administration and AHCA after nursing assistants at Heritage Park Rehabilitation and Healthcare alleged that management was concealing cases of COVID-19 and not providing them with protective equipment.

A subsequent, unannounced state inspection of the facility cited multiple deficiencies, including a failure to supply adequate PPE. The state surveyor noted that the doors of at least seven isolation rooms were open when they should have been closed and none of the seven rooms had isolation gowns or masks readily available for staff to use.

Multiple CNAs and nurses at the facility told the inspector they’d had to procure masks on their own from friends and had been wearing the same ones for days and even weeks. At one point, a group of CNAs became so upset that they gathered around the time clock and announced they were walking out. A regional nurse at the facility convinced them to stay and returned a couple hours later with N95 masks, according to the report.

Another nurse at the facility told the inspector that she and other aides had cared for a feverish resident who was transferred to the hospital after his condition worsened. The resident ended up testing positive for COVID, but staff were not told about his diagnosis for a week. By then, a CNA who’d taken care of him had also fallen ill, and another resident had tested positive. “The management again did not do investigation into who was around him,” the nurse said.

According to state data, seven residents of Heritage Park Rehabilitation and Healthcare have died of COVID-19; as of mid-July, eight COVID-positive patients had been transferred to other facilities, and 20 staffers had tested positive for the disease. The facility was on the Nursing Home Watch List with a conditional license as of the end of July and has a two-star, or “below-average,” rating from CMS.

Jennifer Trapp, a spokeswoman for Consulate Health Care, which operates Heritage Park, did not respond to the specific allegations but says the company has “worked tirelessly” to protect its staff and residents. Trapp says the company has followed all CDC and CMS guidelines “to the letter,” worked with state and local health agencies to secure adequate PPE and testing and provided “constant staff education on effective infection control protocols, proper use of PPE, best practices for staying safe at home, and much more.” She says the chain has fared better than much of the industry when it comes to COVID.

Avante’s Biegasiewicz says the need for N95 masks caught everyone in the industry by surprise. It’s not something skilled nursing facilities usually need or stock, and by the time it was apparent, there was a worldwide shortage.

“Everything else we had on hand — we had isolation gowns and caps and goggles and all the things we needed for isolation, but, of course, not to the magnitude of supply we’d need in preparation for a pandemic,” Biegasiewicz says. “None of us were prepared for the amount of PPE we would need — not necessarily that we needed it right away — but as a back supply if we did have any outbreak.”

To try to stem the tide of illness and death, Florida over the summer began providing self-swab test kits to nearly 4,000 facilities, which will perform the testing on 195,000 staff every two weeks. The state has also designated 22 COVID isolation centers for long-term care residents who aren’t sick enough to require hospitalization but can’t return home.

The Division of Emergency Management, meanwhile, has been working with the National Guard since March to get PPE supplies to facilities. By the end of June, it had delivered more than 10 million face masks, 1 million gloves, 500,000 face shields and 1 million gowns to providers. “We’re running an operation three times the size of a Category 5 (hurricane) response,” Jared Moskowitz, the state emergency management director, told nursing home operators in a June phone call.

But some say the state has fallen short when it comes to COVID testing. The emergency order to test long-term care workers every two weeks didn’t go in effect until July, when outbreaks were already widespread, and it didn’t include everyone who enters facilities. Contractors, vendors and even state inspectors aren’t required to be tested before entering — and many in the industry worry that testing at two-week intervals is not frequent enough to halt an outbreak.

In late July, CMS announced it would send rapid, point-of-care testing machines to all skilled nursing facilities and will require weekly testing in nursing homes in states with a 5% or greater positivity rate. Brian Lee, executive director of Families for Better Care, a nonprofit that advocates for nursing home residents and their families, says his group has been pushing for rapid testing for months and believes it's the "only effective solution" to getting a handle on COVID. “If you don’t have it in place in the facility, on site, you have no idea what’s going on with the virus,” he says.

The costs of the pandemic are also weighing on the industry. Brookdale Senior Living, a $4-billion company that operates more than 75 senior communities in Florida and hundreds more around the country, reported $10 million in additional facility operating expenses preparing for and responding to the pandemic through the end of March, according to a quarterly Securities and Exchange Commission filing.

The company says it has had to spend more on equipment, sanitation and disposable food service supplies. Labor costs are also higher — and Brookdale anticipates increased expenses related to workers’ compensation, health insurance, as well as COVID-19 testing of residents and staff that’s not covered by the government. Knapp, of the Florida Health Care Association, says one round of testing in a building can cost up to $24,000. At the same time, occupancy rates have dropped — falling 6.5% in skilled nursing facilities across the nation, according to a year-over-year analysis by the National Investment Center for Seniors Housing & Care (NIC), a non-profit that provides data and analytics on the industry.

