The susceptibility of nursing home residents to highly infectious COVID-19, difficulty in identifying asymptomatic carriers, lack of personal protective equipment (PPE), and a slow response to testing of residents and staff are the primary factors that nursing homes believe caused the ravaging impact by the Coronavirus pandemic. However, advocates for residents in long-term communities contend that there were pre-existing problems regarding staffing levels, infection controls, and the buildings themselves that also contributed to the devastating impact of the virus.
Ohio reports indicate that 1,247 of the state’s 1,781 total deaths occurred in long-term care facilities as of May 20. Since the State Health Department’s Long-Term Care Facility Database was completed on April 15, there have been a reported 4,666 residents and 2,124 staff members testing positive for COVID-19.
According to data from the Kaiser Family Foundation, Ohio has more than 950 nursing homes with 73,826 residents, and the Ohio Assisted Living Association reports that another 30,000 persons reside in assisted living centers throughout the state.
A 2019 report from the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) stated that one of the most common deficiencies cited between 2013 and 2017 was infection control. This trend continues into 2020 across our nation. The Centers for Disease Control and Prevention (CDC) reported that nationally each year there are between 1 to 3 million serious infections occurring in long-term facilities, with about 380,000 deaths.
The fact that many nursing home rooms are designed to house more than one resident makes it difficult to separate sick residents from healthy ones, as has been required according to CMS and CDC COVID-19 guidelines.
Nursing Home Compare reported that in Ohio, 536 of the state’s nursing homes are reportedly below average in staffing. It was also noted that the virus not only affected lower rated facilities, but also hit 5-star rated ones as well.
Compliance Perspective
Failure to comply with infection control guidelines or staffing requirements, and being limited by structural issues, makes it difficult to isolate residents when necessary, both prior to and during the COVID-19 pandemic. This may contribute to the spread of infection, placing residents in greater jeopardy of succumbing to the disease, and could be considered violations of state and federal regulations.
Discussion Points:
- Review policies and procedures for acuity-based staffing levels and infection control practices, and consider the facility’s structural layout. Then develop a plan to address any areas of noncompliance in meeting the needs of residents and following CMS infection control regulations and CDC guidelines.
- Train staff regarding infection control, protocols for hand hygiene, proper use of personal protective equipment, and the risk of contagion for themselves and their residents due to noncompliance.
- Periodically audit to determine if identified issues with staffing levels and infection control are corrected and in compliance.
