Nurising Home Concern

From USA Today:

“Coronavirus a concern in nursing homes, where 75% have been cited for infection control errors”

Nursing homes are a perfect-storm environment for the coronavirus, pairing residents at greater risk of serious illness with facilities that may be ill-equipped to prevent the spread of infection within their walls and beyond. Seventy-five percent of U.S. nursing homes have been cited for failing to properly monitor and control infections in the last three years — a higher proportion than previously known, according to a USA TODAY analysis of federal inspection data. Those citations have been as mild as a paperwork problem, and as serious as a nursing home not telling state officials about an outbreak as unmonitored workers spread disease to patients. In each case, the citation is a warning signal for practices and shortcomings that could become crucial factors in an outbreak both inside and outside the facility. North Carolina’s governor has said the state’s first coronavirus case came through Washington state, where the virus has devastated the Life Care Center in Kirkland. Failed infection control means nursing homes can spread the new coronavirus, also known as COVID-19, far beyond their walls, said Charlene Harrington, a professor emeritus of nursing at the University of California, San Francisco. "Nursing homes are viewed only as a problem to residents and maybe the staff, but in this case you can see it can affect the entire community," she said. “Poor care in one nursing home becomes an epicenter for the entire community.” Underscoring the link between infection control and the spread of the coronavirus, on Wednesday the Centers for Medicare & Medicaid Services announced that its inspections would focus solely on issues related to controlling infection and other serious health and safety threats, such as allegations of abuse — beginning with nursing homes and hospitals. The agency made that shift effective immediately, allowing inspectors to focus on addressing the spread of COVID-19. Dr. David Gifford, who represents the nation’s nursing homes as chief medical officer at the American Health Care Association, cautioned that the vast majority of citations do not relate to situations that have caused significant harm. He said inspectors catch most issues early enough that facilities can address them before anyone is hurt. “It’s always helpful when the federal surveyors come in and identify areas that could be better on infection control,” Gifford said. “What the public needs to know is… if they aren’t corrected, the regulations require (the government) to shut the nursing home down within six months.”

 ‘An infection-rich environment’:     The Life Care Center, which U.S. authorities believe to be the site of the first outbreak in a long-term facility, received a five-star overall rating by federal regulators but previously had been criticized for its infection control procedures.  Federal regulators assign points for violations — no points at all for the most benign infractions that affect few people, many points for violations that threaten lives or are widespread. U.S. nursing homes averaged about 10 points over three years, the USA TODAY analysis shows. Life Care Center’s single violation last year accounted for 16 points. It had received no infection control citations in the previous two years. The 2019 inspection report described a resident’s daughter saying her mother’s open heel wound often touched the ground while nurses were working. Inspectors found other basic problems at Life Care, such as kitchen staff not properly washing their hands or changing gloves, federal records state. After the recent COVID-19 outbreak, the Life Care Center said it implemented infection control recommendations from the Centers for Disease Control and Prevention and from state and local health departments. The facility also said it is limiting visitors, monitoring residents and employees, and asking staff to stay home if they are sick. “The coronavirus in long-term care facilities is a horrible example of a perfect storm,” said attorney Steven Levin, of Levin & Perconti in Chicago, a practice focused on representing nursing home residents and their families. “In my opinion, the nursing homes that we deal with have extreme difficulty in handling everyday infections, and it’s an infection-rich environment.” About 26.8 percent of nursing homes have received at least as many violation points as Life Care Center in the past three years, USA TODAY’s analysis shows. And thousands of nursing homes — more than 15 percent of them — were cited for individual problems at least as bad as those at Life Care. About 1 percent had problems that were worse.  The worst over the three-year analyzed period was The Westbury Place in Houston, cited for two 8-point violations and two 150-point violations. Among failures cited: Not using sterile equipment for tracheotomy care; not keeping patients in isolation when they had the hard-to-cure infection known as MRSA; and not properly cleaning a catheterized patient for five days. More common were the types of mistakes at Wheat State Manor in Whitewater, Kansas, which accumulated 64 points from federal inspectors. In one inspection, an employee checked a patient for incontinence, cleaned up another patient's incontinence, helped both patients move into chairs and then left — all without washing hands between patients or after the work was done. Regulators said that kind of infection control problem affected many residents, but caused little actual harm.  Wheat State Manor was one of more than 300 nursing homes that racked up four citations for infection control problems over the three years. Six nursing homes had seven violations each: Lakeview Terrace, York Healthcare & Wellness Center, and Country Villa Rehabilitation Center, all in Los Angeles; Champaign Urbana Nursing and Rehab in Savoy, Illinois; Aperion Care Forest Park in Forest Park, Illinois; and The Enclave in San Antonio. All accumulated more points than the Life Care Center. One inspection report for Lakeview Terrace ran 28 pages. Among the problems: A worker who may have been infectious handed out food trays. Workers there weren’t washing their hands before helping someone with a drug-resistant infection, and then didn’t wash their hands before going on to help other patients.

