On April 28, a resident at Oregon Healthcare, a Dayton area nursing home, started burning up with a fever.
By May 1, the feverish resident — a schizophrenic man with a history of hypertension and congestive heart failure who required use of a wheelchair — was tested for COVID-19.
“There was no evidence [the resident] had any Covid-19 infection control precautions implemented, nor does it indicate the resident was moved into isolation at this time,” inspectors wrote.
Nurses’ notes indicate days later, he was found out of his room in a hallway on multiple occasions, cursing at staff and other residents. Despite protocol, he had not been placed in an isolation unit, and staff had not covered his face with a mask to control viral spread.
His test results came back May 6. Indeed, he had COVID-19, a highly infectious respiratory disease that has ravaged nursing homes throughout Ohio and the rest of the country. But it wasn’t until May 7 that the armada of doctors, nurses and administrators who operate the facility implemented any infection control precautions or even moved the patient into isolation, according to federal inspection documents.
By that time, the regulators deemed 46 residents could have been exposed to the new coronavirus.
At least 50 residents and 12 staff at Oregon Healthcare have contracted COVID-19 since April 15, according to state data from Wednesday.
Oregon is not the only facility with infection control failures. Of 858 inspections specifically aimed at nursing homes’ COVID-19 responses, 35 turned up deficiencies, according to slides from a June 23 Ohio Department of Health powerpoint obtained by the Ohio Capital Journal.
The Lucas County facility’s dead comprise a piece of the 2,022 known Ohio nursing home and long-term care facility residents who have died from COVID-19 since it arrived in Ohio in January, a staggering 70% of the state’s death toll.
Though the documented failings are disturbing, inspectors only found infection control failures in 4% of nursing homes, raising questions of their efficiency given the scope of the outbreaks.
Tory Hogan, a professor of health services management and policy at Ohio State University who researches nursing homes and infection control, said in an interview the audits seemed rushed and not a useful means to help nursing homes stave off infections.
“This pandemic is about more than just, yes, we’re doing it on a given time when these people come in,” she said.
While the nursing home industry says it’s facing insurmountable challenges given its vulnerable clientele, the Centers for Medicare and Medicaid Services citations paint a picture within a small share of facilities of haphazard care and preventable mistakes, potentially costing human life.
At Oregon Healthcare, like other facilities, the care center had a history of infection control problems. In March, regulators cited the facility for another infection control violation. A resident had a long list of health problems, including a dangerously low white blood cell count, leaving him or her vulnerable to disease.
Regardless, inspectors observed a nurse enter the patient’s room without protective equipment like a gown, gloves, and face mask that protocol requires. Inside the room, a collection device used to empty the resident’s catheter sat on the back of a toilet shared with three other residents, unlike in the bag or nightstand, as protocol requires.
A statewide problem
Of the 25 largest nursing home outbreaks in the state, officials cited three for infection control violations that could have enabled the virus to glide through the facilities.
At Kenton Nursing and Rehabilitation Center in Hardin County, inspectors cited the facility for scheduling six nurses to alternate between caring for COVID-19 patients and non-COVID-19 patients on the same shifts between May 20 and June 6.
Two patients who had private rooms, according to the report, went on to test positive for COVID-19. The report does not explicitly connect the nurses to the infections. However, it cites CDC guidance advising segregating staff between COVID-19 positive and negative residents.
At least 66 residents and 15 staff at the facility have been infected. Ten have died (death data is available by county, and Kenton is the only nursing home with COVID-19 cases in Hardin County).
At Amherst Meadows, a Stark County nursing home, inspectors observed a nurse wearing a gown with a hole at the waist and her N95 mask in her pocket while in the room of a patient on droplet precautions for COVID-19.
The nurse then alleged to inspectors that “the facility had caused the COVID-19 within the facility due to transferring the residents.” She said the N95 did not fit her properly
At least 65 Amherst residents have contracted COVID-19, along with 21 staff.
At the facility’s most recent annual inspection in September, inspectors cited the facility for failing to properly report a flu outbreak at the facility.
The most egregious infection control violation reported during the coronavirus pandemic traces back to a nursing home without any reported coronavirus cases.
At SKLD Defiance, CMS found the nursing home put the health and safety of residents in “immediate jeopardy” when they failed to stop a norovirus outbreak from snowballing among residents and staff in early March.
According to the CDC, the norovirus — a highly contagious virus causing vomiting and diarrhea — is spread through contact with an infected person, consuming contaminated food or water, or touching contaminated surfaces and putting unwashed hands in your mouth.
Inspectors found staff flouted protective equipment guidelines and hand washing protocols, allowed residents to share bathrooms (a major source of transmission), and let a family member enter the room of a positive patient.
Seven residents tested positive for norovirus, another 46 were “at serious potential risk for harm” of transmission, and 10 staff (including the director of nursing) developed gastrointestinal symptoms, requiring time off of work.
The Ohio Capital Journal requested interviews and sent questions to administrators of all the nursing home facilities in this report, only one of whom responded.
A spokesman for the Ohio Health Care Association, which represents the industry, did not respond to interview requests as well.
Kathryn Bartley, administrator at Amherst Meadows, declined interview requests. In a statement, she said one in three nursing homes in the U.S. have been cited for infection control populations, which help the facilities better themselves.
“Nursing homes take care of the most vulnerable population with over 70% of deaths in the state of Ohio being in nursing homes,” she said. “COVID-19 has shown our industry, CMS, and ODH the need for improvement is there when it comes to Infection Control. Amherst Meadows has worked with the local health department and ODH to make sure safety measures and the appropriate training have been completed to provide the safest environment possible.”
Hogan, the Ohio State researcher, said a blame game is the easy way out. Despite serving the most vulnerable, she said nursing homes aren’t getting the money they need from the federal government to beef up their response.
It’s easy to require a nursing home to dedicate staff to a COVID-19 unit, she said, but what if the facility can’t afford new staff? Or only has a handful of infected residents?
“The ability to respond for them has been a challenge,” she said. “Not only the ability to respond but the ability to get the training to their staff and do it correctly. Everybody has really been drinking out of a firehose.”
Infection control is a chronic problem for nursing homes, Hogan said, with deficiencies found in between 15% and 30% of the facilities.
Plenty of blame has fallen at the feet of nursing home operators, she said, but there hasn’t been any surge of help either.
“It’s really easy to point our fingers at the nursing home administrators, but they haven’t really been given the tools to be successful,” she said.