For the time being, government subsidies have helped. Under the federal CARES Act, an emergency fund administered by the Department of Health and Human Services has made grants available to health care providers for health care-related expenses or revenue lost because of the pandemic. Brookdale received $29.5 million through the program. The company reported another $85 million under Medicare’s Accelerate and Advance Payment Program, which was temporarily expanded to provide loans to impacted health care providers.

Genesis Healthcare, which operates hundreds of skilled nursing centers and assisted living facilities across the country, has received about $220 million in state and federal funds and an additional $160 million in accelerated and advanced Medicare payments, according to B.J. Hauswald, the company’s senior vice president for strategic development. During a July 9 industry webinar hosted by NIC, Hauswald said about 8,000 residents (60%) of its facilities had tested positive or been presumed to have been infected with COVID-19, and approximately 20% of those infected died. State data show seven deaths at the company’s five Florida facilities.

Ultimately, she says the sector’s recovery is dependent on its ability to “get occupancies back up.” Before COVID, she says, Genesis was on track to have its “best year ever” with 88% occupancy. But after hospitals began canceling elective surgeries, referrals fell to 80% of what they were pre-COVID, admissions dropped by half and overall occupancy fell to 75% across its portfolio of properties. She says the company recently completed its second budget for the year and was planning to roll out new incentives that balance growing admissions with the demands of infection control.

“It will be all hands on deck to get our facilities back on line,” says Hauswald, who remains optimistic that business will eventually bounce back. “The good news is that when you’re in such a big hole, the first 5% to 10% comes back relatively easy. It’s going to be that last 5% that’s going to be a little but more difficult.”

Industry Players

Florida’s long-term care industry includes more than 3,000 assisted living facilities and nearly 700 nursing homes. More than two-thirds of nursing homes in the state are for-profit entities, according to 2017 data from the Kaiser Family Foundation. It’s a fragmented market, with a number of chains such as Maitland-based Consulate Health Care — which operates approximately 10% of the state’s long-term care facilities — and many mom-and-pop operators. Over the past decade, the industry has seen increased competition from home health care companies as more seniors seek to age in place, and some have branched into that business area as well.

Along with Consulate, some notable players in Florida include:

HCR ManorCare: The nation’s second-largest nursing home chain, based out of Toledo, Ohio, operates 26 Florida facilities, concentrated primarily in Tampa Bay, Southwest Florida and South Florida. Following a 2018 bankruptcy, the chain was purchased by Ohio-based non-profit health system ProMedica and the real estate investment firm Welltower. Under the joint venture, Welltower owns the actual properties and ProMedica leases the properties and operates the facilities. HCR ManorCare also restructured as a non-profit entity. In a report to bondholders, ProMedica reported more than $2.3 billion in combined operating revenue for its skilled nursing and assisted living facilities in 2019.

Greystone Health: The Tampa-based company provides a range of services — including rehab, Alzheimer’s care, dialysis and hospice — at its 30 Florida care centers. It also operates 12 facilities in Missouri and one in Illinois and offers home health services. In 2016, the company's total operating revenue was $248.2 million, according to Provider magazine, which is published by the American Health Care Association and National Center for Assisted Living, the largest trade associations for the industry.

Life Care Centers of America: Headquartered in Cleveland, Tenn., Life Care Centers of America operates 21 nursing home and rehab facilities in Florida and owns or operates more than 200 skilled nursing, rehabilitation, Alzheimer’s and senior living campuses in 28 states. The company’s Kirkland, Wash., facility was the first in the nation to make headlines in March for a COVID-19 outbreak. The chain ranks fourth nationally by size, according to Provider magazine, and Forbes pegged the company’s annual revenue at $3 billion in 2018.

Signature HealthCARE: Signature relocated its headquarters from Palm Beach Gardens to Louisville, Ky., in 2010 but still operates 20 long-term care facilities and offers home care services in 11 locations. Signature had $982 million in total operating revenue in 2016, according to Provider magazine.

Palm Healthcare Management: The Sarasota-based LLC operates 15 centers throughout Florida that offer a range of services, including skilled nursing, rehab, memory care and more. The for-profit company had an estimated $203 million in operating revenue in 2016, according to Provider magazine.

Avante Group: The private Orlando- based company manages 12 skilled nursing facilities and two assisted living facilities around the state and recently started assisting in the managing of the Miami Care Center, a COVID-only isolation facility at the former Pan American Hospital in Miami. In 2016, Provider magazine estimated Avante had $202 million in total operating revenue.

