A recent majority staff report from the Senate Finance Committee reviewed the performance of the 15,600 Medicaid and Medicare enrolled nursing facilities from across the country. The purpose of the report was not to answer all the questions about how nursing homes dealt with the deadly effects of the Coronavirus on residents and staff. Instead, the report focused on determining what steps could have been taken to prevent the high number of deaths in nursing homes, and what steps could be taken to stem the tide of deaths as the pandemic continues, or for any future pandemic.
The following are what the report calls Lessons Learned: What Worked Best Before and During the COVID-19 Pandemic:
- Early lock-down of facilities, ending in-person visitation, and asking staff not to work at other nursing homes.
- Maintained adequate staffing levels—some offered bonuses or other incentives to employees to show up for work.
- Adequate supplies of PPE in advance of the pandemic, and an infection control specialist overseeing employees’ use of masks, gowns, and other protective equipment in the earliest phase of the pandemic.
- Frequent cleaning of bathrooms, common areas, and doorknobs, and ensuring the proper disposal or decontamination of PPE.
- Instituted and scrupulously adhered to a daily screening policy for employees and new residents entering the facility throughout the emergency period.
- Relied on cohorting strategies that ensured the isolation of the infected from uninfected residents and employees.
- Performed intermittent testing of staff to prevent the introduction of COVID-19 and executed contact tracing and isolation for those who tested positive.
- Communicated promptly with public health officials and family members of residents who were impacted by this virus.
- Had an excellent track record prior to the pandemic, with State Survey Agencies uncovering few deficiencies, especially in the area of infection control and prevention.
The full report may be viewed at: https://www.finance.senate.gov/imo/media/doc/SFCNursingHomesCOVIDMajorityStaffSFCReport23Sep2020FINAL.pdf
Compliance Perspective
As the COVID-19 crisis continues with the realization that similar or possibly even worse crises could occur in the future, nursing homes have an obligation to be better prepared and to evaluate the effectiveness of their responses thus far, and to identify the areas where improvement is needed that may help prevent the loss of life that accompanies failure to implement effective responses. Inadequate preparation may be considered provision of substandard quality of care, in violation of state and federal regulation and COVID-19 guidelines.
Discussion Points:
- Review policies and procedures guiding the facility’s response to pandemics such as the COVID-19 crisis. Also review reports like the Senate Majority Staff review of nursing home performance during the first eight months of the pandemic for possible implementation of improved responses.
- Train staff on COVID-19 guidelines for infection control and the impact on lives that failure to follow those guidelines can have.
- Periodically audit to ensure that staff are diligently following the facility’s infection control plan, and that the facility’s administration is proactive in evaluating and improving its ability to respond currently and in the future to infections like COVID-19.
