08 19 2020
Velandy Manohar, MD
Chair- Community Engagement and Outreach Committee, Of the Consumer Advisory Council of the Office of Health Strategy.
These are very sad, upsetting reports: Nationwide, more than 40% of all COVID-19 deaths through July occurred in nursing homes compared to 74% in Connecticut’s long-term care facilities. COVID-19 hit nursing homes in the Northeast states particularly hard, but those living in Connecticut long term care facilities died more frequently than in any other state
More than 3,000 nursing home residents who had COVID-19 have died in Connecticut so far. Deaths peaked in mid-April, with 50 people dying each day
Half of those who contracted COVID-19 lived in the same 26% of Connecticut’s nursing homes, the report said.
Researchers found several trends that may help Connecticut’s policy makers target their response if there is another surge.
- For-profit nursing homes had 60% more cases and deaths per licensed bed than non-profit facilities.
- Nursing homes with a memory care unit had only a slightly higher rates of cases and deaths.
- Nursing homes rated by the federal government prior to the outbreak had fewer cases and deaths. (Read about that here).
- Nursing homes with a recent complaint had 35% more deaths and cases. (Read about that here).
- Infections were more likely in nursing homes in communities where the number of COVID-19 cases was highest.
- Nursing homes with the best staffing experienced fewer cases and deaths.
Nursing home which earned 4 and 5 stars for their staffing had lower number of cases and lower number of deaths compared to Nursing homes with 2 and 3 stars.[Graph included in report -Page 9]
From Section B1 Supplemental Report May 2020 Report: Page 9
- Inspections at several Connecticut nursing homes found lapses in infection control and prevention and poor practices for the prolonged use of protective gear necessary during the COVID-19 pandemic, according to a half-dozen reports released Wednesday.
- By May 14, 2020 1,627 nursing home residents in Connecticut have died from COVID-19 or related complications. That is roughly one out of every 13 skilled nursing home residents. 5 of the six Facilities reported on had serious lapses. These facilities are named, concerns and the consequences are specified
Those deaths account for more than half of all COVID-related fatalities in Connecticut.
From Section B2 Supplemental Report June 2020 Starting Page 14
- Data from the Centers for Medicare and Medicaid Services (CMS) shows that nursing homes where the virus has hit particularly hard were more likely to have infection control issues than those with fewer cases. Those lapses were also more likely to occur in facilities where more of the residents are people of color
- There have been, to date, a total of 8,322 documented infections among residents in Connecticut nursing homes – and 57% of them lived in homes where inspectors found infection control lapses. Comparatively, about half that number – 27% – were in homes where no shortfalls were identified. Likewise, 58% of the nearly 2,400 residents who died from COVID-19 were in the nursing homes with inspection lapses compared to 28% in the homes with none.
- Dr. Matthew Cartter, the top epidemiologist at the state Department of Public Health, said. “Were all nursing homes equally at risk, or were some at greater risk than others? We don’t know the answers, but data suggest that not all nursing homes were equally likely to be impacted by the COVID-19 virus.”
- Death counts higher in facilities with more people of color Page 16
For example, at Riverside in East Hartford – where more nursing home residents have died than any other facility in the state – 43% of the residents were black or Latino. Statewide, that figure is only 18%. At Abbott Terrace Health Center in Waterbury, which has the second highest number of COVID-19 deaths, 39% of the residents were black or Latino.
- This racial disparity of nursing home fatalities is particularly large in Connecticut. Researchers at the University of Chicago reviewed nursing home data in nine states, and found Connecticut had the second largest disparity in the numbers of nursing homes that have had at least one resident infected or die from COVID-19. Only Illinois had more.
- We found a strong and consistent relationship between race and the probability of COVID-19 cases and deaths. Nursing homes with the lowest percent white residents were more than twice as likely to have COVID-19 cases or deaths as those with the highest percent white residents,” Tamara Konetzka, a professor in the university’s Departments of Public Health Sciences and Medicine, testified before the U.S. Senate Special Committee on Aging two weeks ago.
- A May 21 New York Times analysis on the racial infection rate disparities in nursing homes in 17 states puts Connecticut in sixth place for having the largest gaps between homes where at least one-quarter of the residents are black or Latino and facilities with fewer than 5% of these populations.
- Widespread infection control lapses Page 17:
Long-term care facilities have struggled for years to follow best practices to control the spread of infections.
