As the Coronavirus pandemic surges on, nursing homes across the country have become major hotspots. This pattern emerged in spite of new changes implemented by the Center for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS) to stop the virus from spreading.
Since March, nursing facilities have restricted all visitors and non-essential staff, with exceptions made for dementia or end-of-life care. Staff members who are working have been screened daily for fever and certain respiratory symptoms.
For residents who display symptoms or test positive for COVID-19, facilities have been directed to isolate them in a private room, where dedicated staff can tend to this group of patients.
Even with these comprehensive policies, significant loopholes have allowed COVID-19 to thrive in nursing facilities over the past several months.
Patients Are a Vulnerable Demographic
According to the latest update from Governor Lamont, 1,487 nursing home deaths in Connecticut have been attributed to COVID-19.
As we have learned, the elderly population is more susceptible to contracting the virus than other groups. Based on a report from Johns Hopkins University, residents often have multiple co-morbid chronic and complex conditions compared to the rest of the adult population.
Older people are also more frail and may have several physical limitations. As a result, residents in a nursing home or assisted living facility often require help with everyday tasks, such as getting out of bed, dressing and using the toilet. Contact with staff is therefore inevitable, even when residents are kept in separate rooms.
Insufficient PPE for Staff
The issues facing doctors and medical professionals in hospitals are also affecting nursing home workers, including a lack of personal protective equipment (PPE). Based on an account in the Aurora Sentinel, staff at private nursing facilities may be experiencing an even more dire situation than state-run homes. As one example, a care worker created a face mask out of paper towels and rubber bands. Other workers report a shortage of medical-grade gloves and are sterilizing cleaning gloves as an alternative.
Issues with Staffing and Testing
For years, the shortage of workers in nursing homes has been widely known. During a pandemic, staff members may be receiving less training, which increases the chances for negligence.
Statistically, skilled nursing facilities and assisted living centers get grouped together, although they care for different types of patients. Individuals in assisted living don’t need as much medical attention and are taken to a separate medical center for appointments. Staffing wise, these centers employ more personal care workers who assist residents with daily tasks and have fewer trained medical staff in house.
Because assisted living addresses a different population, several states exempt them from CMS staffing requirements. In turn, these facilities have fallen through the cracks when it comes to updating cleaning procedures and receiving supplies.
Both types of facilities have implemented screening procedures for staff entering but the testing, often relying on fever-level temperatures and breathing difficulties, allows asymptomatic individuals to enter and proceed to interact with residents.
Testing has not been widely available for all residents and staff and, until recently, neither was a national reporting system. Delays initially prevented nursing facilities from receiving testing supplies.
Worst-Affected Homes Have a History of Infection Control Violations
A report in the Washington Post found that 40 percent of all Medicare-certified nursing facilities with publicly reported COVID-19 cases received at least one citation for failing to adhere to infection control protocols. Some of these violations occurred mere months before this pandemic.
New reporting standards went into effect in 2016 to help nursing facilities control the flu, pneumonia and other infectious diseases. Since then, CMS data has shown a range of violations, including:
- Not tracking symptomatic residents
- Continuing to use dirty or un-sanitized equipment
- Failing to ensure all employees wash their hands
- Not changing oxygen equipment regularly
- Improper wound care
- Not responding to resident care in a timely manner
Since the new CMS standards went into effect, infection control has been the most-cited violation. As it’s considered minor, facilities have yet to face any type of penalty or monetary fine.
Since states have implemented shelter-in-place orders, the CMS has devoted more time and resources toward monitoring infection control. Their efforts have yielded surprising findings: In spite of the updated recommendations from the CDC and CMS, the CMS found that staff at one-third of all homes weren’t following hand-washing guidelines and one-quarter weren’t correctly using PPE.
No Nationwide Data Collection
On April 19, the CMS announced a nationwide data collection effort for Medicare-certified nursing facilities. The goal would be to publish complete nationwide numbers, broken down by state and facility for outbreaks and deaths, available to the public.
The CDC has since provided an interface for nursing facilities to report the number of COVID-19 deaths, staffing levels, available tests and amount of PPE and hand-hygiene supplies. All nursing facilities were required to begin this degree of reporting by May 17.
According to an NBC News report, inconsistent policies, insufficient numbers and limited public access have affected where PPE and testing get sent, how hotspots get identified, and how family members are updated about their loved ones.
Has insufficient infection control resulted in dire consequences for your loved one in a nursing home? Trantolo & Trantolo’s nursing home negligence lawyers are on your side. To bring a claim to our attention, contact us today.