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At least four people have died at a COVID-19 outbreak at a long-term care facility in Livingston that started after most residents had received at least the first dose of the vaccine.

Livingston Health and Rehabilitation Center is Park County’s only skilled nursing facility that provides 24-hour care to residents. The facility had its first case of COVID-19 on Jan. 28, and since then, at least 21 residents and eight staff members have tested positive for COVID-19. Four of those residents have since died.

More than 80% of residents have received at least their first dose of the vaccine, and many — but not all — staff have also been vaccinated. Long-term care facilities were prioritized for vaccinations along with front-line health care workers by the state. A patient cannot receive the COVID-19 vaccine if they actively have COVID or are in quarantine after being exposed to the virus.

Park City-County Health Officer Laurel Desnick said the facility infection rate of about 50% shows that many people who received the vaccine have since tested positive. She said that means they were either infected when they received the vaccine or became infected in the days immediately afterward. She also said the circumstance may raise questions about vaccine efficacy in especially frail people. She said the vaccinations may have kept the outbreak from becoming much worse.

“It’s a very sad and disappointing time for this to be happening,” Desnick said. “Vaccines look like they’re going to be helpful, but they only work if people take the vaccine.”

Numerous calls to Livingston Health and Rehabilitation Center, as well as attempts to reach facility owner EmPres Healthcare Management were not returned. 

The Montana Department of Public Health and Human Services declined an interview request from Montana Free Press and did not answer specific questions about the outbreak.

Department spokesman Jon Ebelt said in an email that the state will help facilities with infection control through webinars and assessments and provide direct support to the facility. Desnick said the facility has accepted all the help the state has offered

Overall, spread of COVID-19 at nursing homes has declined drastically since the vaccine was introduced. New cases among nursing home residents are down 82% since December and at their lowest number since the beginning of the pandemic, a sign that “the vaccine is working,” according to the American Health Care Association and National Center for Assisted Living

“We’d gone a whole year without a major outbreak in any of these senior-living settings, and people were starting to feel like we were going to be able to open up a little bit, maybe allow more family members in and go back to group activities, maybe even allow residents to get out of the facility now and then for an activity. It raises questions about making changes right now.”

Park City-County Health Officer Laurel Desnick

In Montana, there have been at least 5,667 cases in assisted-living facilities since the beginning of the pandemic, though the spread has slowed since vaccines have been introduced. As of Feb. 26, there are 281 active COVID-19 cases in similar facilities. 

But that’s not the case everywhere, as demonstrated by the outbreak in Livingston.

Prior to the ongoing outbreak, Park County had not had a major outbreak or a single death in any of its senior facilities, Desnick said.

“We’d gone a whole year without a major outbreak in any of these senior-living settings, and people were starting to feel like we were going to be able to open up a little bit, maybe allow more family members in and go back to group activities, maybe even allow residents to get out of the facility now and then for an activity,” Desnick said. “It raises questions about making changes right now.”

Desnick said the health department will get more information as time goes on about what went wrong.

“It will be a while before we fully understand how this happens, but in the meantime, it really reinforces that we all need to be extremely careful, especially when interacting with vulnerable people,” Desnick said.

Across Montana, at least 476 people in long-term care or assisted-living facilities have died from COVID-19, a third of the deaths in the state. 

A study published this week in the journal Health Affairs found that high staff turnover at nursing homes likely led to increased deaths at such facilities across the United States. The average turnover rate was 128%, and some facilities had turnover of more than 300% during the pandemic.

Desnick said that systemic issue extends to Park County and to Montana, where nursing homes are chronically understaffed and underfunded. Outbreaks also create issues because they can lead to staff being out sick or in quarantine. 

Livingston Health and Rehabilitation Center has been cited by federal inspectors for more than two dozen deficiencies since 2017. In 2018, the facility was fined $53,346 by federal regulators for an inspection that led to nine separate deficiencies, including not employing properly licensed staff, not completing care plans for residents in a timely manner and not properly storing residents’ medical records. At the most recent inspection in October, the facility received one violation notice.

Desnick said the outbreak shows that the pandemic is not over, even as many states lift public health requirements. Park County has kept its mask mandate in place, even after the state lifted the requirement in February.

“Many people in the community have the impression the pandemic is behind us, and it most definitely is not,” Desnick said. “This is an example of why we still need to be very careful.”

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Johnathan Hettinger

Johnathan Hettinger is a journalist based in Livingston. Originally from Central Illinois and a graduate of the University of Illinois, he has worked at the Midwest Center for Investigative Reporting, the Livingston Enterprise and the (Champaign-Urbana) News-Gazette. Contact Johnathan at jhett93@gmail.com and follow him on Twitter.