In Connecticut, federal watchdogs at the Government Accountability Office recently reported that half of the state’s nursing homes had infection-control problems for multiple years leading up to the pandemic — compared to 33% in New York, 24% in Massachusetts, 22% in New Hampshire, 39% in New Jersey, and 8% in Rhode Island. Connecticut’s performance, however, was slightly better than the 55% national average.
- The researchers from the University of Chicago found no correlation between the inspection ratings given before the pandemic and nursing homes having a single case of COVID-19. A CT Mirror report in early May, found otherwise for homes where a large number of residents have the virus, and the inspections released last week show that inspectors are more likely to find lapses in facilities with higher coronavirus infections and death rates.
- Five homes among the 39 in Connecticut where problems have been found since the pandemic began have been cited and fined, officials said. One nursing home has been issued two of those citations. The department declined to disclose the homes where fines have been issued, or their amounts
- Causes for the spread of infection could also be things that would show up on inspections; inspectors found lapses ranging from improper use or no use of protective equipment, failure to document residents’ conditions, failure to appropriately cohort residents, a lack of signage outside rooms where residents with coronavirus were staying, insufficient hand sanitizing procedures, and failure to enforce social distancing.
- The most citations: Page 20
Of the five nursing homes with the most COVID-19 deaths, inspectors found problems at four. Riverside in East Hartford was the only one to have no lapses during either of its two inspections. The inspections turned up deficiencies at Kimberly Hall North in Windsor, Abbott Terrace in Waterbury, Shady Knoll in Seymour and Regency House & Rehabilitation Center in Wallingford.
- Coll said a single bad inspection at a nursing home may not be as good of an indicator of a problem as at those homes where violations are found on multiple visits. Among the reports released so far, At seven of those homes, deficiencies were found during separate visits.inspectors visited 72 homes at least twice.
- Inspectors found issues during all three visits to RegalCare in New Haven. There have been 54 infections and seven deaths there.There were specific descriptions of lapses in several facilities.
We have all shared ideas on what we had observed and experienced with respect to lethal gaps in optimal care provided in some NH. The Mathematica Interim Report and these reports I have curated gives us data that are disturbing, are still evolving in the sense mor inspection reports will be forthcoming. There are many areas of concern and can be focused on during our discussions.
Velandy Manohar, MD
A.
Most Recent report 08 18 2020. Two supplemental Reports follow. Section B 1 and 2
COVID-19 hit nursing homes in the Northeast states particularly hard, but those living in Connecticut long term care facilities died more frequently than in any other state – a result of missteps by the state and a nursing home industry hamstrung by limited knowledge of the pathogen’s nature, how it spreads and to whom it posed the greatest risks.
While an interim report released by the state Tuesday makes no sweeping conclusions or findings of fault on the part of the nursing home industry or state government, it does identify a number of factors and phenomenon that contributed to the lethality and severity of the outbreak here, including a lack of testing and slowness in implementing a mask requirement at nursing homes.
“The Connecticut plan focused exclusively on hospitals and did not explicitly address long term care facilities,” says the 93-page document prepared by Mathematica, a policy research consulting company hired by the administration of Gov. Ned Lamont. Another report is expected before October.
“Early responses to the COVID-19 outbreak were undermined by gaps in scientific knowledge about how the virus spreads, the range and severity of symptoms (especially in older adults), and underlying factors that might place an individual at greater risk,” the report observed.
Nevertheless, state guidance to nursing homes on infection control “tended to follow federal guidance rather than proactively respond to the rapidly evolving situation in Connecticut and neighboring states,” the report said.
It observed that Connecticut did not issue a universal masking order for personnel in all health facilities until April 4, the day after it was recommend by the federal coronavirus task force. New York moved faster, requiring universal masking for health workers three weeks earlier on March 13.
Further, vacancies in the state office charged with managing public health emergencies — six of the nine positions — contributed to problems in managing the pandemic, the researchers also found. There were related shortcomings in communication with the industry cited as well.
“We know now that limited COVID-19 testing capacity and limited scientific knowledge about the novel coronavirus during the first difficult months of this pandemic made it very challenging to contain the spread of COVID-19,” said Lamont in a statement. “Despite these limitations, CT made some very critical decisions in our response to COVID-19 that saved lives and improved public health. Because of the hard work and sacrifice of long-term care workers, and residents and their families, we have seen a consistently low number of cases and deaths among staff and residents of long-term care facilities since early June.”
