Were Nursing Homes Doing a Poor Job Prior to the Pandemic?
Nursing homes across the country were caught off guard when the coronavirus swept through their facilities in early 2020, leaving scores of frail and elderly patients at risk of catching the deadly disease.
Staggering numbers of them did. Then they started dying. Over 30,000 – and counting – of the nation’s 1.4 million nursing-home residents have perished after contracting the relentless respiratory ailment. Why? Besides overcrowded conditions and shared spaces such as dining rooms, common areas and, often, bathrooms, staff members failed to follow proper protocols to prevent and control infection in those in their care.
A government analysis of data from the Centers for Medicare & Medicaid Services (CMS) found that over 80 percent of the 14,550 nursing homes surveyed fell short of maintaining standard-operating procedures involving the most basic of behaviors by their employees: staying home when they are sick and washing their hands.
“Warning signs were ignored and nursing homes were unprepared to face a pandemic,” Democratic Oregon Sen. Ron Wyden, who commissioned the report, told The Associated Press in an article titled “Watchdog cites persistent infection lapses in nursing homes.” “There need to be big changes in the way nursing homes care for seniors.”
The Government Accountability Office (GAO) released the 15-page report to Wyden on May 20. Titled “Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic,” it is signed by John Dicken, the agency’s healthcare director. In it, researchers reveal five years’ worth of records from nursing homes in all 50 states and Washington D.C.
“Our analysis of CMS data shows that infection prevention and control deficiencies were the most common type of deficiency cited in surveyed nursing homes, with most nursing homes having an infection prevention and control deficiency cited in one or more years from 2013 through 2017 (13,299 nursing homes, or 82 percent of all surveyed homes),” according to the report. “Infection prevention and control deficiencies cited by surveyors can include situations where nursing home staff did not regularly use proper hand hygiene or failed to implement preventive measures during an infectious disease outbreak, such as isolating sick residents and using masks and other personal protective equipment to control the spread of infection. Many of these practices can be critical to preventing the spread of infectious diseases, including COVID-19. In each individual year from 2013 through 2017, the percent of surveyed nursing homes with an infection prevention and control deficiency ranged from 39 percent to 41 percent. In 2018 and 2019, we found that this continued with about 40 percent of surveyed nursing homes having an infection prevention and control deficiency cited each year.
“About half – 6,427 of 13,299 (48 percent) – of the nursing homes with an infection prevention and control deficiency cited in one or more years of the period we reviewed had this type of deficiency cited in multiple consecutive years from 2013 through 2017,” the report continues. “This is an indicator of persistent problems.”
A figure on page 5 of the report shows that 2,967 nursing homes, or 18 percent, had no deficiencies during the five-year period; 2,563, or 19 percent, had deficiencies in multiple nonconsecutive years; and 4,309, or 32 percent, had deficiencies in one of those years.
“Furthermore, of the 6,427 nursing homes with an infection prevention and control deficiency cited in multiple consecutive years, 35 percent (2,225 nursing homes) had these deficiencies cited in 3 or 4 consecutive years, and 6 percent (411 nursing homes) had these deficiencies cited across all 5 years,” according to the report. “At the state level, all states had nursing homes with infection prevention and control deficiencies cited in multiple consecutive years.”
The research paints a pathetic picture of the safety of nursing homes and the health and welfare of a precious population of grandmothers and grandfathers. In New York, for example, there was an outbreak at a nursing that affected 38 residents, but the staff did not keep tabs on who was sick and who was not. That led to the lack of isolation of the 38 residents, some of whom kept showing up for meals at dinner time. Seven employees at a nursing home in California never were tested for tuberculosis prior to them being hired, the report cites.
“One of the first coronavirus outbreaks in the United States occurred at a nursing home in Washington state,” states a Reuters article titled “U.S. nursing homes plagued by infection control issues pre-COVID-19: report.” “Since then, nursing homes across the nation have reported cases. More than 30,000 coronavirus deaths are linked to long-term care facilities…about one-third of the reported U.S. deaths related to the virus.”
CMS administrator Seema Verma said the agency is planning to form a commission to evaluate the response by nursing homes to the coronavirus.