Growing CVOIS-19 coronavirus outbreaks at nursing homes in Washington, Illinois, New Jersey and other states in our nation are laying out for all to see the industry’s long-running problems, including a struggle to control infections and a staffing crisis that relies on poorly paid aides who cannot afford to stay home sick.
Earlier this year, that came into light at the deadliest place in the US’ coronavirus crisis, the 5-Star rated Life Care Center in the Seattle suburb of Kirkland, where federal investigators believe a contributing factor in 35 deaths so far was low-pay workers who came to work with the illness and potentially spread it to other nearby facilities where they took extra shifts.
Beyond that at least 15 more have died and dozens have been infected at long-term care facilities across the nation, with major outbreaks of 46 infected in the Chicago suburb of Willowbrook, 4 deaths at 2 facilities in New Jersey, 13 infected in Little Rock, Arkansas, and 11 infected in Troy, Ohio, with 30 more showing symptoms.
“Nursing homes would always have been ground Zero, but given we already have huge staffing shortages, this will be magnified,” a Harvard Medical School professor who has studied staffing problems at homes said in a telephone interview. “It could be worse for today’s nursing homes than ever.”
Most troubling, he said, is that 75% of the nation’s nursing homes do not meet federal minimum marks for staffing and many workers are inexperienced. As 80% nursing home employees are hourly workers, and given the low wages have in the past often left for other higher paying jobs just as they become familiar with proper healthcare procedures.
Staffing problems at the nation’s 16,000 long-term care facilities will be worsened by the coronavirus crisis, experts tell us. Why? Because lockdowns and school closures have left many sector workers with no choice but to stay home and take care of their children.
“We have the most vulnerable people in a situation where … many nursing homes do not do what they have to do because they are understaffed, not sufficiently trained and there is high turnover, I am frightened,” said a plaintiff’s lawyer that practices in the field..
It is challenging, the work is hard, people are underpaid and underappreciated.
Nursing homes have been struggling to control infections. Nearly 10,000 of the 16,000 nursing homes in the US fell short on at least 1 infection control measure over the past 4 years, according to an analysis of inspection reports by Kaiser Health News. Some “deficiencies” cited seem relatively minor, such as incomplete record keeping. Others are more serious, such as staff not washing hands before helping residents put on a diaper or leaving open sores on a foot exposed to dirty floor.
Lapses are common even at homes with high government ratings for overall quality, 40% of the highest ranked homes have been cited for infection problems. Among the lowest rated facilities, those with a single Star, 8 in 10 have been cited.
The Chateau Nursing and Rehabilitation Center in Willowbrook, Ill, which had a 2-Star overall federal rating at the time of the coronavirus outbreak, was found in a Y 2018 inspection to have big gaps in basic care.
One reason for the sloppiness is the vast majority of care deficiencies do not come with a fine.
One thing this coronavirus has shown is that the enforcement system is too tolerant of facilities not meeting the standards of care.
Despite its 5-Star rating, state inspectors at Life Care in Kirkland last April found infection-control deficiencies following 2 flu outbreaks that affected 17 residents and staff. A follow-up inspection found that it had corrected the problems.
Several family members and friends who visited residents at Life Care in the days before the outbreak told reporters that they did not notice any unusual precautions, and none said they were asked about their health or if they had visited China or any other countries struck by the virus.
They said visitors came in as they always did, sometimes without signing in. Staffers had only recently begun wearing face masks, and organized events went on as planned, including a Mardi Gras party on 26 February attended by dozens of residents, visitors and staffers.
Although federal and state health authorities have not yet tied the Kirkland outbreak and infections at 23 other area nursing homes to any one staffer, they found homes in the area were vulnerable because staff members worked with symptoms, worked in more than one facility, and sometimes did not know about or follow recommendations about protecting their eyes or being careful while in close contact with ill patients.
These healthcare workers need the money from the job, in many cases they do not have sick leave, and some do not recognize the vital symptoms, if they do they are likely to deny them.
Dr. David Gifford, CMO for the American Health Care Association, an industry group, said that such problems cannot easily or quickly be fixed, and that the outbreaks at nursing homes reflect the nature of the virus, which can be spread by asymptomatic patients, rather than underlying staffing issues.
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