Lamont went on the say that “I am grateful for the thorough work done by Mathematica to help us learn from our response thus far so we can make improvements as needed as we work to avoid another surge in COVID-19 cases. I look forward to reviewing the final report, and working with the long-term care industry to keep our residents and families safe from COVID-19.”
Industry leaders said they are reviewing the findings and plan to work with the state as it prepares for the next resurgence of the virus.
“There is much that can be learned from the interim report, including areas that will be further studied for the final report,” a joint statement from Matt Barrett, president of the Connecticut Association of Health Care Facilities and Mag Morelli, President of LeadingAge Connecticut. “We do want to point out that Mathematica has affirmed in the interim report, consistent with other academic and scientific findings, that the incidence of community spread of the virus is a key characteristic in determining COVID-19’s presence in elderly congregate settings like nursing homes and assisted living communities. In this regard, the two associations continue to urge Connecticut residents to stay the course on the known strategies to keep community spread down, such a wearing a mask, observing social distancing and handwashing. It is crystal clear that we can hold down the community prevalence of COVID-19 with these proven strategies.”
To prepare their report, Mathematica researchers interviewed more than 60 people, including state legislators, family members of those living in long term care facilities, and officials in the Lamont administration. They did not interview Renee Coleman-Mitchell, who served as the commissioner of the Department of Public Health for much of the pandemic until she was abruptly fired in May.
Nationwide, more than 40% of all COVID-19 deaths through July occurred in nursing homes compared to 74% in Connecticut’s long-term care facilities.
More than 3,000 nursing home residents who had COVID-19 have died in Connecticut so far. Deaths peaked in mid-April, with 50 people dying each day.
To prevent another resurgence in nursing homes, the report recommends the state continue regularly testing residents – an approach the state was slow to adopt. The state has committed to continue paying for testing through October. The report recommends the state actually expand its testing policies so that nursing homes with more COVID-19 cases are tested more frequently and so those who have tested positive in the past can be tested regularly going forward.
Staffing issues at the state’s nursing homes will need to be addressed to prevent rapid spread moving forward, Mathematica concluded. Some of the initial response by the industry was hampered by staffing shortages caused by the disease itself, the report observed. The researchers recommend that staff exposure to residents be limited by reducing the number of staff who are working at multiple nursing homes or in different wings of a facility.
“Facilities should consistently assign staff to work on the same unit and with the same residents,” the report recommended.
Accommodating such working conditions will likely be expensive, as many staff work in multiple locations to supplement the low wages they are paid.
Which nursing homes were hit the hardest?
Half of those who contracted COVID-19 lived in the same 26% of Connecticut’s nursing homes, the report said.
Researchers found several trends that may help Connecticut’s policy makers target their response if there is another surge.
- For-profit nursing homes had 60% more cases and deaths per licensed bed than non-profit facilities.
- Nursing homes with a memory care unit had only a slightly higher rates of cases and deaths.
- Nursing homes rated by the federal government prior to the outbreak had fewer cases and deaths. (Read about that here).
- Nursing homes with a recent complaint had 35% more deaths and cases. (Read about that here).
- Infections were more likely in nursing homes in communities where the number of COVID-19 cases was highest.
- Nursing homes with the best staffing experienced fewer cases and deaths.
Nursing home which earned 4 and 5 stars for their staffing had lower number of cases and lower number of deaths compared to Nursing homes with 2 and 3 stars.[Graph below]
CT Mirror Capitol Bureau Chief Mark Pazniokas contributed to this report.
Supplemental reports:
Section B
- Report from May 2020 - Limited inspection reports show COVID-19 lapses in nursing homes. Inspection reports on six homes are the first to be released.
https://ctmirror.org/2020/05/14/limited-inspection-reports-show-covid-19-lapses-in-nursing-homes/
This story has been updated with a response from an affected nursing home.
Inspections at several Connecticut nursing homes found lapses in infection control and prevention and poor practices for the prolonged use of protective gear necessary during the COVID-19 pandemic, according to a half-dozen reports released Wednesday.
The reports provided by the state Department of Public Health are the first detailed accounts of targeted inspections ordered by the federal government on March 20 and later expanded by Gov. Ned Lamont to cover all 213 skilled nursing homes, where the novel coronavirus has infected 6,000 and is attributed to more than 1,600 deaths.