Some states stood out as more problematic. In Washington state, where the nursing home outbreak began, about 85 percent of nursing homes received an infection control citation, USA TODAY’s analysis found. But it California and Michigan both fared worse, with more than 90 percent cited. Guam's one nursing home was cited, as were all six of those in Puerto Rico.  In Rhode Island and North Carolina, though, only about a third of nursing homes were cited for infection control violations. Even among nursing homes that received federal regulators’ highest overall ratings and highest healthcare ratings, 41 percent still had problems with infection control. This is of particular concern because, in a healthcare crisis, nursing homes often become a key escape valve.  “Part of the resource crisis we are facing is ensuring that there is enough good care available in skilled nursing facilities to take some of the load off acute care hospitals in a widespread epidemic,” said Mike Dark, staff attorney for California Advocates for Nursing Home Reform. He said skilled nursing facilities in the U.S. already take hundreds of thousands of patients a year when they are discharged from acute care hospitals.

‘A societal judgment you have to make’:     Even before the coronavirus appeared, as many as 380,000 people were dying of infections every year in long-term care facilities, according to the Centers for Disease Control and Prevention. Some studies cited by the CDC have suggested that 1.5 million Americans in long-term care, including nursing homes, may get an infection every other year, sending perhaps 150,000 of them to the hospital. Some of that, advocates say, stems from the way nursing homes are operated. Typically understaffed, nursing homes can be places where making money – or even just making it through a shift – depends on cutting corners. Wendy Meltzer, executive director of Illinois Citizens for Better Care, said good infection control takes time. “If you don't have enough staff to begin with, then the time you take to wash your hands and put on gloves and change gloves and make sure that linens are changed appropriately and take people's temperature and what you need to do," she said, “that all takes away from the day-to-day, minute-to-minute, hour-to-hour pressures.” Often when people think about nursing homes, they focus on doctors and nurses, said Greg Kelley, president of SEIU Healthcare Illinois Indiana Missouri & Kansas, a union that represents more than 91,000 healthcare, child care, home care and nursing home workers. But Kelley said nursing homes rely on housekeepers, dietary workers and others to keep their facilities operating. Those workers, on the front lines of infection control, may make poverty-level wages and not receive enough sick days or paid time off. And there is no one to replace them. That means sick employees often show back up to work. A U.S. Department of Health and Human Services plan for addressing nursing home infections said the flu can spread easily among residents who live near each other and frequently see healthcare workers. But healthcare workers themselves, the plan said, contribute to the problem, with many not getting the annual flu shot. Residents also often routinely suffer from illnesses like pneumonia that threaten their lives, and those of other residents. Few nursing homes have full-time infection-control specialists. One study found less than 10 percent of infection prevention specialists in nursing homes and skilled nursing facilities had specific training, such as a certification, in infection control procedures. In acute care environments like hospitals, 95 percent had that training. Gifford, of the American Health Care Association, said nursing homes are required to have infection control and emergency preparedness plans that include how to deal with an outbreak or pandemic. “I think that even with all the planning that you do, things come up that are really hard and complicated that need to be addressed to sort of a broader community,” Gifford said, “and I think that’s what we’re seeing up in Washington.” In Washington, he said many workers were exposed to the virus and could not come to work. Initially, part of the plan was to backfill with nurses from other facilities. But the facility learned that the state doesn’t allow nurses to move quickly and easily across state lines. When they tried to mobilize federal workers, Gifford said, that led to various challenges, including with pay.  Other problems emerged, too. Test results weren’t readily accessible, he said, and the facility quickly ran out of some key supplies, like masks. When it located supplies, he said, some suppliers were afraid to deliver them. Meltzer said there are simple-sounding ways to prevent the coronavirus from spreading at nursing homes: Take visitors' and employees' temperatures as they come into the buildings, require every facility to have someone working in infection control, and mandate that assisted living facilities and other places follow the federal governments' regulations for nursing homes. All of that requires more staffing, which means more money. While those solutions may sound simple, they can be costly. "Ninety percent of nursing homes in the country would be screaming about how they couldn't afford to do this," Meltzer said. "And that's just a societal judgment you have to make, about who's worth what. ... For the most part, residents really don't come out well on this."

^ The current state of nursing homes across the country is only being highlighted but Convid-19. My Grandmother lives in a nursing home in New York (I offered to let her come live with me here, but she didn’t want to be away from the town she has lived all of her life in) and I make a point to see how she is doing and being treated when I am there in person  - and I check on her by phone when I can’t be there in person. Whether there is a pandemic or not we should not allow our elderly citizens to be treated in such a poor way. They have done so much for us and our country and deserve to be treated with dignity and respect. ^

https://www.usatoday.com/story/news/investigations/2020/03/06/coronavirus-spread-nursing-home-infections-can-go-beyond-their-walls/4964397002/