Minimum Daily Requirements

Nursing Home Staffing: Two decades ago, Florida nursing homes were required to provide each resident with at least 1.7 hours of CNA care and 36 minutes of care from an RN or LPN during a 24-hour period. In 2001, the Legislature passed a sweeping nursing home package that increased the requirement for CNA care to 2.3 hours per resident per day and boosted direct nursing care to a full hour. Staffing levels are slightly higher today. CNAs must provide at least 2.5 hours of direct care per resident per day, and a facility can’t staff below one resident CNA per 20 residents. Nursing staff are still required to provide an hour of care per day, with a minimum of one nurse per 40 residents — and facilities must provide each resident with a combined minimum of 3.9 hours of direct care per day provided by licensed nurses, respiratory therapists, respiratory care practitioners and CNAs. “Medically fragile” residents require a combined minimum of five hours of direct care each day.

Assisted Living Staffing Requirements

While some states have no minimum staffing requirements for assisted living facilities, Florida does. ALFs are not required to have a worker on staff 24 hours a day who is awake unless the facility has more than 16 residents. 

On the Front Lines

Amy Runkle has been working as a certified nursing assistant in a nursing home for more than 30 years and considers it her calling. Her father was a firefighter, and her mother was also a CNA. They inspired her to help others, she says. “I feel like I serve the public. It makes me feel good to be able to help (the elderly) and sit with them and hear their stories,” she says — but COVID-19 is putting a strain on residents and staff.

Before the virus came along, Runkle says she could take her time with residents as she tended to their daily needs, such as feeding, bathing, grooming and helping them go to the bathroom. “Now, it’s rush, rush, rush, rush,” she says. “We’re working with less staff than we were before (COVID). It’s so much more stressful now than it was. Things are so much more difficult.”

On a recent nightshift, Runkle provided care for 19 residents. When she works in the facility’s COVID isolation unit, there’s an added layer of stress. “You have to mask up, gown up,” she says. Because the gowns hold in heat, her arms are drenched in sweat within minutes. There are no N95 masks available in the facility, but her union provided her with a KN95 mask, a respirator mask approved by the Chinese government. They’re supposed to be about as effective as N95 masks, filtering out 95% of particles, although the U.S. government has warned users that a rash of counterfeit KN95 masks has flooded the market during the pandemic. “As far as PPE goes, there’s just not enough to go around,” Runkle says.

Meanwhile, isolation is taking a toll on residents. Since March, family and friends have not been allowed to visit — and in order to maintain social distancing within the facility, residents are confined to their rooms. “More of them are getting depressed and kind of just giving up,” she says. “A lot of them just want you to sit down and talk to them. We don’t have time to even do that right now. Our stock answer anymore is, ‘OK, honey, I will. I’ll be back. I just have to finish what I’m doing.’ And trust me, you never get a chance to go back.”

Learning Curve

In an April video posted on Facebook, Ashley Roberts, executive director of Grace Manor at Lake Morton in Lakeland, talked about the steps the memory care facility was taking to protect its residents from COVID. She said the company was sanitizing its building several times a day and all staff were wearing protective equipment. “So far, all of our residents and our staff are COVID-free, and we are hoping to remain that way,” Roberts said.

Weeks later, beginning in May, an outbreak ripped through the 50-bed assisted living facility. By June, 33 residents were hospitalized with COVID-19 and seven eventually died. On June 2, the state stepped in and temporarily halted admissions to the facility.

Inspectors noted that while staff at the facility were wearing masks, they weren’t wearing gloves or other personal protection equipment — and they weren’t washing hands or changing masks in between caring for patients. The facility was also failing to keep sick residents away from others. A coughing, COVID-positive resident was observed seated in a dining room with several other residents as she awaited transfer to the hospital. The facility’s executive director told the Agency for Health Care Administration that the facility was struggling to keep residents from wandering around and removing their masks. A staffing shortage — some workers were out sick, and others had quit — added to the confusion.

Grace Manor at Lake Morton appears to have made swift changes after the state action. Three subsequent inspections found no deficiencies and a Facebook video posted by the assisted living facility on July 14 showed new infection control strategies in place, including new outdoor handwashing stations for employees and third-party vendors and supply cabinets stocked with gowns and N95 masks. The facility has also built interior walls to separate hallways from common areas and allow for social distancing of residents. Staff now work 12-hour shifts, as opposed to eight-hour shifts, to limit the frequency of people coming and going and reduce potential exposures to the virus.

As of July 6, all residents and staff at Grace Manor Lake Morton tested negative for COVID-19. Staff will continue to get tested every two weeks under a pair of rules handed down in mid-June by the DeSantis administration.

Dana Mercaldi, director of sales and marketing for Mainstay Senior Living, which operates Grace Manor at Lake Morton, says the company has “worked hard” to protect its residents during the unprecedented health care crisis and continues to adhere to CDC guidelines, “including disinfecting practices, aggressive hygiene, proper distancing and mask wearing,” along with its new protocols. “That’s why the moratorium was lifted so quickly. There is nothing more important to us than protecting our residents and staff,” she said in an e-mail.


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