The reports on homes in Chester, East Haven, Milford, Orange, Seymour and Waterford were released without the DPH saying if they were the only six nursing homes with deficiencies or merely the first subjects in a series of reports on how the industry has handled the pandemic.
None of the reports detailed inspections at homes with some of the highest numbers of people dying from COVID-19, such as Kimberly Hall North in Windsor, Abbott Terrace Health Center in Waterbury and Riverside Health and Rehabilitation Center in East Hartford.
Av Harris, a spokesman for the department, said there is a delay in releasing some reports.
“It takes time to get these completed and posted,” he said Wednesday. “It’s not an overnight process.”
The federal government ordered states on March 20 to work with the Centers for Disease Control and Prevention to select nursing homes for inspections. On April 19, Lamont announced the state would be visiting every nursing home to conduct “infection control surveys.”
Multiple requests over the last several weeks for copies of findings from the first round of nursing home inspections went unanswered, even though the governor regularly pointed to them in highlighting what the state is doing to improve conditions in nursing homes. Lamont said Vice President Mike Pence, who leads the federal coronavirus response, recognized the Connecticut effort in a recent conference call with governors.
“One of the things on the nursing homes you might find interesting is the Pence task force – they did give Connecticut a shout out as one of the leading states in terms of having a physical inspection of each and every one of the nursing homes,” Lamont said.
To date, 1,627 nursing home residents in Connecticut have died from COVID-19 or related complications. That is roughly one out of every 13 skilled nursing home residents.
Those deaths account for more than half of all COVID-related fatalities in Connecticut.
Of the six nursing home inspection reports made public, five show infection control lapses. The sixth facility was cited for failing to notify a resident’s conservator of the person’s change in condition.
The five nursing homes with infection control and prevention violations are Aaron Manor in Chester, Whispering Pines Rehabilitation and Nursing Center in East Haven, Shady Knoll Health Center in Seymour, New London Sub-Acute and Nursing in Waterford, and Orange Health Care Center in Orange.[There were several facilities I noticed when I scanned the scores of complaints. VM]
At Aaron Manor, inspectors found in April that managers had failed to ensure their infection control and prevention strategy included the cleaning of frequently touched surfaces and instructions on the proper use of protective equipment among housekeeping staff.
One employee was seen pushing a food cart from a COVID-19 unit to a non-COVID-19 area and then touching a kiosk screen after touching the cart. Members of the housekeeping staff were seen handling soiled clothing without protective gear, and the facility didn’t have a clean space for folding and storing laundry once it came out of the washing machine.
Aaron Manor has recorded 25 cases of coronavirus and 10 deaths.
The chief executive officer for Ryders Health Management, which owns several nursing homes in the state including Aaron Manor, said the care they provide is excellent.
“Aaron Manor has the most dedicated staff and continues to provide outstanding care for our patients. We receive daily appreciation from both families and patients for our staff’s heroic efforts,” said Martin Sbriglio. “At a time when we are facing World War 3 in health care we need to work in collaboration with local, state and federal agencies. Finger pointing is a failed strategy. Working together to correct the last decade of failed policies will result in better care for all Connecticut’s citizens.”
Inspectors who visited Whispering Pines the same month found that staff had failed to appropriately isolate residents who tested positive for COVID-19 or who were suspected to have contracted the disease. The facility also failed to implement a plan for early detection for the residents showing symptoms. Whispering Pines has logged 24 deaths and 52 cases of COVID-19.
Terrance Brennan, the nursing home’s administrator, responded to the issue with this statement: “Caring as it does for the most vulnerable in the community, Whispering Pines was an early victim of the coronavirus at a time when the state, the country and the world were struggling with the pandemic, and when guidance from experts was reactive and quickly changing. It strives at all times to meet the highest standards, and has followed all proper protocols and guidance from both the CT Health Department and the CDC, and consequently it objects to the preliminary findings of the CT Department of Public Health which is now subject to an appeal.”
At Shady Knoll, inspectors in late April cited the home for failing to isolate residents with COVID-19 from those who were healthy. The facility also failed to create and implement policies on the extended use of personal protective equipment like masks and gloves. Shady Knoll has reported 73 cases of the virus and 29 deaths.
New London Sub-Acute and Nursing was cited for failing to ensure infection control practices were implemented to prevent or stop the spread of the disease. The facility didn’t designate an area for staff or visitors to be monitored when entering the building, the inspectors noted, and a staff member removed her mask and stood less than six feet away from the surveyor during the visit.
