But the industry has made great strides in recent months. Even though the county as a whole saw a second peak in July and early August, since May, COVID-19 related deaths at L.A. County's skilled nursing facilities have seen a steady decline.
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Part of the solution involves the hundreds of physicians and nurses for the county health department, who respond every time there's a facility with an outbreak. They also have regular in-person visits and virtual tours to make sure a facility is prepared for an outbreak.
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"They work very closely with the staff at these facilities to really go through all aspects of infection control and really try to work with them to optimize their procedures so we can try to contain the outbreak and prevent further spread," said Dr. Prabhu Gounder, medical director for the Respiratory Diseases Unit.
Working closely with the private sector was also critical. Rockport Healthcare Services manages 30 facilities in L.A. County and was the first in the state to establish COVID-only facilities like Country Villa East. Residents with the virus are taken there for specialized care and in the hope of halting the spread to other people.
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"We believed by getting residents out, by getting them to specialized treatment centers that we could reduce the risk of patients going to the hospital and ultimately reduce the risk of people dying from the disease," Dr. David Silver, Rockport Healthcare Services.
In many cases, the facilities themselves presented challenges to slow the spread of COVID-19, simply due to how the residents are housed.
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"Many of them were built decades ago and just weren't designed to try and contain this type of highly infectious respiratory disease," said Dr. Gounder.
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The combined efforts of all involved have made a huge difference. Of the 341 skilled nursing facilities in L.A. County, 74% don't have any new coronavirus cases.
"We all learn from each other," said Dr. Silver. "Obviously we stood up but this is a collaborative effort from everybody. Nobody can do it alone and again I can speak for how proud I am of the staff that we have who have really been the champions of all this."
"I'm optimistic. I'm reassured with the trend and I'm hoping that if we continue our effort, you'll see a decline in the number of cases but in the back of my mind I'm also worried and wouldn't want to get complacent because there's still a lot we don't know about this disease," said Dr. Gounder.
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