Under normal circumstances, an unkept visitor’s log at a nursing home might seem trivial. Some visitors may balk at having to sign-in just to see a loved one, especially if they are coming by every week.
But small details, such as an accurate visitor’s log, prove incredibly valuable to health authorities trying to quell the spread of COVID-19 in nursing homes. If a facility experiences an outbreak, up-to-date records of who has visited let authorities quickly inform those who may have been infected.
Unfortunately, nursing homes are notoriously understaffed, and at many facilities, workers are forced to cut corners or skip steps as a matter of habit. Whether or not such slips are understandable given the pressures faced by staff, seemingly small errors can have deadly consequences for nursing home residents.
Normally, when accidents, negligence or abuse happens, facilities have time to hide, delay, and draw out a nursing home lawsuit. The unprecedented public scrutiny nursing homes face during the coronavirus has brought this formerly shadowy problem into the national spotlight.
Nursing Homes Need to Follow Their Own Guidelines
At the Life Care Center in Kirkland, Washington, the nursing home at the epicenter of the coronavirus deaths in Washington state, “the facility’s visitor log was so loosely enforced that it proved insufficient for tracing the disease later on,” local officials told The Wall Street Journal. The shoddy record-keeping was just one of many problems.
After a troubling number of respiratory problems at the facility, managers at Life Care ordered the staff to close the dining rooms and wipe down all surfaces. Despite this, the facility threw a Mardi Gras party and invited all their residents who weren’t showing overt respiratory symptoms.
Staff, visitors, and residents mingled, and within a few days, the nursing home had become a major hotspot of the coronavirus. Many people who attended the gathering were infected and unknowingly carried the virus with them back to their homes and workplaces.
As more people from the Life Care Center tested positive for coronavirus, the facility was told to self-quarantine. Even at this point, with the gravity of the situation clearly in view, the nursing home failed its residents and the surrounding community.
The Wall Street Journal spoke with a local firefighter who arrived at the Life Care Center after they had been given orders to self-quarantine. To his dismay, he told the Journal that instead of adhering to the infection control measures:
“Nurses were moving from room to room with no extra protective equipment that he could see.
When he asked the charge nurse on duty, he recalls her saying that she didn’t know anything about a quarantine.”
Such breakdowns in communication made it nearly impossible for health officials to contain the outbreak, which quickly spread. Nearly 2,500 people have been infected in Washington State, with more than 120 dead. Of those deaths, at least 37 were linked to the Life Care Center.
Around the country, other nursing homes are bracing for a similar viral attack on their residents. What happened at Life Care Center cannot be allowed to happen again.
But is it too late?
The coronavirus has already spread and hit vulnerable populations in long-term care facilities across the country. According to the data published by the Centers for Disease Control (CDC) this week, there are 147 nursing homes across 27 states with at least 1 sick patient.
Even in the best of times, nursing homes are widely known to have problems with infection control. So, what is going to happen under the strain of an unprecedented global outbreak?
Kirkland Nursing Home Residents Were in "Immediate Jeopardy"
As the tragedy began to unfold in Kirkwood, the Centers for Medicare & Medicaid Services (CMS), the federal agency in charge of nursing home oversight, and the CDC investigated the Life Care Center. Regulators wanted to figure out what went wrong and how other facilities should move forward.
According to the CMS findings released on March 23, “The inspectors found three ‘Immediate Jeopardy’ situations, which are situations in which a patient’s safety is placed in imminent danger.”
The specific problems cited in the report were:
- Failure to rapidly identify and manage ill residents.
- Failure to notify the Washington Department of Health about the increasing rate of respiratory infection among residents.
- Failure to possess a sufficient backup plan following the absence of the facility’s primary clinician, who fell ill.
Officials for the Life Care Center have said that they were caught off guard by the novel virus and that the same thing could happen at any facility. That is little comfort for some 1.3 million people who are permanent residents of nursing homes across America.
CMS to Nursing Homes: "Don’t Wait to Be Inspected"
As a result of its findings from the Kirkland investigation, CMS announced a new strategy for nursing home inspections and infection control. CMS Administrator Seema Verma said her agency is halting regular inspections of nursing homes. Instead, “we will work with the CDC to identify areas the virus is projected to strike next, and target our inspections accordingly.”
The targeted inspections will begin immediately, but Verma encouraged facilities to be proactive. She urged nursing home leadership to adopt the updated coronavirus guidelines and to use new self-assessment tool provided by CMS. She said:
“Today, we’re issuing a call to action to nursing homes, hospitals, and the entire healthcare system: Don’t wait to be inspected. Starting today, you can – and should – use CMS’s self-assessment tool to ensure you’re prepared to prevent the spread of Coronavirus.”
She said that residents and their families should feel free to ask their nursing home about their progress with their own CMS self-assessment. “The loss of life in Kirkland was a tragedy,” Verma said. “This new process seeks to ensure that the tragedy is not repeated elsewhere.”
Coronavirus Flourishes in Nursing Homes
Verma encouraged patients and families to be proactive in trying to limit the spread of infections, as well. She discouraged visits for all but the direst situations, citing the CDC data on the spread of coronavirus to 147 nursing homes in America.
“Although 147 is a small fraction of the over 15,000 nursing homes across the country,” she said, “given the disproportionate effect on our nation’s older population, this is a cause for concern.”
According to the CDC, people over 65 with underlying health conditions are at the highest risk of severe coronavirus infection. Nursing home populations include many such vulnerable residents, and Verma acknowledged that “infection control and prevention has been a longstanding challenge for nursing homes.”
In such an environment, viruses and other diseases can flourish, decimating the vulnerable population. This is exactly what happened in Kirkwood, and according to the CDC, it could happen again.
The findings released last week from the CDC investigation of the Life Care Center suggest that “once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors.”
The coronavirus presents a number of new challenges for nursing homes, but there are basic levels of preparedness, coordination, and infection control that facilities need to meet.
Now, more than ever, nursing homes need to rise to the standards of care they promise to residents and their families.
“These are solemn obligations for nursing homes at all times,” said Verma, “but their urgent necessity is only sharpened by the coronavirus outbreak.”
Breaking their promise is breaking the law. Failing to provide quality care is always dangerous — under the specter of viral outbreak, such failures are sure to prove catastrophic.
As one of the key battlegrounds of America’s fight against the spread of the coronavirus, nursing homes are going to have to do better. If they don’t, any price they pay will pale before the cost borne by residents, their families, and the well-being of the entire country.