“The surveyor backed up and requested the supervisor reapply the face mask,” the inspector wrote. Another employee entered the building through a rear door without a face mask.
The nursing home has logged 74 COVID-19 cases and one death.
During an unannounced visit on April 28, inspectors faulted the Orange Health Care Center for failing to develop policies related to the extended use of protective gear in a facility where residents had tested positive for COVID-19. Staff were not required to change out their protective equipment between residents confirmed to have coronavirus and those with test results pending. Orange Health Care had 43 COVID-19 cases and two deaths.
Golden Hill Rehab Pavilion in Milford, which has come under scrutiny for its high number of coronavirus cases and for accusations of not informing residents’ families of their conditions, was cited for failing to notify a resident’s conservator of a change in condition. The resident was moved offsite for testing and given new medication without the person’s conservator being updated, the inspector found. The resident has since died.
Golden Hill has reported 82 cases and 23 deaths.
Supervisors at some of the homes said they disagree with the inspectors’ findings. Others filed plans of correction, but stressed they were not admitting guilt.
Officials at Aaron Manor noted that they had educated staff members on proper procedures and that policies were established to make sure high-touch areas were cleaned regularly.
“The filing of this plan of correction does not constitute an admission that the deficiencies alleged did in fact exist,” they wrote. “[It] is filed as evidence of the facility’s desire to comply with the requirements.”
Attempts to reach the other five nursing homes Thursday morning were not immediately successful.
Matt Barrett, the leader of the Connecticut Association of Health Care Facilities, said nursing homes are performing well, given the circumstances.“Nursing homes have been performing at an extraordinary level during the pandemic, especially when considering the constantly changing guidance from public health officials as they learned more about the highly contagious virus and it’s transmission from asymptomatic carriers,” he said. “Nursing homes have also been challenged by the fact that public health officials only recently made nursing [home] testing a priority and the inadequacy of personal protective equipment. Regulatory enforcement is a component of the oversight of nursing homes, but while nursing homes remain in the throes of the public health emergency, they need less of this punitive approach, and more support from regulators.”
Section B 2: Report from June- Nursing homes rated by the federal government prior to the outbreak had fewer cases and deaths. (Read about that here).
Several weeks into the COVID-19 pandemic, government inspectors found infection control problems in one out of every four Connecticut nursing homes they examined. The problems ranged from staff not using protective equipment to commingling residents infected with the virus with those who were not.
Data from the Centers for Medicare and Medicaid Services (CMS) shows that nursing homes where the virus has hit particularly hard were more likely to have infection control issues than those with fewer cases. Those lapses were also more likely to occur in facilities where more of the residents are people of color.
There have been, to date, a total of 8,322 documented infections among residents in Connecticut nursing homes – and 57% of them lived in homes where inspectors found infection control lapses. Comparatively, about half that number – 27% – were in homes where no shortfalls were identified. Likewise, 58% of the nearly 2,400 residents who died from COVID-19 were in the nursing homes with inspection lapses compared to 28% in the homes with none. Not all facilities were accounted for in the state breakdown.
Experts say it is too early to know exactly why some nursing homes suffered more than others, but pulling reasons from data is a top priority to shield them all from a potential second wave.
“What we’ve been trying to figure out is, ‘Why are some of these facilities at higher risk for serious illness and death than others?'” Dr. Matthew Cartter, the top epidemiologist at the state Department of Public Health, said. “Were all nursing homes equally at risk, or were some at greater risk than others? We don’t know the answers, but data suggest that not all nursing homes were equally likely to be impacted by the COVID-19 virus.”
The Department of Public Health is exploring explanations from whether the harder-hit homes had more residents with underlying health conditions, more minority residents, or more lapses in following infection control guidelines.
“There will be a lot of work that’s done both during the pandemic and afterwards looking at what happened in long-term care facilities. It’s also important to point out for COVID-19 for nursing homes in the United States, it’s like a Category Five hurricane,” said Cartter, who has investigated hundreds of outbreaks during his career. “The level of infection control prevention in those facilities was sufficient to handle normal outbreaks, but they were never built to withstand a pandemic.”
For COVID-19 for nursing homes in the United States, it’s like a Category Five hurricane. The level of infection control prevention in those facilities was sufficient to handle normal outbreaks, but they were never built to withstand a pandemic.”— Dr. Matthew Cartter, DPH
Figuring out how to shield nursing homes from another viral outbreak is particularly important in Connecticut, since facilities here have some of the highest COVID-19 infection and death rates in the U.S., according to preliminary data released Monday by the federal government.
Death counts higher in facilities with more people of color
The Connecticut Department of Public Health has not been able to produce a breakdown of the race and ethnicity of COVID-19 nursing home deaths, but it did for the first time last week release a rundown of the characteristics of who is living in each of the state’s 213 nursing homes.
Facilities where more of the residents are black or Latino have higher numbers of residents who have been infected with or died from COVID-19, the data shows.
For example, at Riverside in East Hartford – where more nursing home residents have died than any other facility in the state – 43% of the residents were black or Latino. Statewide, that figure is only 18%. At Abbott Terrace Health Center in Waterbury, which has the second highest number of COVID-19 deaths, 39% of the residents were black or Latino.
This racial disparity of nursing home fatalities is particularly large in Connecticut. Researchers at the University of Chicago reviewed nursing home data in nine states, and found Connecticut had the second largest disparity in the numbers of nursing homes that have had at least one resident infected or die from COVID-19. Only Illinois had more.
“We found a strong and consistent relationship between race and the probability of COVID-19 cases and deaths. Nursing homes with the lowest percent white residents were more than twice as likely to have COVID-19 cases or deaths as those with the highest percent white residents,” Tamara Konetzka, a professor in the university’s Departments of Public Health Sciences and Medicine, testified before the U.S. Senate Special Committee on Aging two weeks ago.
A May 21 New York Times analysis on the racial infection rate disparities in nursing homes in 17 states puts Connecticut in sixth place for having the largest gaps between homes where at least one-quarter of the residents are black or Latino and facilities with fewer than 5% of these populations.
The state has noticed the reports on these disparities and is doing its own analysis now, Cartter said. That study will also look at whether minority residents were more likely to have other underlying health conditions that made them more vulnerable to the virus.
Widespread infection control lapses
Long-term care facilities have struggled for years to follow best practices to control the spread of infections.
In Connecticut, federal watchdogs at the Government Accountability Office recently reported that half of the state’s nursing homes had infection-control problems for multiple years leading up to the pandemic — compared to 33% in New York, 24% in Massachusetts, 22% in New Hampshire, 39% in New Jersey, and 8% in Rhode Island. Connecticut’s performance, however, was slightly better than the 55% national average.
The researchers from the University of Chicago found no correlation between the inspection ratings given before the pandemic and nursing homes having a single case of COVID-19. A CT Mirror report in early May, found otherwise for homes where a large number of residents have the virus, and the inspections released last week show that inspectors are more likely to find lapses in facilities with higher coronavirus infections and death rates.
Five homes among the 39 in Connecticut where problems have been found since the pandemic began have been cited and fined, officials said. One nursing home has been issued two of those citations. The department declined to disclose the homes where fines have been issued, or their amounts.
Matthew Barrett, president of the association that represents for-profit nursing homes in the state, said home operators made the necessary improvements whenever inspectors found deficiencies.
“Nursing home operators and their employees want the same thing that state public health regulators want – and they want it even more – which is to beat back this highly contagious and insidious virus threatening the health of nursing home residents it is their mission to serve,” said Barrett, executive director of the Connecticut Association of Health Care Facilities. “In every case,” he continued, “operators have made immediate corrective actions and the public can be assured that practices are in place that will lead to the quality outcomes everyone wants.”
“Caregivers deserve recognition for the extraordinary work they are doing battling a virus that has confused and challenged medical and academic experts and public health officials across the nation, especially in how the virus transmits from individuals who are carriers but show no symptoms,” Barrett said. “COVID-19 is a historic virus in this regard. It challenges normal infection control concepts. The inspection reports must be viewed from this context and perspective.”
Dr. Patrick Coll, associate director for clinical geriatrics at UConn Health’s Center on Aging, said there are many unknowns as to why certain facilities and people are impacted more harshly. He suspects that lapses in following infection-control guidelines played a small role, while lack of testing, and therefore quarantining, of staff and residents was the chief reason the virus spread so quickly.
“My feeling is that the occurrence of COVID-19 in a nursing home doesn’t mean that the facility did not follow standards with regards to infection control. They have been very, very serious with regards to their infection control measures, and they still saw significant numbers,” said Coll, who consults for a handful of the facilities. “Most likely, it was asymptomatic staff. So staff who didn’t know they had COVID were coming into work and they may have been exposing some of the residents to the virus.”
Officials at DPH said they believe nursing homes here have been hit particularly hard because New York City and the region has been the nation’s epicenter for COVID-19 infections. Barbara Cass, the agency’s branch chief for health care and quality safety, said that “it could be a host of things.” It could be that some nursing homes have older residents, or have more severe health issues or are located in urban centers where there are heavier concentrations of the disease, she said.
Causes for the spread of infection could also be things that would show up on inspections; inspectors found lapses ranging from improper use or no use of protective equipment, failure to document residents’ conditions, failure to appropriately cohort residents, a lack of signage outside rooms where residents with coronavirus were staying, insufficient hand sanitizing procedures, and failure to enforce social distancing.
The inspections are performed to help nursing homes improve, said Donna Ortelle the agency’s chief for facilities, licensing and investigations.
“Our surveyors need to have assurances that when they identify an issue, remediation, or coaching, or training or in-servicing is started right away,” said Ortelle. Measures are validated while the surveyors are still at the facility, she said.
The most citations
Of the five nursing homes with the most COVID-19 deaths, inspectors found problems at four. Riverside in East Hartford was the only one to have no lapses during either of its two inspections. The inspections turned up deficiencies at Kimberly Hall North in Windsor, Abbott Terrace in Waterbury, Shady Knoll in Seymour and Regency House & Rehabilitation Center in Wallingford.
Related links
Read individual nursing home reports here.
Coll said a single bad inspection at a nursing home may not be as good of an indicator of a problem as at those homes where violations are found on multiple visits. Among the reports released so far, At seven of those homes, deficiencies were found during separate visits.inspectors visited 72 homes at least twice.
Inspectors found issues during all three visits to RegalCare in New Haven. There have been 54 infections and seven deaths there.
Findings included three residents sharing a room, one of whom had COVID-19. While the infected resident was waiting to be transferred to the secluded section of the nursing home, staff was observed having significant contact with each of the residents to help dress or use the toilet without changing their protective equipment.
Amitai Dagan, the vice president for marketing at RegalCare, said their strategy has evolved as they learn more about the virus and receive additional guidance.
“The guidelines from DPH and the CDC to our industry have been fluid and constantly being changed and revised, so our plan to protect our staff and residents has been that as well, always with the intention to keep everyone safe,” she said. “Since the initial deficiency findings, the team at RegalCare at New Haven have been continuously educating the staff on the appropriate usage of PPE. Competencies and weekly audits are being done to ensure accuracy of the implemented Plan of Correction.”
She added that staff has ample protective equipment and are now only reusing it in line with federal guidelines. Inspectors visited the home again Tuesday. She expects a clear record from that visit, she said.
During a May inspection of Windsor Health and Rehabilitation, a licensed practical nurse was seen pouring medications without wearing a mask or other protective gear. The nurse said she had recovered from COVID-19 and “did not need to wear a mask.”
Supervisors said that no residents or staff became sick as a result of the violation, and that the facility would ensure all employees wore masks. There have been 48 residents infected and 22 deaths there.
“Our priority and focus are the commitment to providing our patients and residents with the utmost care and to continue to deliver our services in a safe and dignified manner to our residents,” said Lara Alatise, owner and administrator of Windsor Health. “All of our staff have been educated, and reeducated, to take a number of steps to ensure our that our patients and residents receive the safest care during this pandemic and at all times.”
At Touchpoints at Farmington, inspectors in April noted that the facility failed to store clean jumpsuits worn by staff in a separate area from soiled jumpsuits. There have been 84 residents infected and 19 deaths there.
David Skoczulek, vice president of business development for iCare Health Network, which owns the nursing home, said the company disagrees with the findings.
“We have appealed this allegation and fully expect that it will be reversed upon review,” he said. “During this unprecedented pandemic, we have taken a leadership role in establishing prudent practices for nursing homes in Connecticut. The fact that a single DPH surveyor erroneously characterized this practice as deficient should not detract from the ongoing and heroic efforts of our frontline caregivers.”
Velandy Manohar, MD
Chair- Community Engagement and outreach Committee of the
Community Advisory Council of the Office of Health Strategy of CT